LESSON PLAN ON

ECLAMPSIA
SUBMITTED TO
MRS. CIMIL BABU
ASSISTANT PROFESSOR
HOLI FAMILY COLLEGE OF NURSING

PREPARED BY:
VARSHA SHARMA
TUTOR
HOLI FAMILY COLLEGE OF NURSING
 IDENTIFICATION DATA

NAME: MS. VARSHA SHARMA

SUBJECT: OBSTETRICS AND GYNACOLOGICAL NURSING
TOPIC: ECLAMPSIA
GROUP: GNM 3rd YEAR
NO OF SUDNETS: 30
METHODS OF TEACHING: LECTURE CUM DISCUSSION
AV AIDS: PPT, CHALK BOARD
DATE AND TIME:
DURATION: 60 MINUTES
VENUE/PLACE: GNM 3RD YEAR CLASSROOM
LANGUAGE: ENGLISH

PREVIOUS KNOWLEDGE OF GROUP:

GROUP HAS SOME KNOWLEDGE ABOUT ECLAPSIA.
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 SPECIFIC CONTENT TEACHING LEARNING EVALUATION
OBJECTIVE ACTIVITY/A.V. 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 of DEFINITION Teacher will be able to define What is

teaching Pre-eclampsia when complicated with convulsions and/or eclamsia with the help of PPT. eclampsia?
students will coma is called eclampsia. Thus it may occur in women who
be able to have pre-eclamsia or in women who have pre-eclampsia
define superimposed on essential 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 of PATHOPHYSIOLOGY OF ECLAMPSIA Teacher will be able to describe Describe about
teaching The physiological changes that occur in the various organs about pathophysiology of pathophysiology
student will in severe per-eclampsia and eclampsia. Are well eclampsia by using PPT. of eclampsia?
be able to documented.
describe about
pathophysiolo
gy of
eclampsia. .

10Min At the end of ONSET OF CONVULSIONS Teacher will be able to explain List down about
teaching convulsions occur more frequently beyond 36th week . On about onset of convulsions with the onset of
student will rare occasion, convulsion may occur in early months as in the help of PPT. convulsions?
be able to hydatidiform mole.
explain about Antepartum (50%)
onset of
convulsions. Fits occur before the onset of labour. More often, labor
starts soon after at times. It is impossible to differentiate it
form 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 of ECLAMPTIC CONVULSIONS Teacher will be able to explain What are the
teaching The convulsions are epileptiform and consist of four stages. about eclamptic convulsions stages of
student will 1.Premonitory Stage with the help of charts. eclamptic
be able to  The patient becomes unconscious. convulsions ?
explain about  Twitching of the muscles of the face, tongue and
eclamptic limbs.
convulsions.  Eye balls roll or are turned to one side & become
fixed.
 This stage lasts for about 30 sec.
1.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.
1.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.
 1.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 of Complications Teacher will be able to explain List down the
teaching about complication eclampsia complications of
student will MATERNA FETAL with the help of PPT. eclampsia?
be able to Injuries: Prematurity
explain about  Tongue bite,
the  Injuries due to fall from
complication bed
of eclampsia.  Bed sore
Pulmonary complications Intra uterine
 Edema due to aspiration. Asphyxia-due to
 hypostatic or infective. placental
 Adult respiratory syndrome insufficiency
 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
 Thrombocytopenia
 Disseminated intravascular
coagulopathy.
 Postpartum: Shock, sepsis,
psychosis
5min At the end of Prevention Teacher will be able to explain What are the
teaching  Prevention of eclampsia rests on Early detection & about Prevention of eclampsia preventive
student will effective institutional treatment with judicious with the help of PPT. measures for
be able to termination of pregnancy during pre – eclampsia. eclampsia?
explain about • Adequate sedation,Antihypertensive therapy or
the prevention prophylactic anticonvulsant therapy soon after
of eclampsia. delivery in pre-eclampsia.
• Meticulous observation for 24 – 48 hours.

5min At the end of MANAGEMENT Teacher will be able to explain List down the
teaching Goal about Management of management of
student will  Control seizures eclampsia with the help of PPT. eclampsia?
be able to  Control Hypertension
explain about  Stabilize and deliver
the First aid treatment outside the hospital:
Management  The patient should be shifted to the referral
of eclampsia. hospitals.
 She must be heavily sedated before moving.
 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
a. 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.
a. 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.
b. 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.
c. d.Antihypertensives& diuretics: Ex: hydralazine,
labetalol, calcium channel blockers or nitro
glycerine.
d. 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 of NURSING RESPONSIBILITIES Teacher will be able to explain Enlist nursing
teaching  Closely monitor vital signs. about nursing responsibility of responsibility of
student will eclampsia with the help of PPT. eclamsia?
 Monitor fetal heart rate
be able to
explain about  Urine output should be maintained at a level
nursing of 100 mL or more during the four hours
responsibility preceding each dose.
of eclampsia.  Monitoring serum magnesium levels and the
patient’s 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 an
existing condition in the brain,
such as epilepsy.
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.