Learning Focus:
Recognizing reproductive health emergencies and escalating timely care for suspected ectopic pregnancy in the correctional environment.
Patient Presentation
A 27-year-old incarcerated female presents to Nursing Sick Call with complaints of worsening abdominal pain and a missed period.
History of Present Illness
- Last menstrual period (LMP) approximately six weeks ago, shortly before incarceration
- In custody for four weeks
- Lower abdominal cramping for five days, worsening over the last 24 hours; now sharp, left-sided pain radiating to the shoulder tip
- Intermittent nausea, breast tenderness, light vaginal spotting over last 5 days
- Pain rated 8/10, stabbing
- No fever, chills, dysuria, hematuria, or diarrhea
- Feels lightheaded upon standing
- One prior pregnancy at age 21 (miscarriage)
- No known history of pelvic inflammatory disease or tubal surgery
Review of Systems
- Positive: missed period, lower abdominal pain, breast tenderness, light spotting, shoulder pain, dizziness
- Negative: fever, chills, vomiting, dysuria, vaginal discharge, syncope
- Allergies: No known drug or food allergies
- Medications: None routinely
- Vital Signs: 99.3°F, P 116, R 18, BP 92/60, SpO₂ 97% RA, BMI 24
Focused Assessment
- Mildly pale, uncomfortable, guarding left lower abdomen
- Abdomen soft, tender in suprapubic and left lower quadrant; guarding present
- Rebound tenderness equivocal
- No palpable masses
- Pelvic exam not performed by nurse — urgent provider evaluation required
- Slight diaphoresis noted
Prompt:
Which findings are abnormal and require immediate provider notification?
How do the patient’s vital signs support your concern for an urgent condition?
The nurse synthesizes findings to determine significance:
- Left lower quadrant pain, hypotension, and tachycardia → potential internal bleeding.
- Missed period with positive pregnancy test → pregnancy of unknown location.
- Shoulder pain and dizziness → possible diaphragmatic irritation and hypovolemia.
Prompt:
Which cues suggest this is a reproductive emergency rather than a benign early pregnancy?
How might incarceration delay recognition or access to emergency care?
Prioritize Hypotheses (Nursing Perspective)
Possible conditions
- Ectopic pregnancy – strongly suspected based on cues; medical emergency.
- Early intrauterine pregnancy with threatened abortion – possible, but hemodynamic instability suggests a more critical condition.
- Ovarian torsion or cyst rupture – less likely, but still urgent and requires provider evaluation.
Prompt:
How would you describe this patient’s presentation to the provider?
What key facts (vitals, pain description, LMP, pregnancy status) must be included in your report?
Generate Solutions (Within Nursing Scope)
Nursing Actions and Communication Steps:
- Immediately notify the on-site or on-call provider of findings.
- Initiate emergency protocol: obtain IV access and begin fluid resuscitation per emergency protocol or provider orders.
- Prepare for transport: coordinate with custody to expedite transfer.
- Stay with patient, reassess and document vitals and symptoms frequently.
- Provide reassurance and privacy while maintaining safety and security.
Correctional-Specific Considerations
- If possible, determine pregnancy timing relative to incarceration to clarify whether conception occurred in custody.
- Maintain patient confidentiality while ensuring custody is informed of the emergency.
- Advocate for emergent hospital evaluation without delay.
- Document findings, actions, patient response, communication, and custody notifications precisely.
Prompt:
What challenges could delay emergency transport in your facility?
How can the nurse advocate effectively while maintaining safety and confidentiality?
Nursing Actions Taken
- Urine pregnancy test performed: positive.
- IV line started; normal saline bolus initiated per protocol.
- Vital signs monitored continuously.
- Provider notified immediately.
- Custody staff informed of emergent transfer needs.
- Documentation completed, including assessment findings and time of provider contact, time of custody notification and who was notified, and patient education and comprehension and response to interventions.
Prompt:
What communication strategies ensure timely escalation to both provider and custody staff?
What documentation details are most critical for continuity of care?
Evaluate Outcomes and Reflect
Outcome:
Patient was transported emergently to the community hospital, diagnosed with ruptured left tubal ectopic pregnancy, and underwent laparoscopic salpingectomy. Postoperatively, she returned to the facility stable. Nursing provided wound care, pain management, follow-up labs, and coordinated mental health referral for grief support.
Prompt:
What follow-up nursing care priorities exist for post-surgical reproductive patients in custody?
How can the correctional nurse promote both physical recovery and emotional healing?
Reflection
How did you recognize that this patient’s presentation represented a life-threatening condition?
What steps ensured you stayed within nursing scope while acting decisively?
How does this scenario illustrate advocacy and ethical responsibility for incarcerated women’s health?
Key Takeaways for Correctional Nursing Practice
- Correctional nurses do not diagnose — they assess, recognize, and report critical findings requiring provider evaluation.
- Ectopic pregnancy is a life-threatening emergency; rapid recognition and escalation are essential.
- Timing of incarceration must always be documented when new pregnancy is confirmed behind the wall.
- Nursing advocacy is critical to overcome security-related delays in emergent care.
- Compassionate, trauma-informed support is essential following reproductive emergencies in custody.
- As always, documentation is an important part of patient care.