Preeclampsia

y Is a hypertensive disorder of pregnancy developing after 20 weeks of gestation & characterized by edema, hypertension, and proteinuria.

Eclampsia
y Etiology 1. Cause is unknown 2. Possible contributing factor include: a) Genetic or immunologic b) Primigravid status c) Conditions that create excess trophoblastic tissue, such as multiple gestation, diabetes, or hydatidiform mole Is an extension of preeclampsia & is characterized by the onset of seizure activity.

Pathophysiology
 Preeclampsia is a multisystem, vasoplastic disease process characterized by hemoconcentration, hypertension, and proteinuria.

Assessment findings
1) Clinical manifestation of mild preeclampsia a) Increase B.P exceeding 140/90 mmHg; baseline is above 30 mmHg systolic pressure b) Generalized edema in the face, hands & ankles c) Weight gain 1.5kg per month in the 2nd trim or more than 1.3 to 2.3kg per week in 3rd trim 2) Warning signs of worsening preeclampsia a) Rapid rise B.P b) Rapid weight gain c) Generalized edema d) Increase proteinuria e) Epigastric pain f) Visual disturbances g) Oliguria (below 120 ml in 4hrs) h) Irritability i) Severe nausea and vomiting 3) Clinical manifestation of severe preeclampsia a) B.P exceed 160/110 mmHg in two take 6hrs b) Proteinuria exceeding 5g/24hrs c) Oliguria ( > 400ml in 24hrs)

d) Headache e) Blurred vision, spots before eye f) Dyspnea g) Epigastric pain h) Nausea & vomiting 4) Eclampsia - Experienced seizure - More complication such as: a) Cerebral Hemorrhage b) Liver rupture c) Coma

Nursing management
1) Monitor for, and promote the resolution of complications a) Monitor V/S and FHR b) Promote rest and relaxation c) Measure & record UO, protein level & specific gravity d) Assess for edema e) Weigh the client daily f) Assess for placental separation, headache and visual disturbance 2) Treatment a) Mild preeclampsia - Bed rest in L lateral recumbent position - Balanced diet - Administration of magnesium sulfate b) Severe preeclampsia - Complete bed rest - Balanced diet and fluid and electrolyte replacement - Administration of magnesium sulfate and antihypertensive hydralazine c) Eclampsia - Administer: i. Magnesium sulfate ii. Hydralazine iii. Sedative anticonvulsants ( diazepam, phenobarbital or phenytoin). d) Institute seizure precaution may occur up to 72hrs after delivery e) Absolute treatment for preeclampsia and eclampsia is delivery of the infant f) Address emotional and psychological needs