Nursing Patient With Eclampsia
Definition : Eclampsia is a serious complication of pregnancy , and can be characterized by the presence of seizures . Usually eclampsia is a continuation of pre - eclampsia though sometimes - sometimes not known in advance . Another definition of eclampsia is new onset gestational hypertension followed by a grand mal seizure ( Zeeman , Fleckenstein , twickler , & Cunningham , 2004) , and seizures in pre - eclampsia which can not be attributed to other causes ( Abbrescia & Sheridan , 2003) . Seizures in eclampsia is not associated with a brain condition and usually occurs after 20 weeks of pregnancy .
etiology
Eclampsia can occur if left untreated pre - eclampsia , eclampsia same so that the cause of the different causes of pre-eclampsia . There are several risk factors that predispose certain known , among other things :
primigravida status
Family history of pre - eclampsia or eclampsia
Ever eclampsia or pre - eclampsia
new husband
Extremes of maternal age ( < > 35 years )
Since the beginning of suffering vascular hypertension , kidney disease or autoimmune
diabetes Mellitus
multiple pregnancy
manifestations Kinis
Symptoms and signs found in patients with organ -related eclampsia affects, among others, namely : Oliguria ( less than 400ml/24 hours or urine remained less than 30 ml / hour , epigastric pain , blurred vision , dyspnea , Headache , Nausea and vomitting , scotoma , and seizures .
Most cases are linked with hypertension and proteinuria due to pregnancy but one - the only real sign of eclampsia is the occurrence of seizures eklamtik , which is divided into four phases .
premonitory stage
This phase is usually not known except by constant monitoring , rotating eye - turn when muscles tense face and hands .
Stadium Tonic
As soon as the premonitory phase turned into a tense hands clenched . Sometimes the mother along with the mother tongue biting teeth clenched , while the hands and feet become stiff . Respiratory muscle into spasm , which can cause the mother to stop breathing . This stage lasts for about 30 minutes .
Stadium clonic
In this phase, but the muscle spasms stop start jerked violently . Frothy , blood-tinged saliva on the lips and sometimes - sometimes could draw breath . After about two minutes to stop seizures , coma heading , but some cases leading to heart failure .
Stadium coma
Mother unconscious , noisy breath sounds . This situation may last only a few minutes or even a few hours to settle dpat .
pathophysiology
In normal pregnancy , vascular volume and cardiac output increased . Despite increased , abnormal blood pressure in normal pregnancy . This may be because women hhamil become resistant to the effects of a vasoconstrictor , such as angitensin II . Prisoners increased peripheral vascular effects of some vasodilators such as prostacyclin ( PGI 2 ) , prostaglandin E ( PGE ) , and endothelium -derived relaxing factor ( EDRF ) . Tromboxan and PGI 2 ratio increased . Tromboxane produced by the kidneys and trophoblastic tissue , causing vasoconstriction and platelet aggregation .Vasospasm decrease the diameter of the blood vessels , which would damage the endothelial cells and degrade EDRF . Vasoconstriction will also disrupt the blood and improve blood pressure . As a result, the circulation to all organs of the body including the kidneys , liver , brain , and placenta decreases . Changes - changes that occur are as follows :
Decreased renal perfusion caused a decrease in glomerular filtration rate ( GFR ) ; so that blood urea nitrogen , creatinine , and uric acid increased.
Decreased blood flow to the kidneys causing kidney damage . This causes the protein to pass through the glomerular membrane is normally impermeable to large protein molecules . Loss of protein colloid osmotic pressure causes decreased and the fluid can move to interstitial space . This can lead to edema and a decrease in intravascular volume , which increases blood viscosity and hematocrit meningktanya . Response to reduce the intravascular volume , angiotensin II and aldosterone will be released to trigger the water and sodium retention . Tempers circle pathological processes : the addition of angiotensin II and hypertension increasingly lead to vasospasm ; aldosterone increase retention and edema lookups will get worse .
