ECLAMPSIA

NURSING

1. Mittal College Of Nursing Ajmer Submitted to-Mrs. Snehlata parashar (Lecturer OBG) Submitted by-Neelam Sharma (Bsc nursing 4 th year)

2. Topic Name -

3. Contain Introduction Definition Incidence Types of eclampsia Etiology Risk factor Pathophysiology

4. Clinical feature Stage of convulsions Investigation Management

5. Introduction: Hypertension is most common medical problem encountered during pregnancy. Hypertensive Disorders are: pre-eclampsia Eclampsia Gestational hypertension Chronic hypertension The term of Eclampsia is derived from a Greek word, meaning “Like a Flash of lightening”.

6. Definition- Eclampsia is a acute and life threatening complication during pregnancy, usually in patient who has developed Preclampsia characterized by the hypertension, edema, protein uria involving convulsion and coma is called Eclampsia.

7. Incidence: The incidence varies widely form country to country and even between different zones of the same country. While in the develop countries, it’s prevalence is far and few but in the developing ones, particularly in the rural areas, it is still high and contributes significantly to the maternal deaths .The hospital incidence in India range from 1 in 500 to 1 in 30.

8. Types of eclampsia:

9. Etiology: Unknown Hypertension Protein uria Edema Convulsion Coma

10. Risk factor: Advance age more than 35 yr Primigravida Pre hypertension Renal disease Multigravida Family history of eclampsia

11. Pathophysiology: Edema + protein urea+ seizure+ increase B. P. Continue hypertension | Brain Blood supply not proper { hypoxia} | Distrub brain physiology (continue depolrization) | Excessive relase of stimulus /electric impulse { i. e. Seizure}

12. Clinical feature: Hypertension Sever general edema Protein uria Weight gain Sever headache Vomiting Convulsion Coma

13. Stages of convulsions: 1 Pre monitory stages (20 -30 sec) Olfactory hallucinations Roll of eye Head turn and fix one side 2 Tonic stage : ( 20 – 30 sec) Complete muscle rigidity Opisthotonus position

14. 3. Clinic stage: (1 – 2 min) sever musles rigidity mostly jaw muscles Jerking movement Tounge biting 4 Comma stage : It is also called pre found stage or recovery stage. - patient some time conscious

15. Investigation: Complete blood count Hematocrit value Platelets count Serum urin acid test Lft Non stress test Serum Creatinine level estimation Cardiotocography

16. USG opthalmoScopy Urin test (protein uria)

17. Management: First aid : 1. Provide Safe place 2.Lying on firm and hard surface 3. Turn the patient head one side ( To prevent aspirate oral secration 4. Ventilation of the patient means loose clothes 5. Don’t interpreate with seizure 6. Hospitalized the patient immediately

18. Steps of management: Hospital management General management 2. Obstetrical management ( these are 2 steps) Control or uncontrol fits Duration of pregnancy

19. General management: Step 1- To collect the detail history. Essential investigation of patient. Vaginal or abdominal examination. Step 2 – fluid replacement (RL) by 24 hours calculation Formula – ( 24 hr urine output + 1000 ml fluid) 1. Anti convulsions and sedatives: Magnesium sulfate

20. Magnesium sulfate before check out: Respiratory rate > 12 breath per min Knee zerk reflex present Urinary out put 30 ml Per hr { 4gm intravenous, remaining 10 gm (intramuscular 5gm in each buttocks} 2. Lytic cocktail- pethidine Phenergan

21. 2. Anti hypertensive medication ( pentral route) Labitalol Methayldopa ACE inhibitors 3. Anti biotics are also used. ( in this e clampsia condition the most important term status epilepticus it means repeated seizure that last choice are thiopentol sodium is given)

22. Obstetrical management: This are devided 4 stages: 1 st stage- Fits are control Duration of pregnancy over than 37 weeks Mgt – induction of labor( cervix favorable) Cesarean section( cervix un favorable) 2 nd stage- fits are control but baby is immature. ( Continue pregnancy until featus maturity)

23. 3 rd stage : fits are uncontrolled. No sign of labor process. Mgt: 6-8 hr delivery performed. 4 th stage: labor process started 1.ARM(artificial rubture of membrane) By foceps deliverey By vacuum deliverey 2. Cesarean section

24. Nursing management: Assessment: To check out TPR and blood pressure. To check out female weight every day. Check Regular health status. To check anxiety level. To check fetus wellbeing status. Comfortable position: position are changed every 4 hr. Fits: Side rails up. In use of mouth Gag to prevent tonge bite.

25. Turn the patient one side to prevent aspirate gastric and oral secration. Airway clearance. Given oxygen therapy. Use asceptic technique Diet protein intake 2gm/kg/ day. To remove free redical that use of vitamin A, C, E. To provide psychological support.. To provide adequate rest.