JIET COLLEGE OF NURSING, JODHPUR

SUBJECT- Midwifery and obstetrical Nursing

LESSON PLAN ON
ECLAMPSIA

SUBMITTED TO: SUBMITTED BY:

Prof.K.Punithalakhmi Dr.Preeti Chouhan

Principal Associate Professor

JIETCON, JODHPUR JIETCON, JODHPUR

SUBMITTED ON:
 IDENTIFICATION DATA

Name of the teacher : Dr. Preeti Chouhan

Class : B.Sc. Nursing Part-IV

Venue : LT-1, JIETCON

Name of The Subject : Midwifery and Obstetrical Nursing

Name of The Topic : Postnatal Examination

Group : B.Sc. Nursing Part-IV

Student’s strength : 40 students

Name of the Evaluator :

Duration of Teaching : 45 min

Method of Teaching : Lecture cum Discussion

Av Aids : Black Board, Power Point Presentation,

Charts, Handouts

Previous Knowledge of the Group : Students Have Some Previous Knowledge

about the Topic
 OBJECTIVES

General Objective:
After the completion of class students will be able to gain in depth knowledge
about Eclampsia.

Specific Objectives:
 To introduce the topic (Eclampsia).
 To define Eclampsia.
 To explain about pathophysiology of eclampsia.
 To explain about onset of eclampsia.
 To explain about eclamptic convulsions
 To explain about the complication of eclampsia
 To explain about the prevention of eclampsia.
 To explain about the Management of eclampsia
 To explain about nursing responsibility of eclampsia.
 TIME SPECIFI CONTENT TEACHING EVALUATI
C LEARNING ON
OBJECT ACTIVITY/A.V.
IVE AIDS
2 Min INTRODUCTION
Eclampsia is seizures or
convulsions in a
pregnant woman. This
condition is life-
threatening to the
mother and baby if not
treated promptly.
Eclampsia is not related
to an existing condition
in the brain, such as
epilepsy. Luckily,
eclampsia is a very rare
condition, affecting
only one in 2,000 to
3,000 pregnancies each
year. It can occur after
developing another
condition called
preeclampsia.
4 Min At the end DEFINITION Teacher will be able to What is
of Pre-eclampsia when complicated with define eclamsia with eclampsia?
teaching convulsions and/or coma is called eclampsia. the help of PPT.
students Thus it may occur in women who have pre-
will be eclamsia or in women who have pre-
able to eclampsia superimposed on essential
define hypertension or chronic nephritis.
Eclampsia INCIDENCE
.
The incidence varies widely from country to
country and even between different zones in
the same country. In the developed countries,
its prevalence is estimated to be around one
in two thousand deliveries. It is more
common in primigravida (75%), five times
more common in twins than in singleton
pregnancies and occur between the 36week
and term in more than 50%.
5min At the end PATHOPHYSIOLOGY OF Teacher will be able to Describe
of ECLAMPSIA describe about about
teaching The physiological changes that occur in the pathophysiology of pathophysiol
student various organs in severe per-eclampsia and eclampsia by using ogy of
will be eclampsia. Are well documented. PPT. eclampsia?
able to
describe
about
pathophys
iology of
eclampsia.
.

10Min At the end ONSET OF CONVULSIONS Teacher will be able to List down
of convulsions occur more frequently beyond explain about onset of about the
teaching 36th week . On rare occasion, convulsion may convulsions with the onset of
student occur in early months as in hydatidiform help of PPT. convulsions?
will be mole.
able to Antepartum (50%)
explain
about Fits occur before the onset of labour. More
onset of often, labor starts soon after at times. It is
convulsio impossible to differentiate it form
ns. intrapartum fits.
Intrapartum (30%)
Fits occur during for the first time during the
labor.

Postpartum (20%)
Fits occur for the first time in puerperium,
usually within 48 hours of delivery.
Except on rare occasion, an eclamptic patient
always shows previous manifestation of acute
 fulminating preeclampsia called premonitory
symptoms.
10Min At the end ECLAMPTIC CONVULSIONS Teacher will be able to What are the
of The convulsions are epileptiform and consist explain about eclamptic stages of
teaching of four stages. convulsions with the eclamptic
student  Premonitory Stage help of charts. convulsions ?
will be  The patient becomes unconscious.
able to  Twitching of the muscles of the face,
explain tongue and limbs.
about  Eye balls roll or are turned to one side
eclamptic &become fixed.
convulsio  This stage lasts for about 30 sec.
ns.  Tonic stage
 The whole body goes into a tonic
spasm – the trunk – opisthotonus,
limbs are flexed and hands clenched.
 Respiration ceases and the tongue
protrudes between the teeth.
 Cyanosis appears.
 Eye balls become fixed.
 This stage lasts for about 30 sec.
 Clonic stage
 All the voluntary muscles undergo
alternate contraction and relaxation.
 The twitching start in the face Then
involve one side of the extremities
and ultimately the whole body is
involved in the convulsion.
 Biting of the tongue occurs.
 Breathing is stertorous and blood
stained frothy secretions fill the
mouth; cyanosis gradually disappears.
 This stage lasts for 1 – 4 minutes.

