Teaching Learning Guide Topic: Eclampsia Date: Dec 11, 2012 nd Level of participants: 2 year Nursing Students Facilitators:

Venue: RLE room 1. Fil Jun Silvano General Objectives: At the end of 32 minutes, the participants will be able to discuss Eclampsia, its definition, Causes, 2. Athena Roselle Garcia Symptoms, Treatment, and When to Seek Medical Care. 3. Terence Serafin Teaching and Learning Activities Teachers Students

Specific Objectives At the end of 32 mins of discussion, the participants will be able to discuss, illaborate, and identify Eclampsia: 1. Definition and Overview

Content

Time Allotment

Evaluation

Reference http://www.eme dicinehealth.co m

Quesstio n 1.1
Eclampsia, - is a condition that causes a pregnant woman to develop seizures or coma. Usually previously diagnosed with preeclampsia (high blood pressure and protein in the urine). In some cases, seizures or coma may be the first recognizable sign that a pregnant woman has had preeclampsia. Toxemia of pregnancy is a common name formerly used to describe preeclampsia and eclampsia.

Answer

5 mins.

5 mins.
2.1 Abnormalities in the endothelial system (the lining cells of blood vessels) 2.2 Preeclampsia usually occurs with first pregnancies. 2.3 Women older than 35 years. 2.4 Women with high blood pressure before pregnancy. 2.5 Women with diabetes. 2.6 Women with other medical problems (such as connective tissue disease and kidney disease).

2. Causes

2.7
Obese women also have a higher risk.

5 min.
3.1 The hallmark symptom of eclampsia is seizures, or convulsions. 3.2 Risk of eclampsia rises as blood pressure increases above 160/80 mm Hg. 3.3 Blurred vision, seeing spots, occasionally blindness, and even severe headaches. 3.4 Abnormally slower growth of the baby than expected (48 weeks), the baby may be sluggish or seem to decrease the frequency and intensity of its movements.

3. Symptoms

7 mins.

4.1 4. Treatment Surgical and Medical

Once eclampsia develops, the only treatment is delivery of the baby (if eclampsia occurs prior to delivery).

4.2 Magnesium sulfate (given intravenously) is the treatment of choice once eclampsia develops. 4.3 Occasionally, recurrent seizures require additional treatment with a short-acting barbiturate such as sodium amobarbital. Other medications including diazepam (Valium) or phenytoin (Dilantin) have been used to treat eclampsia; however, they are not as effective as magnesium sulfate. 4.4 Patients may also receive treatment for elevated blood pressure while being treated for eclampsia. Common blood pressure medications (for women with eclampsia) include hydralazine (Apresoline) or labetalol (Normodyne, Trandate) and nifedipine are commonly used medications used to reduce blood pressure slowly to systolic levels below 160 mm Hg. It is unusual to require medication for high blood pressure after six weeks following delivery (unless the person has a problem with high blood pressure that is unrelated to pregnancy). 4.5 Once the mother's condition is stabilized following a seizure, the doctor will prepare to deliver the baby. This can occur either by cesarean delivery or induction of labor and vaginal delivery. If the patient is already in labor, labor can be allowed to progress provided there is no evidence that the baby has become "distressed" or compromised by the seizure. 4.6 The closer the person is to the due date, the more likely the cervix will be ripe (ready for delivery), and that induction of labor will be successful.

4.7
Medications such as oxytocin (Pitocin) or prostaglandins may be given to induce labor and/or ripen the cervix. A Foley catheter is sometimes placed in the cervix to mechanically "speed" the dilation process.

5 mins.

4.8 Some patients may be given steroids IV if the fetal gestational age is less than 32 weeks. 5. Diagnosis

5.1 Encephalopathy, Hypertensive refers to the transient migratory neurologic symptoms that are associated with the malignant hypertensive state in a hypertensive emergency. - Malignant hypertension which is characterized by the presence of papilledema, heralding neurologic impairment from an elevated intracranial pressure (ICP) hypertensive crisis is classified as either: - hypertensive emergency - Acute or ongoing vital target organ damage (eg, damage to the brain, kidney, or heart) in the setting of severe hypertension (a prompt reduction in blood pressure is required within minutes or hours) hypertensive urgency - The absence of target organ damage in the presence of a severe elevation in blood pressure (with diastolic blood pressure frequently exceeding 120 mm Hg) + reduction in blood pressure is required within 2448 hours -

5.2 Eclamptic seizures may be divided into 2 phases. - Phase 1 lasts 15-20 seconds and begins with facial twitching. The body becomes rigid, leading to generalized muscular contractions. Phase 2 lasts about 60 seconds. It starts in the jaw, moves to the muscles of the face and eyelids, and then spreads throughout the body. The muscles begin alternating between contracting and relaxing in rapid sequence.

5.3 Coma or period of unconsciousness, lasting for a variable period, follows phase 2. After the coma phase, the patient may regain some consciousness, and she may become combative and very agitated. However, the patient will have no recollection of the seizure. + Tonicclonic seizures - generalized seizure that affects the entire brain. 5.4 Hyperventilation or overbreathing - state of breathing faster or deeper than normal, causing excessive expulsion of circulating carbon dioxide - arterial concentration of CO2 tension is falling (Paco2) below normal (35-45mmHg). A period of hyperventilation occurs after the tonicclonic seizure. This compensates for the respiratory and lactic acidosis that develops during the apneic phase. Seizure-induced complications can include tongue biting, head trauma, broken bones, and aspiration.

5 mins.

6. When to Seek Medical Care

6.1 If a person has any question about either their health or their baby's health 6.2 If a pregnant female has severe or persistent headache or any visual disturbance, such as double vision or seeing spots (This may be a warning sign that preeclampsia could progress to eclampsia.) 6.3 If during pregnancy, the blood pressure is greater than or equal to 160/110 mm Hg, call the doctor immediately! 6.4 If a pregnant patient has severe pain in the middle of their belly or on the right side of the belly under the ribs (This may be a warning sign that preeclampsia is worsening.) 6.5 If any unusual bruising or bleeding is noticed 6.6 If excessive swelling or weight gain is noticed 6.7 If the baby (fetus) has slowed down its movements 6.8 If any vaginal bleeding or cramping is noticed