Nursing Patient With Eclampsia

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 .

understanding agreement

understanding agreementIn Public Law , the agreement here refers to the International Treaty . Currently the international community , international agreements play a vital role in regulating life and relationships between countries. International agreement is essentially a major source of international law to regulate the activities of states or other subjects of international law . Until 1969 , the manufacture of the International agreements only governed by customary law . Based on the draft chapters prepared by the International Law Commission , was organized an International Conference in Vienna from March 26 until May 24, 1968 and from April 9 to May 22, 1969 to codify the common law . Conference gave birth to the Vienna Convention on the Law of Treaties signed on May 23, 1969 . The Convention came into force on January 27, 1980 and is a positive international law . Article 2 of the 1969 Vienna Convention defines international agreement ( treaty ) is an agreement made ​​between states in written form and governed by international law , whether in a single instrument or two or more related instruments and whatever the name given to him . The definition above contains
elements :
· The existence of a subject of international law , namely states , international organizations and liberation movements . Recognition of the state as a subject of international law that have full capacity to make international agreements listed in Article 6 of the Vienna Convention . International organizations are also recognized as a party to make an agreement with the requirements of the agreement comes dar will make Member States and international treaties that created a field of international organizations such authority . Such restrictions seen in Article 6 of the Vienna Convention . Capacity liberation movements recognized but is selective and limited . Selective means these movements must be recognized first by the region where the movement was . Limited movement means participation in the agreement is to carry out the wishes of movement establish an independent state .
· International legal regime . International agreements should be subject to international law and should not be subject to a certain national laws . Although the agreement was made ​​by the state or an international organization , but if it has been subject to a particular national law chosen , the agreement is not a treaty.
Terms of invalidity of the agreement
Unlike the agreement in private law is valid and binding on the parties since the existence of an agreement , but in public law agreement shows only the testimony of the agreement , not the validity of the agreement . And after the agreement was valid , not necessarily binding on the parties if the parties have not ratified . Stages of making the agreement include :

    a. negotiations where countries sent their representatives to a bilateral or multilateral conferences ;
    b . acceptance of the agreement (adoption of the text ) is the acceptance of the content of the agreement is determined by the conference participants with the consent of all participants by voting ;
    c . testimony of the agreement ( authentication of the text ) , is a formal act which states that an agreement has been received conference . Article 10 of the Vienna Convention , carried out according to the procedures contained in the agreement or in accordance with what has been decided by the delegates at the conference . If not specified then the validation can be done to affix the signature or initials under the agreement .
    d . agreement bind themselves ( consent to the bound) , given in a variety of ways depending on the agreement of the parties at the time entered into an agreement , whereby a way to express approval are as follows :
1 . signing , Article 12 of the Vienna Convention states :
- Approval of an agreement to be bound can be expressed in the form
signature of the representative of the country ;
- If the agreement itself is declared ;
- When it is proven that the participating countries agreed to negotiate such ;
- If the full powers of representatives state says so or otherwise
clearly at the time of negotiations .2 . endorsement , through the ratification of the agreement which was approved by a competent authority in the member state .
As a result of the agreement

    1 . For the state : Article 26 of the Vienna Convention states that each of the applicable treaty commits states parties and must be performed in good faith or in good faith . Implementation of the agreement was carried out by state organs should take the necessary measures to ensure its implementation . Holding capacity agreements based on the principle of pacta sunt servanda .
    2 . For other countries : Unlike the agreements in the field of private law which may not cause the rights and obligations to third parties , the treaty can cause due to third parties for their approval , can grant to third countries or third countries have inflicted upon without consent the country ( example : Article 2 ( 6 ) of the UN Charter which states that countries not members of the United Nations must act in accordance with the principles of the United Nations as far as possible when it is considered necessary for international peace and security ) . Article 35 of the Vienna Convention provides that international agreements can have an effect for a third -party liability for their consent where consent is manifested in written form .
The termination of the agreement

    1 . accordance with the terms of the agreement itself ;
    2 . the approval later stated in a separate agreement ;
    3 . due to certain events that do not implement the agreement , which is a fundamental change in the vehicle on member states , the emergence of new norms of international law , war .