 Stage of coma
 Following the fit, the patient passes
on to the stage of coma. It may last
for a brief period or in others deep
coma persists till another convulsion.
 On occasion, the patient appears to be
in a confused state following the fit
and fails to remember the happenings.
 Rarely, the coma occurs without prior
convulsion.
 The fits are usually multiple,
 recurring at varying intervals. When
it occurs in quick succession it is
called status ecliptics.
 Following the convulsions, the
temperature usually rises; pulse and
respiration rates are increased and so
also the blood pressure. The urinary
output is markedly diminished;
proteinuria is pronounced and the
blood uric acid is raised.
5 min At the end Complications Teacher will be able to List down the
of explain about complication
teaching MATERNA FETAL complication eclampsia s of
student Injuries: Prematurity with the help of PPT. eclampsia?
will be  Tongue bite,
able to  Injuries due to fall
explain from bed
about the  Bed sore
complicati Pulmonary complications Intra uterine
on of  Edema due to Asphyxia-due
eclampsia. aspiration. to placental
 hypostatic or insufficiency
infective.
 Adult respiratory
syndrome
 Embolism
Hyper pyrexia Birth Trauma
Cardiac: Acute left
ventricular failure.
Renal failure
Hepatic –necrosis, sub
capsular haematoma
Cerebral: oedema
hemorrhage
Disturbed vision: due to
retinal detachment or
occipital lobe ischemia.

Hematological
 Thrombocytopeni
a
 Disseminated
intravascular
coagulopathy.
 Postpartum:
 Shock, sepsis,
psychosis
5min At the end Prevention Teacher will be able to What are the
of  Prevention of eclampsia rests on explain about preventive
teaching Early detection &effective Prevention of measures for
student institutional treatment with judicious eclampsia with the help eclampsia?
will be termination of pregnancy during pre – of PPT.
able to eclampsia.
explain  Adequate sedation,Antihypertensive
about the therapy or prophylactic
preventio anticonvulsant therapy soon after
n of delivery in pre-eclampsia.
eclampsia.  Meticulous observation for 24 – 48
hours.

5min At the end MANAGEMENT Teacher will be able to List down the
of Goal explain about management
teaching  Control seizures Management of of
student  Control Hypertension eclampsia with the help eclampsia?
will be  Stabilize and deliver of PPT.
able to First aid treatment outside the hospital:
explain  The patient should be shifted to the
about the referral hospitals.
Managem  She must be heavily sedated before
ent of moving.
eclampsia.  To maintain sedation – IM of
Largactil 50mg &Phenargan 25mg or
Morphine 15mg or paraldehyde 10ml.
Midwife should be accompanied &equipped
to prevent injury&to clear the air passages.
Hospital : principles
 To control the hyper excitable state
and to arrest convulsions.
 To control or to stabilize the pre-
eclamptic manifestations.
 To prevent and to treat effectively the
complications may arise.
 If undelivered, to deliver the baby by
the quickest and safest method.
General management (MEDICAL):
 The patient should be placed in a
railed cot in an isolated room,
protected from noxious stimuli which
might provoke. further fits.
 Only when the patient is properly
 sedated, a thorough but quick general,
abdominal and vaginal examinations
are made.
 Half hourly pulse, respiration rates
and blood pressure to be recorded.
 If undelivered, the uterus should e
palpated at regular intervals to detect
the progress of labour and the fetal
heart rate is to be monitored.
 Fluid balance: Normally, it should not
exceed 2 litres in 24 hours.
Additional 50ml of 50% dextrose is to
be infused at intervals of 8 hours to
maintain the calories
 Antibiotic: Ampicillin 500mg 1.M.
or I.V. six hourly.
Specific Management
Sedative and anticonvulsant regime
 Lytic cocktail regime;
 An admission:
 25 mg .chlorpromazine and 100 mg
pethidine in 20ml of 5% dextrose are
given I.V along with 50mg
chlorpromazine & 25mg pheregon
given IM.
 Subsequently: Promethazine 25mg
and chlorpromazine 50mg are given
IM, alternatively 4 hourly intervals,
for period upto 24 hours following in
the last fit.
 I.V 500ml of dextrose drip is started
at the beginning with 100mg
pethidine, the drip rate is adjusted to
20 to 30/mt. Not more than 2lt of
dextrose and in all 300 mg pethidine
are to be given in 24 hours.
 Diazepam therapy: It is used in initial
doses of 40mg I.V. A further 40mg in
500ml of 5% dextrose is infused at 30
drops/min.
 c. Phenytoin therapy: It is given by
slow I.V with ECG monitoring.
Initial dose is 10mg/ kg. followed by
5mg/kg 2 hours later. There after
200mg is given orally after 24 hours.
It is continued until 48 hours after
 delivery.
 d.Antihypertensives&diuretics: Ex:
hydralazine, labetalol, calcium
channel blockers or nitro glycerine.
 Diuretics ex: frusemide 20-40 mg I.V.

