What Is Preeklampsia
Nursing Diagnosis For Preeclampsia. Preeclampsia is the incidence of hypertension and edema due to proteinuria accompanying pregnancy after 20 weeks of gestation or shortly after birth. Eklampsia is a preeklampsia that is accompanied by seizures and coma or incurred due to neurological disorders (Selekta Capita Medicine 3rd Edition).
Preeklampsia is a set of symptoms that arise in pregnant women, maternity and childbirth which consists of hypertension, proteinuria and edema but no menjukkan signs of vascular abnormalities or hypertension before, whereas the symptoms usually appear After a 28-week-old pregnancy or more.
Preeclampsia is a complication of pregnancy marked by the onset of hypertension 160/110 mmHg or more accompanied proteinuria and/or accompanied udema at 20 weeks of gestation or more (care of Obstetrical Pathology: 2009).
Preeklampsia is divided in 2 the light and heavy. A disease is classed weight when one or more of the following symptoms: signs
- Pressure systolic 160 mmHg or higher, or a diastolic pressure of 110 mmHg or more.
- Proteinuria 5 g or more in 24 hours; 3 or 4 + on the qualitative examination;
- Oliguria, urinary 400 ml or less in 24 hours
- cerebral Complaints, eyesight or pain in the area of epigastrium
Prevention Of Preeclampsia
A regular, rigorous antenatal examination can find early signs of preeclampsia, and in that case should be the appropriate translation. We should be more alert to the emergence of preeclampsia in the presence of predisposing factors such as those already printed above.
The usual incidence of preeclampsia can not be prevented from light, but the frequency can be reduced by providing adequate illumination and the implementation of good supervisors in pregnant women. Illumination about the benefits of rest and diet in prevention. Rest does not always mean in bed, but daily work needs to be reduced, and is recommended to sit more and more.
Diet high in protein and low in fat, carbohydrates, salt and unnecessary weight. Early recognition of preeclampsia and prompt treatment of patients without providing diuretics and antihypertensive medications is indeed an important advancement of good antenatal examination.
Judging from the gestational age and the development of severe preeclampsia symptoms during treatment, treatment is divided into:
1. Active treatment ie pregnancy immediately terminated or terminated plus medicinal treatment. Active Treatment As much as possible before active treatment of any patient is checked for fetal assessment (NST and ultrasound). Indication:
• Gestational age of 37 weeks or more
• The presence of signs or symptoms of impending eclampsia, failure of conservative therapy after 6 hours of meditation treatment increased blood pressure or after 24 hours of medical treatment, there are symptoms of status quo (no improvement)
• Fetal outcome of ugly assessment (NST and USG)
• The presence of an IUGR sign (the fetus is inhibited)
The presence of “HELLP Syndrome” (hemolysis and enhanced liver function, thrombocytopenia)
2. Mediastinal treatment
Medication of severe patients with severe preeclampsia is:
a. Immediately enter the hospital.
b. Beding tilts tilted to one side. Vital signs need to be checked every 30 minutes, patellious reflexes every hour.
c. 5% dextrose infusion where every 1 liter is interspersed with a 500 cc RL (60-125 cc / jam) infusion.
d. Diet enough protein, low carbohydrate, fat and salt.
e. Provision of anti-seizure magnesium sulphate (MgSO4).
o Initial dose about 4 g MgSO4) IV (20% in 20 cc) for 1 g / min of 20% packing in 25 cc MgSO4 solution (within 3-5 min). Followed immediately 4 grams in left ass and 4 gr in right ass (40% in 10 cc) with needle no 21 length 3,7 cm. To reduce the pain can be given xylocain 2% that does not contain adrenaline on IM injections.
o Re-dosage: 4 gr of IM 40% after 6 hours of initial dose and then re-administered 4 grams of IM every 6 hours in which MgSO4 administration does not exceed 2-3 days.
o Terms of MgSO4 administration
Available MgSO4 antidote that calcium gluconas 10% 1 gr (10% in 10 cc) is given IV in 3 minutes.
Strong positive patellar reflex.
Respiratory frequency more 16 x / min.
Urine production over 100 cc in the previous 4 hours (0.5 cc / kg / h)
o MgSO4 terminated when:
There are signs of toxicity: muscle weakness, decreased physiological reflex, impaired heart function, CNS depression, paralysis and may subsequently cause death from respiratory muscle paralysis due to the presence of 10 magnesium serum at adequate dose is 4-7 mEq / liter. Physiological reflexes disappear at 8-10 mEq / liter. Levels of 12-15 mEq / liter can occur respiratory muscle paralysis and> 15 mEq / liter of cardiac death.
If signs of MgSO4 toxicity occur:
Stop giving MgSO4
Give 10% 1 g (10% in 10 cc) calcium gluconase (IV) within 3 minutes
Do artificial respiration
o MgSO4 discontinued also if after 4 hours post-delivery there is improvement (normotensi).
f. Deureticum is not given unless there are signs of pulmonary edema, congestive heart failure or anacaral edema. Given furosemide injection 40 mg IM.
g. Anti hypertension is given when:
o Systolic blood pressure> 180 mmHg, diastolic> 110 mmHg or MAP over 125 mmHg. The target of treatment is diastolic pressure <105 mmHg (not <90 mmHg) as it will decrease placental perfusion.
o The antihypertensive dose is the same as the usual antihypertensive dose.
o If immediate drop in blood pressure can be given parenteral antihypertensive medications (continuous droplets), injection catapults. Usage dose 5 ampoule in 500 cc infusion fluid or press adjusted with blood pressure.
o If no parenteral antihypertensive is available, a sublingual antihypertensive tablet may be repeated an hourly interval, a maximum of 4-5 times. Together with the initial sublingual administration of the same drug is given orally (Syakib bakri, 1997)
3. Conservative treatment of pregnancy is maintained, plus medicinal treatment.
a. Indication: if the pregnancy paterm less 37 weeks without accompanied by signs of inpending eclampsia with good fetal condition.
b. Medicinal treatment: same with medical treatment on active management. Only loading dose MgSO4 is not given IV, just intramuscularly where grams are on the left butt and 4 grams on the right butt.
c. Obstetric treatment:
During conservative treatment: observation and evaluation are the same as active care only here not termination.
MgSO4 is discontinued when the mother has mild signs of preeclampsia, not later than 24 hours.
If after 24 hours there is no improvement then considered medical treatment fails and must be terminated.
If before the 24 hours to be done the action is given first MgSO4 20% 2 gr IV.
4. Patient discharged if:
a. Patients return to the symptoms / signs of mild preeclampsia and