Decreased blood flow to the liver resulting in liver damage and hepatic edema and hemorrhage sibcapsular , which can lead to hemorrhagic necrosis . Manifested by an increase in liver enzymes in maternal serum .
Vasoconstriction of the blood vessels causes the pressure will destroy the thin capillary walls , and a small cerebral hemorrhage . Artery vasospasm symptoms are headache , visual disturbances , such as blurred vision , spots , and hyperactive deep tendon reflexes .
The decrease in colloid oncotic pressure may cause leakage of the pulmonary capillaries resulting in pulmonary edema . The primary symptom is dyspnea
Decreased placental circulation resulting in infarction risk factors that drive the placental abruption and DIC . When maternal blood flow through the placenta is reduced , resulting in intrauterine fetal growth restriction and fetal hypoxemia and acidosis experience .
WOC ( telampir )
examination Support
a. Laboratory Studies
Albuminuria : +2 or +4
Proteinuria ( 5 g in 24- hour urine or +3 or more on dipstick )
Blood urea nitrogen ( BUN ) : less than 10
Serum creatinine : increased
Creatinine clearance : 130-180
thrombocytopenia
Nursing care of patients Eclampsia
I. Assessment
1 . Client identity
name :
age :
address :
Occupation :
No. . Telephone:
husband :Occupation :No.Telephone :
2 . Health History
a. Formerly Medical History : Have had pre - eclampsia , eclampsia Experienced , vascular hypertension , diabetes mellitus , kidney disease .
b . Health History Now : Pregnancy Doubles , hydatidiform mole , in the frontal headache , blurred vision , scotoma , Vomiting , Nausea hard , pain in the epigastric , hyperreflexia , seizures , dyspnea
c . Family Health History
- There is a family who also had pre - eclampsia
- Families experiencing eclampsia
d . Obstetric History
G2 P1 A0 H1 , Son Ke , Born , BB , Complaints
Menstrual history :
- Mother's first menstruation at the age of 12 years
- After 3 months she started menstruating regularly , the mother did not have complaints during menstruation
History KB : I do not use family planning
Consumption History : Mother love salty foods
3 . physical examination
Vital Signs : BP : systolic > 160 mmHg P : < > 110 mmHg S : 40 ◦ C
MAP : 160/110 = 127
N : < > watery vaginal discharge
· The liquid dripped periodically or radiated suddenly
· Fluid seen at introitus
· There is no contraction in 1 hour
amnionitis
· Watery vaginal discharge and foul smelling after 22 weeks gestation
· Fever / chills
· Abdominal pain
· History of fluid loss
· Uterine tenderness
· DJJ fast
· Bleeding light pervaginavaginitis
· Foul smelling vaginal discharge
· No history of fluid loss
· Itching
· Discharge foaming / color boiling
· Abdominal pain
· Dysuria
Possible delivery term / preterm
Vaginal discharge watery or bloody mucus
· Opening and softening of the cervix
· contraction
antepartum hemorrhage
Bloody vaginal discharge
· Abdominal pain
· Loss of fetal movements
· Vaginal Bleeding
4 . examination Support
· Place the pads on the vulva and check the pads ( visually and through scent ) one hour later
· Use a high -level disinfection speculum for examination pervagina :
o Liquids can be seen coming from the cervix or forming puddles in the posterior fornix .
o Ask the mother to cough as this can cause fluid gushing .
· Examination of blood leukocytes : > 15.000/mm3 case of infection ( N : 5000-9000 ) , temperature > 38 ° C, tachycardia .
· Examination nitrazin : relies on the fact that vaginal secretions and urine is acidic while alkaline amniotic fluid . Hold a sheet of paper nitrazin the hemostat and touch the paper into a pool of liquid at the end of the speculum . Paper changes color yellow to blue indicates alkalinity ( amniotic fluid ) . Blood and vaginal infections give some false positive results .