MANAGEMENT DURING FIT

1.Premonitory stage:
1. A mouth gag – to prevent tongue bite and
should be removed after the clonic phase.
2.The air passage to be cleared off the mucus
with a mucus sucker.
3.Foot end should be elevated – Postural
drainage
4. Oxygen is given until cyanosis disappears.
Status eclampticus:
 Thiopentone sodium 0.5mg dissolved
in 20ml of 5% dextrose is given I.V.
very slowly.
 In unresponsive cases CS
 Prophylactic antibiotics – to reduce
the complication like pulmonary
&puerperal infection
 Pulmonary edema :
 frusemide 40mg I.V followed by
20mg of mannitol IV.
 Pulse oxymeter – to monitor,
 aspiration of the mucus
 Heart failure:
 Oxygen inhalation
 Parenteral lasix &digitalis
 Anuria:
 The treatment should be in the line as
formulated in the chapter of anuria.
 It is often surprising that urine output
returns to normal following
termination of pregnancy.
Hyperpyrexia:
 It is difficult to bring down the
temperature as its is central in origin.
 However, cold sponging and
antipyretics may be tried.
Psychosis:
 Chlorpromazine or Eskazine
(trifluoperazine) is quite effective.
 Intensive care monitoring:
 Patient with multiple medical
problems needs to be admitted in an
intensive care unit where she is
looked after by a team consisting of
an obstetrician, a physician and an
expert anesthetists.
 Cardiac, renal or pulmonary
complications are managed
effectively.
 Use of blood gas analyser (to detect
hypoxia and acidosis), pulse oximeter
and central venous pressure monitor
should be done depending on
individual case.
 A deeply unconscious patient with
raised intracranial pressure needs
steroid and or diuretic therapy.
 CT scan or MRI may be needed for
the diagnosis.
5Min At the end NURSING RESPONSIBILITIES Teacher will be able to Enlist
of  Closely monitor vital signs. explain about nursing nursing
teaching responsibility of responsibility
 Monitor fetal heart rate
student eclampsia with the help of eclamsia?
will be  Urine output should be of PPT.
able to maintained at a level of
explain 100 mL or more during the
about four hours preceding each
nursing dose.
responsibi  Monitoring serum magnesium
lity of levels and the patient’s
eclampsia. clinical status is essential to
avoid the consequences of
over dosage in toxemia.
 Clinical indications of a safe
dosage regimen include the
presence of the patellar reflex
(knee jerk) and absence of
respiratory depression
(approximately 16 breaths or
more/minute).
 When repeated doses of the
drug are given parenterally,
knee jerk reflexes should be
tested before each dose and if
 they are absent, no additional
magnesium should be given
until they return.
 Serum magnesium levels
usually sufficient to control
convulsions range from 3 to 6
mg/100 mL (2.5 to 5
mEq/liter).
 The strength of the deep
tendon reflexes begins to
diminish when magnesium
levels exceed 4 mEq/liter.
 Reflexes may be absent at 10
mEq magnesium/liter, where
respiratory paralysis is a
potential hazard.
 An injectable calcium salt
should be immediately
available to counteract the
potential hazards of
magnesium intoxication in
eclampsia.
2min SUMMARY .
Eclampsia is seizures or convulsions in a
pregnant woman. This condition is life-
threatening to the mother and baby if not
treated promptly. Eclampsia is not related to
in the brain, such as epilepsy an existing
condition
2min
CONCLUSION
Today classroom teaching given on
eclampsia, definition, pathophysiology,
management, nursing responsibility. The
class was effective.
REFERENCES
 American College of
Obstetricians and
Gynecologists.
ACOG Practice Bulletin No.
33. Diagnosis and
management of preeclampsia
and eclampsia. Obstet
Gynecol . 2002;99:159-167.
 Houry DE, Salhi BA. Acute
complications of pregnancy.
In: Marx JA, ed.Rosen's
Emergency Medicine:
Concepts and Clinical
Practice. 7th ed. Philadelphia,
PA: Elsevier Mosby;
2009:chap 176.
 Sibai BM. Hypertension. In:
Gabbe SG, Niebyl JR,
Simpson JL, et al.,
eds. Obstetrics: Normal and
Problem Pregnancies . 6th ed.
Philadelphia, PA: Elsevier
Saunders; 2012:chap 35.