Eclampsia

Introduction

Eclampsia, a dramatic and often unpredictable complication of pregnancy-induced hypertensive disorders, is characterized by sudden hypertension, proteinuria, edema, and seizures.

A relatively rare syndrome, eclampsia complicates approximately 3 in 100 pregnancies, with higher incidence rates in preeclamptic or twin pregnancies, women of low socioeconomic status or in developing countries, and nulliparous patients younger than 20 years or multiparous patients older than 35 years of age.

However many medical disorders can occur during pregnancy, childbirth, and in the post delivery time. One of those disorders in pregnancy is eclampsia.

Eclampsia is a major cause of perinatal morbidity and mortality and can present during the antepartum, intrapartum, or postpartum periods. Late postpartum eclampsia presents as convulsions, with onset occurring at more than 48 hours postpartum.

Demographic Data

Eclampsia was found to be more common among young and adolescent women .

Age Distribution

Age group [ years ]

19 or less20-2425-2930 or more

22 [46.80%]

19 [40.42%]3 [6.38% ]3 [ 6.38%]

19 or less20 - 2425 - 2930 or more

Significance of the Study

Pregnancy Induced Hypertension is a rare complication that occur within 42 days after delivery. We have chosen this case for the reason, that we became curious and interested regarding the deeper medical diagnosis for the occurrence of the certain disease.

It is very necessary for pregnant women to have knowledge concerning the subject matter for them to be aware and educated about the possible complications that may arise on their pregnancy.

Educating them to seek early and regular prenatal care is the best way to prevent complications that may lead to maternal various diseases.

What is Pregnancy-induced Hypertension?

Pregnancy-induced hypertensionPregnancy-induced hypertension is defined as the development is defined as the development of new arterial hypertension in a pregnant woman after 20 weeks gestationof new arterial hypertension in a pregnant woman after 20 weeks gestation.

It occurs most often in young women with a first pregnancy. It is more common in twin pregnancies, in women with chronic hypertension, preexisting

diabetes, and in women who had PIH in a previous pregnancy

Symptoms seen in patient:

Blood pressure elevation (140/100)

Episodes of Two-Clonic Seizure

Blurred Vision

Diagnostic done with the patient:

Diagnosis is often based on the increase in blood pressure levels, but other symptoms may help establish eclampsia as the diagnosis. Tests for eclampsia may include the following:

Blood pressure measurement

Urinalysis

Frequent weight measurements

Blood Chemistry

Hematology

Treatment done with the patient: Bed rest (either at home or in the hospital may be recommended)

Hospitalization (as specialized personnel and equipment may be necessary)

Magnesium sulfate given IV by infusion pump to prevent or limit seizures

Anti-Convulsion

Anti-Hypertensive

Foley catheter

Normal Delivery

Calcium Channel Blocker

Reproductive System

Functions:

1. Production of female sex cells

2. Reception of sperm cells from the male

3. Nurturing the development of and providing nourishment for the new individual

4. Production of female sex hormones.

Baby and Placenta

The placenta is also a kind of padding, and maintains a unique environment in which your baby can develop and grow. The placenta forms from the same cells as the embryo and attaches itself to the inner wall of the uterus, growing as your baby grows and the volume of your amniotic fluid increases. When it's finished growing, it is circular and weighs about a pound; when the body expels it after the birth, many women are surprised at its size and weight.

Blood Vessel

Functions:

1. Carry blood

2. Exchange nutrients, waste products and gases

3. Transport

4. Regulate blood pressure

5. Direct blood flow

Structure and Functions of Blood Vessels

Structure Functions

Arteries - The walls (outer structure) of arteries contain smooth muscle fiber that contract and relax under the instructions of the sympathetic nervous system.

Transport blood away from the heart;Transport oxygenated blood only (except in the case of the pulmonary artery).

Arterioles - Arterioles are tiny branches of arteries that lead to capillaries. These are also under the control of the sympathetic nervous system, and constrict and dilate, to regulate blood flow.

