Digital Nursing Notes: Eclampsia

Description:

Eclampsia is an acute and life-threatening complication of pregnancy, characterized by the appearance

of tonic-clonic seizures, usually in a patient who has developed pre-eclampsia.

 Eclampsia is a rare but severe condition that causes seizures during pregnancy. Seizures are
periods of disturbed brain activity that can cause episodes of staring, decreased alertness, and
violent shaking (convulsions).
 Seizures are generalized tonic-clonic seizures with a duration of 30 to 90 seconds.
 Eclampsia affects about one in every 2,000 to 3,000 pregnancies, and it can affect you even if
you do not have a history of seizures.

Signs of impending seizure:

 Severe headache
 Visual disturbances
 Increased patellar reflexes with clonus
 Restlessness
 Twitching

Emergency care during a seizure:

 Call for help and immediately notify physician

 Prevent injury and aspiration
 Give medications as ordered

Post seizure stabilization:

 Clear airway and suction

 Give oxygen by face mask
 Check for injuries
 Check fetal status
 Evaluate labor status: rapid labor often follows eclamptic seizures

Eclamptic Fit Stages (4 stages):

1. Premonitory Stage (1/2 minute)

 Eye rolled up
 Twitches of the face and hand

2. Tonic Stage (1/2 minute)

 Generalized tonic spasm with episthotonus

 Cyanosis
 Tongue may be bitten between the clenched teeth

3. Clonic Stage (1-2 minutes)

  Convulsions
 Tongue may be bitten
 Face is congested and cyanosed
 Conjunctival congestion
 Blood-stained froth from the mouth
 Stertorous breathing
 Temperature may rise
 Involuntary passage of urine and stool
 Gradually convulsions stop

4. Coma

 Variable duration due to respiratory and metabolic acidosis

 Deep coma may occur (cerebral hemorrhage)
 Labor usually starts shortly after the fit

Classifications of Eclampsia:

 Intercurrent Eclampsia: eclamptic seizures recur in the same pregnancy.

 Recurrent Eclampsia: eclampsia recurs in subsequent pregnancy.

 Ante partum (65%) with the best prognosis.

 Intrapartum (20%).
 Postpartum (15%) with the worst prognosis as it indicates extensive pathology and multisystem
damage.

1. Mild:

 Coma > 6 hours.

2. Severe (Eden's criteria):

 Temperature > 39˚C (pneumonia or pontine hemorrhage)

 Systolic Bp > 200 (cerebral hemorrhage risk)
 Pulse > 120/min (acute heart failure).
 Anuria or Oliguria (renal failure).
 Respiratory rate > 40/min (pneumonia)
 More than 10 fits (status eclampticus).

Pathology of Eclampsia

CARDIOVASCULAR CHANGES

► increased cardiac afterload caused by hypertension,

► cardiac preload, affected by pathologically diminished hypervolemia of pregnancy or iatrogenically
increased by intravenous crystalloid or oncotic solutions

► endothelial activation with extravasation into the extracellular space, especially the lung.

BLOOD VOLUME

► hemoconcentration → hallmark of eclampsia.

► the woman with eclampsia → unduly sensitive to vigorous fluid therapy (an attempt to expand the
contracted blood volume to normal pregnancy levels). She is sensitive as well to even normal blood loss
at delivery.

HEMATOLOGICAL CHANGES. COAGULATION

► the level of plasma clotting factors → decreased;

► erythrocytes may be traumatized → display bizarre shapes and undergo rapid hemolysis

► intravascular coagulation

► maternal thrombocytopenia can be induced acutely; the lower the platelet count, the greater are
maternal and fetal morbidity and mortality.

KIDNEY

►proteinuria

►renal perfusion and glomerular filtration reduced

►plasma uric acid concentration is typically elevated

►glomerular capillary endotheliosis = glomerular capillary endothelial swelling + subendothelial

deposits of protein material (electron microscopy)

►renal tubular lesions → acute renal failure from tubular necrosis (oliguria / anuria and azotemia);
rarely, renal cortical necrosis develops.

LIVER

► elevation of serum aspartate aminotransferase levels

► periportal hemorrhagic necrosis → bleeding from these lesions may cause hepatic rupture, or a
subcapsular hematoma.

BRAIN

► central nervous system → convulsions of eclampsia

► visual symptoms, blindness, retinal artery vasospasm, retinal detachment

► symptomatic cerebral edema: lethargy, confusion, and blurred vision to obnubilation and coma.

► nonspecific electroencephalographic abnormalities.

►The principal postmortem cerebral lesions are edema, hyperemia, focal anemia, thrombosis, and
hemorrhage.

Investigations A. Laboratory Urine: 24-hour urine, Proteinuria.

 Kidney functions: serum creatinine, urea, creatinine clearance and uric acid
 Liver functions: bilirubin, enzymes (SGPT and SGOT)
 Blood: CBC, HCt, Hemolysis indices, Platelet count
 Coagulation Profile: Bleeding + clotting time

Investigations B. Instrumental C. Imaging techniques.

 Eye Fundus Examination

C. Imaging techniques:

 CT scan for the brain

 Ultrasonography
 E. Doppler Velocimetry

Causes:

Doctors do not understand the exact cause of eclampsia, but it appears to be related to a disorder of the
lining of blood vessels.

Nursing Responsibilities

 Position the client on her left side to maximize oxygenation to the placenta
 Obtain a urine sample to check for proteinuria
 Keep bedside rails up to prevent fall if seizures occur
 Advise the client to take magnesium sulfate for seizure prophylaxis
 Carefully monitor magnesium toxicity like flushing, a feeling of warmth, nausea, vomiting,
double vision, and slurred speech.

Health Teachings:

 Advise the client to lessen salt consumption

 Encourage the client to consume a high fiber diet
 Explain to the client the importance of regular exercise
 Educate the client about the importance of avoiding oily foods and foods that are rich in fats