A CASE OF 15 HRS POST

EXPLORATORY LAPAROTOMY ON
ACCOUNT OF ECTOPIC PREGNANCY.
PREVIOUSLY DIAGNOSED AS
ECTOPIC PREGNANCY OF
UNKNOWN LOCATION.
BY MIRIAM KONADU FORDJOUR
OBS AND GYNAE WARD
PRECEPTOR RD FRANK KUSI.

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OUTLINE
• CASE SUMMARY.
• OVERVIEW OF CONDITION.
• NUTRITION ASSESSMENT.
• NUTRITION DIAGNOSIS.
• NUTRITION INTERVENTION.
• MONITORING AND EVALUATION.

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CASE SUMMARY
G.D is a 24 year old woman who is being managed as a
case of 15hrs post exploratory laparotomy on account
of ectopic pregnancy.

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OVERVIEW OF CONDITION
Ectopic pregnancy is a pregnancy in which the fetus
develops outside the uterus, typically in the fallopian
tube. The fertilized egg cannot survive outside the
uterus if left to grow can damage nearby organs and
cause life threatening consequences like blood loss,
blood poisoning and death.

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• Exploratory laparotomy is a surgical procedure where the abdomen is
opened to examine the organs inside. It's performed to diagnose and
treat abdominal issues that can't be addressed with less invasive
methods. The procedure is used to:
• - Treat abdominal trauma
• - Find the source of unexplained bleeding
• - Determine the cause of severe abdominal pain
• - Diagnose and treat conditions like cancer, endometriosis, infection,
Ectopic pregnancy and more.

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NUTRITION ASSESSMENT
Anthropometric data
• MUAC= 28.5cm (normal)
• WEIGHT=54kg
• KNEE HEIGHT=42cm estimating height
• (1.83xkh)-(0.24xage)+84.88
• (1.83x42)-(0.24x24)+84.88=156
• HEIGHT=156cm
• EXTIMATED BMI= 54/1.56²=22.2kg/m²(normal)

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CLINICAL SIGNS AND SYMPTOMS
Fatigue⁺
Loss of appetite⁺
Nausea ⁺
Pain ⁺
Bloody urine ⁻
Diarrhea ⁻
Headaches ⁻

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VITALS
Vitals Result 6-2-2024 Range
BP 95/57 100-120/60-80
PR 94PM 60-100
RR 22CPM 12-20
SPO2 98% 95-100%
TEMP 36.2⁰C 36.1°C-37.2°C

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 DIET HISTORY 24HR RECAL
Time Meal Quantity Calorie (kcal) Protein (g)

7am Hausa koko 500 120 3.55

+ + +
sugar 10.9 40

4pm Banku 169.5 200 3.53

+ + + +
Light soup 625 100 3.94
+ + + +
Cow meat 63 90 17.1
7:30pm Ga kenkey 158.7 200 3.8
+ + + +
Fried fish 61.14 140 11.1
+ + + +
Pepper sauce 100 26 1.23
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DIET HISTORY
24-hour Recall cont.
Time Meal Quantity Calorie (kcal) Protein (g)

TOTAL 916 44.22

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 USUAL INTAKE
MEAL TIME MEAL QUANTITY CALORIES
BREAKFAST 7:30 am Hausa koko 500 120
Or corn porridge 114 80
+ + +
Bread 160
Lunch 12:30-1:00 pm Banku 169.5 200
+ + +
Light soup 625 100
+ + +
Chicken 35 90
Or
Akple 195.3 200
+ + +
Pepper 100 26
+ + +
Fried fish 61.4 140

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Supper 6:00 pm Kenkey 159 200
+ + +
Pepper 100 26
+ + +
Fried fish 61.4 61.14
Or
Boiled rice (plain) 167.7 218
+ + +
Tomato stew 175.3 210
+ + +
Smoked salmon (flaked) 34.5 70

TOTAL 1980kcal

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ENERGY ESTIMATION
Using Harris Benedict equation
RMR=655+ (9.6 x W)+(1.7 x H) - (4.7 x Age)
655+(9.6 x 54kg) + (1.8 x 156cm) – (4.7 x 24)
=1,341.4kcal
TEE
HBE x A.F x I.F
1,341.4 x 1.2 x 1.4
=2253.55KCAL
=2300kcal
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ENERGY PERCENTAGE
% ENERGY REQUIREMENT= 916/2300 ×100
=40%( inadequate)

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PROTEIN NEEDS
According to national institute of health, protein needs for a
post surgery patient is 1.6-2.0g/kg/day.
2g×54kg=108g

Percentage protein intake from 24-hour recall =

(44/108)×100=41% (inadequate)

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 MEDICATION
Medication Uses Nutrient-drug interaction
sodium chloride it is used to treat fluid No interaction.
500ml infusion loss and restore sodium
chloride balance.
Metodopramide It is used to treat nausea Avoid lactose products as
10mg vial and vomiting it increases the symptoms
of lactose intolerance.
Domperidone 10mg Its an anti sickness drug to Grape fruits increases the
tab stop feelings of nausea drugs side effects that’s
and vomiting difficulty in swallowing