Transport blood from arteries to capillaries;Arterioles are the main regulators of blood flow and pressure.

Venules - Venules are minute vessels that drain blood from capillaries and into veins. Many venules unite to form a vein.

Drains blood from capillaries into veins, for return to the heart

Structure Functions

Capillaries - Capillaries are tiny (extremely narrow) blood vessels, of approximately 5-20 micro-metres (one micro-metre = 0.000001metre) diameter.There are networks of capillaries in most of the organs and tissues of the body. These capillaries are supplied with blood by arterioles and drained by venules. Capillary walls are only one cell thick (see diagram), which permits exchanges of material between the contents of the capillary and the surrounding tissue.

Function is to supply tissues with components of, and carried by, the blood, and also to remove waste from the surrounding cells ... as opposed to simply moving the blood around the body (in the case of other blood vessels);

Exchange of oxygen, carbon dioxide, water, salts, etc., between the blood and the surrounding body tissues.

Veins - The walls (outer structure) of veins consist of three layers of tissues that are thinner and less elastic than the corresponding layers of arteries.Veins include valves that aid the return of blood to the heart by preventing blood from flowing in the reverse direction.

Transport blood towards the heart;

Transport deoxygenated blood only (except in the case of the pulmonary vein).

Arteries Veins

Transport blood away from the heart;

Transport blood towards the heart;

Carry Oxygenated Blood (except in the case of the Pulmonary Artery);

Carry De-oxygenated Blood(except in the case of the Pulmonary Vein);

Have relatively narrow lumens Have relatively wide lumens (see diagram above);

Have relatively more muscle/elastic tissue;

Have relatively less muscle/elastic tissue;

Transports blood under higher pressure (than veins);

Transports blood under lower pressure (than arteries);

Do not have valves (except for the semi-lunar valves of the pulmonary artery and the aorta).

Have valves throughout the main veins of the body. These are to prevent blood flowing in the wrong direction, as this could (in theory) return waste materials to the tissues.

Comparison between Arteries and Veins

Normal Abnormal

Blood Vessel are tubes which carry blood. Veins are blood vessels which carry blood from the body back to the heart. Arteries are blood vessels which carry blood from the heart to the body. There are a few main blood vessels which connect to different chambers of the heart. The aorta is the largest artery in our body. The left ventricle pumps blood into the aorta which then carries it to the rest of the body through smaller arteries. The pulmonary trunk is the large artery which the right ventricle pumps into. It splits into pulmonary arteries which take the blood to the lungs. The pulmonary veins take blood from the lungs to the left atrium. All the other veins in our body drain into the inferior vena cava (IVC) or the superior vena cava (SVC). These two large veins then take the blood from the rest of the body into the right atrium.

Narrowing of the blood vessels resulting from contraction of the muscular wall of the vessels, particularly the large arteries, arterioles and veins. The process is the opposite of vasodilation, the widening of blood vessels. When blood vessels constrict, the flow of blood is restricted or slowed, thus, retaining body heat and increasing vascular resistance. Cutaneously, this makes the skin turn paler because less blood reaches the surface. This helps to prevent the radiation of heat.

Functions:

1. Generating blood pressure

2. Routing blood

3. Ensuring one-way blood flow

4. Regulating blood supply

Blood flow through the Heart

Brain

Controls the central nervous system (CNS), by way of the cranial nerves and spinal cord, the peripheral nervous system (PNS) and regulates virtually all human activity. Involuntary, or "lower," actions, such as heart rate, respiration, and digestion, are unconsciously governed by the brain, specifically through the autonomic nervous system. Complex, or "higher," mental activity, such as thought, reason, and abstraction, is consciously controlled.

