Care of Mother With

COMPLICATED PREGNANCY
(Pre-ECLAMPSIA & ECLAMPSIA)
Galang┃Galingana┃Gonzales┃Gusi┃Janolino┃
Lazaro┃Leland┃Lipata
Care Map
Headaches I Hyperreflexia I
Seizure Activity I Dyspnea
 CASE STUDY:
An emergency patient named Alice Sy, 29-year-old
primigravida, came to the hospital. She experienced a
tonic-clonic seizure and was brought to the ER.
Currently her condition, entered the postictal stage
and is still in continuous monitoring.

CASE STUDY: The patient is at 38 weeks’ gestation. The client’s family

said that she complained of a lot of severe headache
and blurred vision. She even has severe twitching or
spastic tendencies. They noticed that she had
developed edema in the face and upper and lower
extremities. Through the week, she reported that she
was having a hard time to breathe even without
exertion of force. She was often tired and nauseated.
 CASE STUDY:
The client insisted not to go to the hospital since she was too afraid to be infected
by the COVID-19 virus. Family history includes, father died from hypertension. Her
sister had preeclampsia during her first born.

The client was not active physically and denied exercising even from the start of her
pregnancy. She was fond of eating junk food while sitting all day, watching TV. His
husband works in a factory. They often argue because of his husband’s habit of
smoking.

Laboratory studies showed that the patient has low platelet count, decrease in
hemoglobin level and presence of protein in the urine (+ 2 proteinuria).

Vital signs: Her blood pressure (BP) was elevated at 171/107 mmHg. Her pulse 81
beats per minute (bpm), respiratory rate 15 breaths per minute, and temperature is
37.5 °C. OS: 90 % FHR: 100 bpm.
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https://prezi.com/p/_atn7p4weymj/week-2-ncm-109/

Note: This is the hyperlink for the Prezi presentation of the care
map about pre-eclampsia/ eclampsia.
QUESTIONS
 QUESTIONS:
1. Differentiate pre-eclampsia from eclampsia.
2. Create a drug study on Magnesium Sulfate.
a. Indication
b. Action
c. Therapeutic Effect
d. Pharmacokinetics
i. Absorption
ii. Distribution
iii. Metabolism and elimination
e. Contraindications
f. Special Precaution
g. Adverse Reactions and Side-effects
h. Interactions
i. Route and Dosage
j. Nursing Implications
3. What is Calcium Gluconate? What is its relationship to Magnesium Sulfate?
 DIFFERENCE OF PRE-
ECLAMPSIA AND ECLAMPSIA
 DIFFERENCE BETWEEN PREECLAMPSIA AND ECLAMPSIA
Preeclampsia Eclampsia

Preeclampsia, also known as toxemia is Eclampsia is a serious complication

characterized by high blood pressure and of pregnancy characterized by life
high levels of protein in the urine of women threatening acute tonic – clonic
after the 20th week of gestation. seizures in a pregnant woman.

Preeclampsia, usually strikes women in Eclampsia essentially occurs in those

their first pregnancy, or those who are women who already have had
carrying twins. preeclampsia and which possibly
was not treated on time.
 Signs and symptoms
Preeclampsia Eclampsia

Without severe features Either seizure or coma accompanied

● BP: 140/90 mmHg by signs and symptoms of
● Systolic pressure: elevated 30 mmHg preeclampsia are present.
● Diastolic pressure: 15 mmHg
● Proteinuria of 1+ to 2+
● Weight gain over 2 lb/week in second
trimester and 1 lb/week in third
trimester
● Mild edema in upper extremities or
face
 Signs and symptoms
Preeclampsia Eclampsia

With severe features Either seizure or coma accompanied by

● BP: 160/110 mmHg signs and symptoms of preeclampsia are
● Proteinuria 3+ to 4+ on a random sample present.
and 5 g on a 24-hour sample
● Oliguria (500 ml or less in 24 hours or
altered renal function tests
● Elevated serum creatinine more than 1.2
mg/dl)
● Cerebral or visual disturbances (headache,
blurred vision)
● Pulmonary or cardiac involvement;
extensive peripheral edema
● Hepatic dysfunction
● Thrombocytopenia
● Epigastric pain
DRUG STUDY ON MAGNESIUM
SULFATE
 a. INDICATIONS
Magnesium sulfate is a common medication in the hospital setting with a variety of
uses. It currently holds many FDA-approvals but also has numerous off-label uses for
a variety of clinical situations.

FDA-approved Indications Non-FDA-approved Indications

● Constipation ● Acute asthma exacerbations

● Hypomagnesemia ● Torsades de pointes during ACLS
● Prevention of seizures in ● Tocolytic to prevent preterm labor
eclampsia/preeclampsia
● Acute nephritis (pediatric patients)
● Cardiac arrhythmias secondary to
hypomagnesemia
● Soaking minor cuts or bruises
 B. action
Magnesium Sulfate is a central nervous system depressant that acts to block
neuromuscular transmission of acetylcholine to hat convulsions. It also halts
premature labor, as it relaxes smooth muscle (Karch,2009)

c. therapeutic effect
Effective parenterally as a CNS depressant, smooth muscle relaxant and
anticonvulsant in labor and delivery, and cardiac disorders. It is a laxative when
taken orally.
 D. Pharmacokinetics
I. Absorption

a. Following administration, 30-50% of the dose is absorbed from the

small intestine.
II. Distribution

a. Crosses the placenta and small amounts enter the breastmilk.

b. Protein-binding: 25-30%

III. Metabolism and Elimination

a. Excretion of absorbed fraction is through urine. Excretion of unabsorbed

fraction is through feces.

b. Elimination is via kidneys.