· Amniocentesis
· Ultrasound : determining gestational age and decreased amniotic fluid index .
· Determination of the volume of amniotic fluid may help in identifying patients with an increased risk of fetal distress .
· Examination of the cervix when it has no pain and irregular contractions .
5 . therapy
General Management :
- Confirm the accuracy of the calculation of gestational age
- Use of high -level disinfection speculum examines untik vaginal discharge ( amount , color , odor ) and singkirka diagnosis of urinary incontinence
- If there is a per - vaginal bleeding with constant abdominal pain , suspected occurrence of placental abruption
- If there are signs of infection ( fever , foul-smelling vaginal discharge ) give antibiotics
- If there are signs of infection and less than 37 weeks gestation ( fetal immature ) :
o Give antibiotics to reduce maternal and neonatal morbidity due to infections and slow delivery
Ø Erythromycin 250 mg orally three times daily for 7 days
Ø Plus amoxicillin 500 mg orally three times daily for 7 days
o Consider moving beyi to the most appropriate services for newborn care if possible
o Give corticosteroids to the mother to improve fetal lung maturity
o Make use of induction of labor with oxytocin at 37 weeks gestation and given prophylactic antibiotics to help reduce streptococcal infection in neonates although the mother has received prior antibiotics .
o If the contraction is palpable and there is a mucous discharge mixed with blood , suspected labor occurs preterem
- If there are signs of infection and gestational age 37 weeks or more ( mature )
- If the membranes rupture more than 18 hours , give penicillin or ampicillin profilksis to reduce the Formatting group B streptococcal infection in neonates . If there are signs of infection after delivery to stop the administration of antibiotics
- Assess the cervix :
o If the cervix good condition ( soft , thin , partially opened ) did induce labor using oxytocin
o If the cervix is not a good condition ( hard , thick , closed ) , matangkan cervix using prostaglandins and oxytocin infusion or fetuses born via cesarean .
Definition : Eclampsia is a serious complication of pregnancy , and can be characterized by the presence of seizures . Usually eclampsia is a continuation of pre - eclampsia though sometimes - sometimes not known in advance . Another definition of eclampsia is new onset gestational hypertension followed by a grand mal seizure ( Zeeman , Fleckenstein , twickler , & Cunningham , 2004) , and seizures in pre - eclampsia which can not be attributed to other causes ( Abbrescia & Sheridan , 2003) . Seizures in eclampsia is not associated with a brain condition and usually occurs after 20 weeks of pregnancy .
etiology
Eclampsia can occur if left untreated pre - eclampsia , eclampsia same so that the cause of the different causes of pre-eclampsia . There are several risk factors that predispose certain known , among other things :
primigravida status
Family history of pre - eclampsia or eclampsia
Ever eclampsia or pre - eclampsia
new husband
Extremes of maternal age ( < > 35 years )
Since the beginning of suffering vascular hypertension , kidney disease or autoimmune
diabetes Mellitus
multiple pregnancy
manifestations Kinis
Symptoms and signs found in patients with organ -related eclampsia affects, among others, namely : Oliguria ( less than 400ml/24 hours or urine remained less than 30 ml / hour , epigastric pain , blurred vision , dyspnea , Headache , Nausea and vomitting , scotoma , and seizures .
Most cases are linked with hypertension and proteinuria due to pregnancy but one - the only real sign of eclampsia is the occurrence of seizures eklamtik , which is divided into four phases .
premonitory stage
This phase is usually not known except by constant monitoring , rotating eye - turn when muscles tense face and hands .
Stadium Tonic
As soon as the premonitory phase turned into a tense hands clenched . Sometimes the mother along with the mother tongue biting teeth clenched , while the hands and feet become stiff . Respiratory muscle into spasm , which can cause the mother to stop breathing . This stage lasts for about 30 minutes .