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 MEDICATION
MEDICATION USES NUTRIENT- DRUG
INTERACTION
Dihydrocodene Used to treat or relieve No interaction
30mg tab pain
Adrenaline Used to relieve No interaction
0.2mg injection hypersensitive reaction
to drugs and allergens

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 OTHER HISTORIES
Food Allergies-NO
Food Intolerance-NO
• Artificial Spices-Yes
• Alcohol –NO
Drinks(SSB)-YES
Herbal Medicine-NO • Smoking- NO
Past Medical History- ulcer resolved • Fruit intake – NO
Past Surgical History- No
• Supplements – NO
• Canned foods- NO
Family History-No
Fluid Intake(2L) • Sleep - 7:30-8:30 pm
• Wake- 5:30 am
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SOCIO- DEMOGRAPHIC HISTORIES
G.D is a 24 year old woman who works as an seamstress and
healthcare nurse. She is married with no children. She is a
Christian that attends Assemblies. She lives at Zopie.

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IMPRESSION
• inadequate energy intake
• Inadequate protein intake
• Inadequate fruit intake
• Food and nutrition related knowledge deficit.
• Loss of appetite.

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NUTRITIONAL DIAGNOSIS
• Inadequate energy intake related to loss of appetite secondary to
nausea as evidenced by energy intake of 916kcal instead of 2300kcal.
• Increased protein needs related to increase in demand for the
nutrient for wound healing as evidenced by protein needs of 108g
instead of 43.2g.

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NUTRITION INTERVENTION
Short Term Goals
• To achieve energy intake of 70%(1610kcal) in 1 week.
• To achieve protein intake of 70%(76g) in 1 week.
• To improve appetite in 4 days.

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NUTRITION INTERVENTION
Long Term Goals
• To achieve and maintain energy intake of 100% in 2 week
• To achieve and maintain protein intake of 100% in 2 week
• To improve and maintain appetite in 4 days.

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NUTRITION INTERVENTION
Plan
• To put patient on 2300kcal soft diet starting with 1610kcal.
• To put patient on 108g of protein with 80% coming from high
biological value starting with 76g to help in wound healing.
• To put patient on 2 servings of fruits high in vitamin C and zinc such
as orange to help in wound healing and to fight infections.

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PLAN CONT’D
• To put patient on 5 servings of vegetables in the form of soups and
stews.
• To counsel patient to add lemon and ginger to their water to help
alleviate nausea.
• To educate patient and family on personal hygiene to prevent
infections.
• To request for full blood count to check for signs of anemia and
infections
• To request for kidney function test to check for acute kidney injury.

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AMDR
Starting with 70%of total energy in 1 week that is 1610kcal and 76g of
protein.
• CHO- 45-65%
• PRO- 10-35%
• Fat- 20-35%
Protein =76g×4kcal=304kccal
304÷1610 x 100 = 19%
CHO =60% of 1610=966kcal
FAT=21÷100 x 1610 kcal =338.1kcal

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AMDR
GRAMMAGE
CHO=966kcal÷4
=242g
PROT. =76g
FAT=338.1÷9 =38g

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SERVINGS DISTRIBUTION
FOOD GROUP SERVINGS CHO(242g) Protein(g)76 Fat(38g)
Starch 12 183 12 1.2
Veggies 5 25 5 -
Fruit 2 30 - -
Milk 1 3.9 2.7 2.9
Meat group(lean) 8 - 56 27

Fat and oil 2 - - 10

241.9 75.7 41.1

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 MEAL DISTRIBUTION

FOOD BREAKFAS MID AM LUNCH MID PM SUPPER

TYPE T(7:30AM) SNACK 12:00PM SNACK 6PM
11;00 1PM
STARCH 4 - 4 - 4
VEGGIES - - 2.5 - 2.5
FRUIT - 1 - 1 -
MILK 1 - - - -
MEAT 1 - 4 - 3
GROUP
FAT AND - - 1 - 1
OIL

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MEAL PLAN (15g CHO serving)
MEAL TIME FOOD QUANTITY CALORIES(Kcal)

BREAKFAST(7:30A Corn porridge 4½ soup ladle 240

M) + + +
Sugar 1 tbsp 60
+ + +
Milk (carnation) 3 dsp 100
+ + +
Egg(boiled) 1 medium size 75

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MEAL PLAN CONT’D
MEAL TIME FOOD QUANTITY CALORIES(Kcal)
MID AM SNACK 11;00 orange 1 medium size 60

LUNCH 12:00PM Soft Banku 1 medium orange size 200

+ + +
Okro soup 2½ soup ladle 240
+ + +
meat (flaked) 4match box 180

MID PM Orange 1 medium size 60

SNACK 1PM

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 MEAL PLAN CONT’D
supper Akple 1 medium orange size 200
2PM + + +
Ayoyo soup 2½ soup ladle 240
+ + +
smoked Salmon 3match box 105
(flaked)

TOTAL 1760kcal

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MONITORING AND EVALUATION
• To monitor and evaluate tolerance and adherence to dietary
recommendation everyday.
• To monitor and evaluate weight changes in 1 week.
• To monitor and evaluate changes in nutrition focused physical findings
(Fatigue, loss of appetite, nausea) daily.

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