 E. contraindications
● Hypersensitivity
● Myocardial damage, diabetic coma, heart block
● Hypermagnesemia
● Hypercalcemia
● Administration during 2 hours preceding delivery for mothers with
toxemia of pregnancy
 F. SPECIAL PRECAUTIONS
● Fetal skeletal demineralization, low blood calcium (hypocalcemia), and high
blood magnesium (hypermagnesemia) abnormalities reported with
continuous long-term use (i.e., longer than 5-7 days) for off-label treatment of
preterm labor in pregnant women; the effect on the developing fetus may result
in neonates with skeletal abnormalities.
● In patients with renal impairment, ensure that renal excretory capacity is not
exceeded.
● Use with caution in digitalized patients.
● Use with extreme caution in patients with myasthenia gravis or other
neuromuscular disease.
● Low blood magnesium (hypomagnesemia) is usually associated with low blood
potassium (hypokalemia) (potassium levels must be normalized).
● Monitor renal function, blood pressure, respiratory rate, and deep tendon reflex
when magnesium sulfate is administered parenterally.
 g. Adverse Reactions and Side-effects

Typically result in magnesium toxicity

● Loss of patellar reflexes
The first warning of impending toxicity in the mother is loss of the patellar
reflex at plasma concentrations between 3.5 and 5 mmol/L.
● Respiratory paralysis occurs at 5 to 6.5 mmol/L.
Heart block
● Cardiac conduction is altered at greater than 7.5 mmol/L.
● Collapse of circulatory system
Cardiac arrest can be expected when concentrations of magnesium
exceed 12.5 mmol/L.
 g. Adverse Reactions and Side-effects
Maternal Fetal/neonatal

Nausea Fetal heart rate decreased variability

Flushing Respiratory depression
Diaphoresis Hypotonia
Blurred vision Decreased suck reflex
Lethargy Poor muscle tone
Hypocalcemia
Depressed reflexes
Respiratory depression-arrest
Cardiac dysrhythmias
Decreased platelet aggregation
Circulatory collapse
 H. Interactions
Potential Interactions

Drug-drug interaction
● Increased CNS depressant effects:
Barbiturates, hypnotics, narcotics, or systemic anesthetics
● Increased hypotensive effects:
Calcium channel blockers
● Decreases absorption of:
Tetracycline's, quinolones, and thyroid medications
● Changes in cardiac conduction causing heart block:
If calcium is used to treat magnesium toxicity in digitalized
patients
 I. Route and Dosage
Route of Administration:
- Intravenous route

Dosage:
- Initially, 2-6 g IV administered in a 250-ml solution over a 20-minute period,
followed by individually calculated IV infusion at a rate to maintain
designated serum levels. Blood serum levels must be maintained at 5 to 8
mg. per 100 ml.
 J. NURSING IMPLICATIONS
• Administer continuous infusion piggybacked into a main IV line so it can be
• discontinued immediately without interfering with fluid administration.
• Always use an infusion control device to maintain a regular flow rate.
• Assess maternal blood pressure and fetal heart rate continuously with bolus
IV administration.
• Assess deep tendon reflexes every 1–4 hours during continuous infusion. Use
the patellar reflex. If patient has received epidural anesthesia, use the biceps
reflex.
• Monitor intake and output every hour during continuous infusion. Urine output
should be 30 ml/hr or greater.
 J. NURSING IMPLICATIONS
• Assess patient’s level of consciousness, including ability to respond to
questions, every hour.
• Obtain serum magnesium levels as indicated, usually every 6–8 hours.
• Keep calcium gluconate, the antidote for toxicity, readily available at the
bedside.
• Maintain serum blood levels (for anticonvulsant use) at 5–8 mg/100 ml. If
blood serum levels rise above this, respiratory depression, cardiac
arrhythmias, and cardiac arrest can occur.
 J. NURSING IMPLICATIONS

• Do not administer additional doses and stop infusion if deep tendon reflexes
are absent or if respiratory rate is less than 12–14 breaths/min or urine output
is less than 30 ml/hr.
• This drug may cause respiratory depression in the newborn if administered
close to birth. Alert neonatal care personnel about this possibility.
• Magnesium sulfate may cause osteoporosis in the mother if given over a long
time.
What is Calcium Gluconate?
What is its relationship to
Magnesium Sulfate?
 What is Calcium Gluconate? What is its relationship to
Magnesium Sulfate?
Calcium gluconate is the calcium salt of gluconic acid. It is a
medication used to treat people with low blood calcium levels. It may be
used to treat conditions caused by low calcium levels such as:
● Osteoporosis
● Osteomalacia/ Rickets
● Hypothyroidism
● Latent Tetany

Pregnant women may experience hypermagnesemia due to the

treatment of eclampsia with the use of magnesium sulfate. In these
situations, calcium gluconate is also considered as the antidote for
magnesium sulfate toxicity.
THANK YOU!
 RESOURCES
● Pillitteri, A., & Silbert-Flagg, J. (2018). Maternal and Child Health Nursing: Care
of the Childbearing and Childrearing Family, 8th Ed. Lippincot Williams and
Wilkins: USA.
● https://reference.medscape.com/drug/mgso4-magnesium-sulfate-344444#5
● https://reference.medscape.com/drug/mgso4-magnesium-sulfate-344444#5