Stadium clonic
In this phase, but the muscle spasms stop start jerked violently . Frothy , blood-tinged saliva on the lips and sometimes - sometimes could draw breath . After about two minutes to stop seizures , coma heading , but some cases leading to heart failure .
Stadium coma
Mother unconscious , noisy breath sounds . This situation may last only a few minutes or even a few hours to settle dpat .
pathophysiology
In normal pregnancy , vascular volume and cardiac output increased . Despite increased , abnormal blood pressure in normal pregnancy . This may be because women hhamil become resistant to the effects of a vasoconstrictor , such as angitensin II . Prisoners increased peripheral vascular effects of some vasodilators such as prostacyclin ( PGI 2 ) , prostaglandin E ( PGE ) , and endothelium -derived relaxing factor ( EDRF ) . Tromboxan and PGI 2 ratio increased . Tromboxane produced by the kidneys and trophoblastic tissue , causing vasoconstriction and platelet aggregation .Vasospasm decrease the diameter of the blood vessels , which would damage the endothelial cells and degrade EDRF . Vasoconstriction will also disrupt the blood and improve blood pressure . As a result, the circulation to all organs of the body including the kidneys , liver , brain , and placenta decreases . Changes - changes that occur are as follows :
Decreased renal perfusion caused a decrease in glomerular filtration rate ( GFR ) ; so that blood urea nitrogen , creatinine , and uric acid increased.
Decreased blood flow to the kidneys causing kidney damage . This causes the protein to pass through the glomerular membrane is normally impermeable to large protein molecules . Loss of protein colloid osmotic pressure causes decreased and the fluid can move to interstitial space . This can lead to edema and a decrease in intravascular volume , which increases blood viscosity and hematocrit meningktanya . Response to reduce the intravascular volume , angiotensin II and aldosterone will be released to trigger the water and sodium retention . Tempers circle pathological processes : the addition of angiotensin II and hypertension increasingly lead to vasospasm ; aldosterone increase retention and edema lookups will get worse .
Decreased blood flow to the liver resulting in liver damage and hepatic edema and hemorrhage sibcapsular , which can lead to hemorrhagic necrosis . Manifested by an increase in liver enzymes in maternal serum .
Vasoconstriction of the blood vessels causes the pressure will destroy the thin capillary walls , and a small cerebral hemorrhage . Artery vasospasm symptoms are headache , visual disturbances , such as blurred vision , spots , and hyperactive deep tendon reflexes .
The decrease in colloid oncotic pressure may cause leakage of the pulmonary capillaries resulting in pulmonary edema . The primary symptom is dyspnea
Decreased placental circulation resulting in infarction risk factors that drive the placental abruption and DIC . When maternal blood flow through the placenta is reduced , resulting in intrauterine fetal growth restriction and fetal hypoxemia and acidosis experience .
WOC ( telampir )
examination Support
a. Laboratory Studies
Albuminuria : +2 or +4
Proteinuria ( 5 g in 24- hour urine or +3 or more on dipstick )
Blood urea nitrogen ( BUN ) : less than 10
Serum creatinine : increased
Creatinine clearance : 130-180
thrombocytopenia
Nursing care of patients Eclampsia
I. Assessment
1 . Client identity
name :
age :
address :
Occupation :
No. . Telephone:
husband :Occupation :No.Telephone :
2 . Health History
a. Formerly Medical History : Have had pre - eclampsia , eclampsia Experienced , vascular hypertension , diabetes mellitus , kidney disease .