understanding agreement

understanding agreementIn Public Law , the agreement here refers to the International Treaty . Currently the international community , international agreements play a vital role in regulating life and relationships between countries. International agreement is essentially a major source of international law to regulate the activities of states or other subjects of international law . Until 1969 , the manufacture of the International agreements only governed by customary law . Based on the draft chapters prepared by the International Law Commission , was organized an International Conference in Vienna from March 26 until May 24, 1968 and from April 9 to May 22, 1969 to codify the common law . Conference gave birth to the Vienna Convention on the Law of Treaties signed on May 23, 1969 . The Convention came into force on January 27, 1980 and is a positive international law . Article 2 of the 1969 Vienna Convention defines international agreement ( treaty ) is an agreement made ​​between states in written form and governed by international law , whether in a single instrument or two or more related instruments and whatever the name given to him . The definition above contains
elements :
· The existence of a subject of international law , namely states , international organizations and liberation movements . Recognition of the state as a subject of international law that have full capacity to make international agreements listed in Article 6 of the Vienna Convention . International organizations are also recognized as a party to make an agreement with the requirements of the agreement comes dar will make Member States and international treaties that created a field of international organizations such authority . Such restrictions seen in Article 6 of the Vienna Convention . Capacity liberation movements recognized but is selective and limited . Selective means these movements must be recognized first by the region where the movement was . Limited movement means participation in the agreement is to carry out the wishes of movement establish an independent state .
· International legal regime . International agreements should be subject to international law and should not be subject to a certain national laws . Although the agreement was made ​​by the state or an international organization , but if it has been subject to a particular national law chosen , the agreement is not a treaty.
Terms of invalidity of the agreement
Unlike the agreement in private law is valid and binding on the parties since the existence of an agreement , but in public law agreement shows only the testimony of the agreement , not the validity of the agreement . And after the agreement was valid , not necessarily binding on the parties if the parties have not ratified . Stages of making the agreement include :

    a. negotiations where countries sent their representatives to a bilateral or multilateral conferences ;
    b . acceptance of the agreement (adoption of the text ) is the acceptance of the content of the agreement is determined by the conference participants with the consent of all participants by voting ;
    c . testimony of the agreement ( authentication of the text ) , is a formal act which states that an agreement has been received conference . Article 10 of the Vienna Convention , carried out according to the procedures contained in the agreement or in accordance with what has been decided by the delegates at the conference . If not specified then the validation can be done to affix the signature or initials under the agreement .
    d . agreement bind themselves ( consent to the bound) , given in a variety of ways depending on the agreement of the parties at the time entered into an agreement , whereby a way to express approval are as follows :
1 . signing , Article 12 of the Vienna Convention states :
- Approval of an agreement to be bound can be expressed in the form
signature of the representative of the country ;
- If the agreement itself is declared ;
- When it is proven that the participating countries agreed to negotiate such ;
- If the full powers of representatives state says so or otherwise
clearly at the time of negotiations .2 . endorsement , through the ratification of the agreement which was approved by a competent authority in the member state .
As a result of the agreement

    1 . For the state : Article 26 of the Vienna Convention states that each of the applicable treaty commits states parties and must be performed in good faith or in good faith . Implementation of the agreement was carried out by state organs should take the necessary measures to ensure its implementation . Holding capacity agreements based on the principle of pacta sunt servanda .
    2 . For other countries : Unlike the agreements in the field of private law which may not cause the rights and obligations to third parties , the treaty can cause due to third parties for their approval , can grant to third countries or third countries have inflicted upon without consent the country ( example : Article 2 ( 6 ) of the UN Charter which states that countries not members of the United Nations must act in accordance with the principles of the United Nations as far as possible when it is considered necessary for international peace and security ) . Article 35 of the Vienna Convention provides that international agreements can have an effect for a third -party liability for their consent where consent is manifested in written form .
The termination of the agreement

    1 . accordance with the terms of the agreement itself ;
    2 . the approval later stated in a separate agreement ;
    3 . due to certain events that do not implement the agreement , which is a fundamental change in the vehicle on member states , the emergence of new norms of international law , war .