Neurons

Generalized seizures are caused by abnormal electrical activity at multiple locations in the brain and/or over a large area of the brain. This results in loss of consciousness and body stiffening, which is followed by shaking of the arms and legs.Abnormal electrical activity may start in one part of the brain and cause isolated symptoms. Sometimes this abnormal electrical activity spreads through the brain, resulting in a generalized seizure. Seizures can be caused by a specific area of the brain that is injured or inflamed, or they can be due to stress on the brain from a more widespread systemic process, such as severely low blood sugar.

Name: Ms. M.T

Age: 19

Sex: Female

Address: 69 Pooc Maligaya, San Vicente, San Pedro Laguna

Civil Status: Single

Occupation: None

Name of Spouse: Mr. Benigno Carpellar

Date of Admission: August 07, 2008

PATIENT’S PROFILE

Chief Complaint: Seizures

History of present Illness: Patient delivered at San Pedro Municipal Hospital. After hours she had 2 episodes of tonic clonic seizures hence referral to our institution and then subsequently admitted.

Physical Examination: Li open, uterus oblique, no abnormal masses

Admitting Diagnosis: NSD Day 0 Post Partum Eclampsia G1P1(1001)

BRIEF HISTORY

LABORATORY RESULTS

HEMATOLOGY:

Diagnostic Exam Result Normal Range Findings

Hemoglobin 136 M:140-170 / F:120-140 gml/dl

Increased

Hematocrit .41 M:0.44-0.54 – F:0.37-.47 Normal

WBC 9.0 5.0-10.0 Normal

Platelet 280 150-400cc/mL Normal

ABO Typing “A”

DIFFERENTIAL COUNT:


Segmenter 69 40-60 Increased

Lymphocytes 31 20-40 Normal

URINALYSIS:


Color Yellow Yellow/Amber Normal

Transparency Clear Clear Normal

Reaction 5.0 4.8-7.8 Normal

SP Gravity 1.030 1.015-1.025 Increased

Sugar Negative Negative Normal

Protein Negative Negative Normal

Pus Cells 2-3 HPF 0-4 HPF Increased

RBC 1.5-2.0 HPF 0-3 HPF Normal

Epithelial Cells Few Few Present Normal

BLOOD CHEMISTRY:

Diagnostic Exam

Result Normal Range Findings

BUN 12.3 mg/dl

10-50 mg/dl Normal

Creatinine 1.1 mg/dl F:0.5-1.0 mg/dl M:0.6-1.2 mg

Increased

SGOT 26.8 1u/L 10-40 IU/L Normal

SGPT 13.9 1u/L 5-35 IU/L Normal

PATHOPHYSIOLOGY

MEDICAL MANAGEMENT DOCTOR’S ORDER RATIONALE

AUGUST 08, 2008:

1.Please admit to OBW2.Secure consent

3. NPO temporarily, DAT when fully awake

4. IVF D5LRS 1L * 20 gtt/min + 10 u oxytocin.

Medication:

5. Cefuroxime 1.5 g/IV LD ANGT

Cefalexin 500 mg/cap q8 * 7 days

6. Magnesium Sulfate 4g SIVP then 5 g/ IM

on each buttocks followed by 5 g/ IM or

alternating buttock q6 * 4 doses

1. To provide maximum care to the patient2. It includes explanation of the procedure to

gain patients cooperation, and for patient’s documentation which can be used for legal purposes.

3. To prevent aspiration that maintains nutritional needs.

4. Fluid replacement and route for intravenous medication. Oxytocin helps induced uterine contraction and prevents post partum hemorrhage

5. Anti-infectives; Prevents occurrence of

infections

6. Anti-convulsants and Laxative; for

prevention of seizure. Watch out for signs

of < tendon reflex, < urine output, >

respiratory rate.