b . Health History Now : Pregnancy Doubles , hydatidiform mole , in the frontal headache , blurred vision , scotoma , Vomiting , Nausea hard , pain in the epigastric , hyperreflexia , seizures , dyspnea
c . Family Health History
- There is a family who also had pre - eclampsia
- Families experiencing eclampsia
d . Obstetric History
G2 P1 A0 H1 , Son Ke , Born , BB , Complaints
Menstrual history :
- Mother's first menstruation at the age of 12 years
- After 3 months she started menstruating regularly , the mother did not have complaints during menstruation
History KB : I do not use family planning
Consumption History : Mother love salty foods
3 . physical examination
Vital Signs : BP : systolic > 160 mmHg P : < > 110 mmHg S : 40 ◦ C
MAP : 160/110 = 127
N : < > watery vaginal discharge
· The liquid dripped periodically or radiated suddenly
· Fluid seen at introitus
· There is no contraction in 1 hour
amnionitis
· Watery vaginal discharge and foul smelling after 22 weeks gestation
· Fever / chills
· Abdominal pain
· History of fluid loss
· Uterine tenderness
· DJJ fast
· Bleeding light pervaginavaginitis
· Foul smelling vaginal discharge
· No history of fluid loss
· Itching
· Discharge foaming / color boiling
· Abdominal pain
· Dysuria
Possible delivery term / preterm
Vaginal discharge watery or bloody mucus
· Opening and softening of the cervix
· contraction
antepartum hemorrhage
Bloody vaginal discharge
· Abdominal pain
· Loss of fetal movements
· Vaginal Bleeding
4 . examination Support
· Place the pads on the vulva and check the pads ( visually and through scent ) one hour later
· Use a high -level disinfection speculum for examination pervagina :
o Liquids can be seen coming from the cervix or forming puddles in the posterior fornix .
o Ask the mother to cough as this can cause fluid gushing .
· Examination of blood leukocytes : > 15.000/mm3 case of infection ( N : 5000-9000 ) , temperature > 38 ° C, tachycardia .
· Examination nitrazin : relies on the fact that vaginal secretions and urine is acidic while alkaline amniotic fluid . Hold a sheet of paper nitrazin the hemostat and touch the paper into a pool of liquid at the end of the speculum . Paper changes color yellow to blue indicates alkalinity ( amniotic fluid ) . Blood and vaginal infections give some false positive results .
· Amniocentesis
· Ultrasound : determining gestational age and decreased amniotic fluid index .
· Determination of the volume of amniotic fluid may help in identifying patients with an increased risk of fetal distress .
· Examination of the cervix when it has no pain and irregular contractions .
5 . therapy
General Management :
- Confirm the accuracy of the calculation of gestational age
- Use of high -level disinfection speculum examines untik vaginal discharge ( amount , color , odor ) and singkirka diagnosis of urinary incontinence
- If there is a per - vaginal bleeding with constant abdominal pain , suspected occurrence of placental abruption
- If there are signs of infection ( fever , foul-smelling vaginal discharge ) give antibiotics
- If there are signs of infection and less than 37 weeks gestation ( fetal immature ) :
o Give antibiotics to reduce maternal and neonatal morbidity due to infections and slow delivery
Ø Erythromycin 250 mg orally three times daily for 7 days
Ø Plus amoxicillin 500 mg orally three times daily for 7 days
o Consider moving beyi to the most appropriate services for newborn care if possible
o Give corticosteroids to the mother to improve fetal lung maturity
o Make use of induction of labor with oxytocin at 37 weeks gestation and given prophylactic antibiotics to help reduce streptococcal infection in neonates although the mother has received prior antibiotics .
o If the contraction is palpable and there is a mucous discharge mixed with blood , suspected labor occurs preterem
- If there are signs of infection and gestational age 37 weeks or more ( mature )
- If the membranes rupture more than 18 hours , give penicillin or ampicillin profilksis to reduce the Formatting group B streptococcal infection in neonates . If there are signs of infection after delivery to stop the administration of antibiotics
- Assess the cervix :
o If the cervix good condition ( soft , thin , partially opened ) did induce labor using oxytocin
o If the cervix is not a good condition ( hard , thick , closed ) , matangkan cervix using prostaglandins and oxytocin infusion or fetuses born via cesarean .
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