Agreement according to Private Law

Agreement according to Private Law
Understanding Agreement
A treaty is an act by which one or more persons bind themselves to one or more other persons (Article 1313 BW). Definition
This agreement contains elements:
a. Deeds, The use of the word "act" in the formulation of this Agreement if it is replaced with a more appropriate word legal action or legal action, because such actions bring legal consequences for the parties to foretell;
b. One or more of the one or more other persons, For the existence of an agreement, there must be at least two parties face to face and give each statement a suitable / fitting each other. The party is a person or legal entity.
c. Bound themselves, In the agreement there are elements of the promise made by one party to the other party. In this agreement, the legal consequences are bound to arise because of his own volition.
Terms of Agreement validity
In order for an agreement to be valid and binding on the parties, the agreement must meet the requirements as set out in Article 1320 BW namely:
1. agreed they were bound themselves; The word "agreed" not to be due to an oversight on the nature of the goods which are the subject of approval or oversight on his part in the approval of self-made, especially considering he was the person; coercion which a person acts out of fear threat (Article 1324 BW); fraud is not only a lie but also the presence of the ruse (Article 1328 BW). The agreements made on the basis of "agreed" based on these reasons, the cancellation may be filed.
2. competent to make the engagement; Section 1330 of BW determines incompetent to make the engagement:
a. People who have not grown
b. They were put under guardianship
c. The women, in cases stipulated by law, and in general all those to whom the law has prohibited making certain covenants. But the fatwa by the Supreme Court, through the Supreme Court Circular No.3/1963 dated 5 September 1963, the women were no longer classed as incompetent. They are authorized to perform legal acts without the help or permission of her husband. As a result of an agreement made by the parties is null and incompetent law (Article 1446 BW).
3. a certain thing; The agreement should specify the type of object agreement. If not, then the agreement is null and void. Section 1332 of BW determines only items that can be traded that can be the object of the agreement, and pursuant to Article 1334 BW new items will be in the future can be the object of the agreement except where prohibited by law expressly.
4. a cause or causa kosher. Invalidity of an agreement causa determined at the time the agreement was made. Agreement without the lawful causa is null and void, unless otherwise provided by law. The first and the second concerns the subject, while the third and fourth terms on the object. The presence of defects will (mistakenly, coercion, fraud) or not competent to make a commitment, on the subject resulted in an agreement may be canceled. Meanwhile, if the third and fourth terms on the object are not met, then the agreement is null and void.
As a result of the Agreement
Section 1338 subsection (1) of the Civil Code, which states that all contracts (agreements) are made legally valid as the law for those who make it. This article may be inferred from the existence of the principle of freedom of contract, but this freedom is limited by the laws of nature force, so that the parties made an agreement must obey the laws of nature force. An irrevocable agreement in addition to the agreement of both parties, or for the reasons stated by the law enough for it. Agreements not only bind to the things expressly stated therein, but also for everything that is according to the nature of the agreement, required by propriety, custom or law. An agreement was not allowed to bring harm to a third party.
The termination of the Agreement
Agreement ends because:

    1. determined by the parties to apply for a certain time;
    2. determine the limits of the law coming into effect of the agreement;
    3. the parties or the law stipulates that the occurrence of events
then approval will be given clear; Specific event in question is a state force (overmacht) set forth in Section 1244 and 1245 of the Civil Code. Circumstances compel a state where the debtor is unable to perform his accomplishments to the creditor due to events beyond his control, for example due to earthquakes, floods, lava and others. Circumstances force can be divided into two kinds: 1. absolute force state is a state where the debtor did not meet perutangannya to creditors, because of the earthquakes, flash floods, and the presence of lava (force majeure). Due to the state of absolute force (force majeure): a. debtor does not have to pay damages (Article 1244 Civil Code); b. creditor is not entitled to the fulfillment of achievement, but also for the sake of free legal obligation to deliver the achievement counter, except for those mentioned in Article 1460 of the Civil Code. 2. circumstances force relative is a situation that causes the debtor is still possible to carry out his achievements, but the achievements of the implementation should be done by giving the victim a large disproportionate use of force or soul beyond human ability or possibility of danger hit by huge losses. Circumstances force did not result in any risk burden, only a matter of time the rights and obligations of creditors and debtors.

     stop the approval statement (opzegging) which can be done by both parties or by either party to the agreement is temporary eg employment agreement;
      judge's decision;
    the purpose of the agreement is reached;
    with the consent of the parties (herroeping)

theory of Behavior

theory of Behavior
According Notoatmodjo ( 2003) , there are several theories of behavior , namely :

    Theory Stimulus Organism
Stimulus theory is that the cause of the organism 's behavior changes depending on the quality of the stimuli ( stimulus ) that communicates with the organism . That is , the quality of communication sources ( sources ) , such as credibility , leadership , speaking style , determine the success of behavior change a person, group or community .

    Theory Festinger ( Dissonance Theory )
This means that a state of cognitive dissonance is a psychological imbalance that is covered by a strain yourself trying to reach equilibrium again . If there is a balance within the individual , then it means it's been a tension away again , and this state is called consonance balance ( equilibrium ) . The imbalance occurs because of the knowledge contained within the individual , an opinion or belief . When individuals face an object and the stimulus or the stimulus raises different opinions or beliefs , self- contradictory in the individuals themselves , and there was dissonance .

    Function theory
This theory is based on the assumption that individual behavior change depending on the needs . This means that the stimulus that can lead to changes in a person's behavior is a stimulus that can be understood in the context of the person's needs .

    Theory of Kurt Lewin
Kurt Lewin's theory is a state of balance between driving forces ( driving forces ) and anchoring forces ( forces restining )