DOCTOR’S ORDER RATIONALE

7.Nifedipine 10 mg/ tab BID (one fully awake)

8. Insert foley catheter

9. Monitor VS q1 including Input and Output

and second please

Refer accordingly.ADDENDUM:Request for the ff: CBC with blood typing Platelet SGOT,SGPT,BUN,CREA,LDH Urinalysis• refer to Medicine for co-managementAUGUST 09, 2008 May consume IVF once magnesium sulfate

is completely given. Follow up all Lab Results May remove foley catheter after last dose of

magnesium is given Continue VS monitoring Refer

7. Calcium channel blocker; for anti-hypertensiveness.

8. For accurate monitoring of I and O; prevention of injury, < bladder retention

9. Deviations from baseline monitoring

CBC to facilitate possible blood transfusion, platelet count to determine bleeding tendencies; SGOT, SGPT, BUN, CREA, LDH; is to rule out PIH either pre-eclampsia, chronic pregnancy. Urinalysis is for direct quantification of protein.

Refer for hypertensive management.

Follow up laboratory results to facilitate fast recovery.

Remove Foley Catheter to provide comfort and adequate rest and sleep.

Drug Name Mechanism of Action

Indication Contraindication Side or Adverse Effects

Nursing Responsibilities

Generic NameCefuroxime

Classification: Cephalosporin, second generation

Dosage: 1.5 g IV LD

Cefuroxime is a second-generation Cephalosporin that inhibits cell-wall synthesis, promoting osmotic instability; usually bactericidal.

Infections of the urinary and lower respiratory tracts.

Contraindicated in patients hypersensitive to drug or other cephalosporins.

Diarrhea

Loose Stools

Abdominal pain

Nausea and

Vomiting

Double check the doctor`s order, the

meds to be given, the dosage, the route, and the time and

frequency.Monitor vital signsUse cautiously in

patients hypersensitive to

penicillin because of possibility of cross-

sensitivity with other beta-lactam antibiotics.

Ask patient about past reaction to

cephalosporin or penicillin therapy before giving first

dose.Identify the

patient.If large doses are

given or if therapy is longed, monitor

patient for superinfection,

specially in high-risk.

Drug Name Mechanism of Action Indication Contraindication Side and Adverse Effects


Generic Name:Nifedipine

Classification: Calcium channel blocker

Dosage: 10 mg 1 tab. BID

Unknown. Thought to inhibit calcium ion influx across

cardiac and smooth-muscle cells, decreasing contractility and oxygen demand. Also may dilate coronary arteries

and arterioles.

Vasospastic angina, classic chronic stable angina pectoris.

Contraindicated in patients hypersensitive to drugs.

Headache

Fatigue or

Lethargy

Edema

Weakness or

Muscle cramps

Dizziness

Disturbed

equilibrium

Flushing

identify the patient.double check the doctor`s order, the meds to be given, the dosage, the route, and the time and frequency.monitor vital signsUse cautiously in patients with heart failure or hypotension and in elderly patients. Don’t give immediate-release form with-in one week of acute MI or in acute coronary syndrome.Monitor blood pressure regularly, especially in patients who take beta-blockers or anti-hypertensive.Watch for symptoms of heart failure.


Indication Contraindication Adverse Effects


Generic NameHydralazine

Classification: Antihypertension

Unknown. A direct-acting vasodilator that mainly relaxes anteriolar smooth muscle.

Essential hypertension (orally, alone, or with other anti-hypertensives), severe essential hypertension (parenterally, to lower blood pressure quickly)

Contraindicated in patient hypertensive to drug and in those with coronary artery disease or mitral valvular rheumatic heart disease.

Tachycardia

Edema

Angina

pectoris

Palpitations

Nausea and

Vomiting

Diarrhea

Anorexia

Constipation

Identify the patient.

Double check the doctor`s order, the meds to be given,

the dosage, the route, and the time

and frequency. Monitor vital

signs Use cautiously in

patients with suspected cardiac disease, CVA, or

severe renal impairment and in those taking other anti-hypertensives.

-


Indication Contraindication Adverse Effects


Generic Name:Magnesium sulfate

Classification: Anticonvulsant

Dosage: 4gm SIVP and; 5g IM on each buttocks

May decrease acetylcholine released by

nerve impulses, but its

anticonvulsant mechanism is

unknown.

