What care should be provided to a patient with an unruptured ectopic pregnancy and stable vital signs prior to evaluation by their obstetrical physician?

Care for a Patient with Unruptured Ectopic Pregnancy Prior to Obstetrical Evaluation

The nurse should prepare the patient with an unruptured ectopic pregnancy and stable vital signs for close monitoring, education about warning signs of rupture, and potential treatment options including methotrexate therapy that will likely be discussed during the obstetrical appointment tomorrow. 1, 2

Immediate Nursing Assessment and Monitoring

• Perform frequent vital sign checks to ensure continued hemodynamic stability, as rupture can occur at any time despite initial stability 1
• Document baseline pain levels and characteristics to help detect any changes that might indicate rupture 2
• Assess for any vaginal bleeding and document amount, color, and presence of clots 2
• Monitor for signs of hemodynamic instability including tachycardia, hypotension, dizziness, or syncope 1, 2

Patient Education About Warning Signs

• Instruct the patient to immediately seek emergency care if she experiences sudden or worsening abdominal pain, as this may indicate rupture 1
• Teach the patient to monitor for signs of internal bleeding including shoulder pain, dizziness, lightheadedness, or fainting 2
• Explain that increased vaginal bleeding warrants immediate medical attention 2
• Emphasize the importance of keeping the scheduled obstetrical appointment, as delayed treatment increases risk of rupture 1

Preparation for Potential Treatment Options

• Inform the patient that her obstetrical physician will likely discuss medical treatment with methotrexate or surgical options 1
• Explain that if methotrexate is chosen, it has a success rate of 78-94% for unruptured ectopic pregnancies, but requires close follow-up 1
• Advise that if methotrexate is administered, breastfeeding would need to be discontinued for at least 3 months after the last dose 3
• Prepare the patient for the possibility of laboratory tests including β-hCG levels, complete blood count, liver and kidney function tests that may be ordered at the appointment 1, 4

Activity and Home Care Instructions

• Advise the patient to avoid strenuous physical activity and sexual intercourse until cleared by her physician 2
• Recommend rest but not strict bed rest unless specifically ordered by a physician 2
• Instruct the patient to avoid taking NSAIDs or other medications that might mask symptoms or affect potential methotrexate treatment 1
• Suggest having a support person available to assist with transportation and home care in case treatment is initiated at tomorrow's appointment 2

Important Considerations and Pitfalls

• Even with stable vital signs, rupture can occur unexpectedly - up to 9% of patients treated with methotrexate experience rupture despite initial stability 1
• The median time to rupture after methotrexate administration is 14 days (maximum 32 days), so vigilance must be maintained even after treatment begins 1
• Patients with higher β-hCG levels (>5,000 mIU/mL) or adnexal masses >3.5 cm have higher failure rates with methotrexate and may require surgical intervention 1
• Emphasize that while waiting for the appointment, any significant change in symptoms should prompt immediate return to emergency care rather than waiting for the scheduled appointment 1