To prevent or control seizures in preeclampsia or eclampsia.

Parenteral Administration contraindicated in patients with heart block or myocardial damage. Also contraindicated in patients with toxemia of pregnancy during 2 hours preceeding delivery.

Drowsiness

Depressed

reflexes

flaccid

paralysis

Hypothermia

Hypotension

Identify the patient. Double check the doctors order, the meds to be given, the dosage, the route, and the time and frequency. Monitor vital signs Use cautiously in patients with impaired renal function. Also use cautiously in woman who are in labor.If used to treat seizures take appropriate seizure precautions.-Monitor fluid intake and output.

Patient’s Name: M.TAge: 19Medical Diagnosis: Pregnancy Induced Hypertension

Nursing Diagnosis: Decreased Cardiac Output related to decreased venous return.Short Term Goal: At the end of my shift, patient will have a decreased blood pressure and will be able to have an adequate rest and sleep.Long Term Goal: At the end of hospitalization, patient will be able to maintain vital signs within acceptable range.

CUES PROBLEM SCIENTIFIC RATIONALE

INTERVENTIONS RATIONALE EVALUATION

SUBJECTIVE:

“Hindi pa ko makabangon nahihilo ako”as verbalized by the patient

OBJECTIVES:

•Increased Blood Pressure (140/100)

•restlessness

•Weak in appearance

•Dizziness

Hypertension

-Inadequate blood pumped by the heart to meet the metabolic demands of the body. [note: In a Hyper Metabolic state although cardiac output and tissue perfusion are interrelated, altough there are differences. When cardiac output is decreased tissue perfusion problems will develop however, tissue perfusion problems can exixt without decreased cardiac output.

•Monitor Blood Pressure; every 15mins. During critical phase; ever 1-4hrs. As conditions improves.

•Provide adequate rest by positioning client.

•Give information about positive signs of improvements, such as decreased edema, improved vital signs and circulation.•Encourage fluid intake.

•Provide quite environment.

-Provides baseline for comparison to follow trends and evaluate response to interventions.

-Decreases oxygen consumption and risk for de-compensation and for maximum comfort.

-To provide Encouragement.

-To minimize dehydration.

-To promote adequate rest.

Goal Met.

The patient will be able to have an

adequate rest and sleep, and the

patient’s blood pressure will decreased.

The patient will be able to respond

well to interventions and

performed actions.

Patient’s Name: M.TAge: 19Medical Diagnosis: Pregnancy Induced HypertensionNursing Diagnosis: Impaired physical mobility related to decrease muscle strength Short Term Goal: After rendering my nursing intervention, patient will be able to verbalize understanding of situation and individual treatment regimen and safety measures.Long Term Goal: Upon discharge, the patient will be able to maintain or increase strength and function of the affected and compensatory body part.

CUES PROBLEM SCIENTIFIC RATIONALE

INTERVENTIONS RATIONALE EVALUATION

OBJECTIVES:

Limited ROM (Range of Motion)

Slowed movement

Impaired Physical Mobility

Limitation in independent, purposeful physical movement of the body or of one or more extremities

•Note situations such as surgery, fractures, amputations and tubings (catheter).

•Observe movements when client is unaware of observations.

•Support affected body parts/joints using pillows.

•Encourage adequate intake of fluids.

•Encourage client’s involvement in decision as much as possible.

- It may restrict movement

-to note any incongruencies with reports of abilities

-to maintain position of function and reduce risk of pressure ulcers -promotes well being and maximizes energy production.

-enhances commitment to plan optimizing outcomes

Goal Met:

The patient will be able to verbalize understanding of

situation and individual

treatment regimen and safety measures.

The patient will be able to maintain

proper function of the part being

affected.

Presented by: Dave Jay S. Manriquez RN.

Eclampsia

Education

Transcript of Eclampsia