Symptoms of Eclampsia and Preeclampsia Variants (Nursing)

by Jacquelyn McMillian-Bohler, PhD, CNM

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      Slides Hypertensive Disorders of Pregnancy Nursing.pdf
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      Slides Hypertensive Disorders Symptoms of Eclampsia and Preeclampsia Variants Nursing.pdf
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      Review Sheet Preeclampsia Nursing.pdf
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      Reference List Maternity Nursing Care of the Childbearing Family.pdf
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    00:01 So let's talk about our last sort of variant of preeclampsia, and that is eclampsia.

    00:06 So remember eclampsia means the onset of tonic clonic seizures after someone has never had those experiences before.

    00:14 So, up to 44% of those seizures are actually going to occur in the postpartum period.

    00:20 So I want you to pay attention to that.

    00:22 44% of those seizures are going to occur in the postpartum period.

    00:27 That is why we have to monitor those patients who are preeclamptic, even after they go to the postpartum floor to make sure that that doesn't happen.

    00:35 So seizures are a little scary sometimes when they happen.

    00:39 And so what we know about eclamptic seizures is that sometimes we get a little warning sign that they're coming.

    00:45 So these are symptoms that often really precede the convulsions.

    00:50 And if we watch for them, we may be able to know that they're coming.

    00:53 So around 60% of the time, the client might complain of really strong frontal headaches.

    00:59 So, when the client begins to really complain about headaches, we want to be extra cautious, and really pay attention to the potential for a seizure.

    01:07 They may experience that blurry vision, or photophobia, where the lights really hurt their eyes, and it's hard to see.

    01:14 27% won't have any symptoms at all, that was particularly scary.

    01:19 25% will have that epigastric pain, that right upper quadrant pain.

    01:24 And then some, we don't know what the percentage is, but they may experience an altered mental status, where they're confused or highly anxious, or something is very different about what's going on.

    01:34 Now, you'll only notice that if you're with your clients.

    01:37 So you want to make sure you're spending enough time that you know, what's baseline for them? I promise we talked about HELLP syndrome.

    01:44 So we'll talk about it now.

    01:46 So HELLP is one of those variants.

    01:48 It's something that can happen as preeclampsia gets worse.

    01:51 And let's talk about what it stands for.

    01:54 So HELLP stands for Hemolysis, that's the H.

    01:58 E stands for Elevated.

    02:00 The next L stands for Liver enzyme.

    02:02 So those are together, elevated liver enzymes.

    02:04 The next L stands for Low, and then it goes with the last letter P, Platelet.

    02:10 So, Hemolysis Elevated Liver Enzymes and Low Platelets.

    02:13 That's what happens when we have that endothelial damage.

    02:16 So the incidence of HELLP syndrome is somewhere between 0.1% and 1% of pregnant patients.

    02:22 And for women with preeclampsia, it goes up to 10% to 20%.

    02:27 So you can see that having preeclampsia can make your likelihood of developing HELLP syndrome, certainly much worse.

    02:33 So, 19% to 27% of clients who experienced HELLP in a previous pregnancy will have HELLP in a subsequent pregnancy.

    02:41 That's why taking a really good history is very, very important.

    02:46 Another variant, or a sign of worsening or severe preeclampsia, is DIC Disseminated Intravascular Coagulopathy.

    02:55 So essentially, what you have is bleeding and clotting going on at the same time.

    02:59 So you have generalized platelet aggregation, that's caused from endothelial damage.

    03:04 So as the vessels sort of constrict, the platelets rushing to try to fill in the holes.

    03:09 So, we have clot formations that are happening, and, yet we're using up all of our platelets.

    03:14 And so when that happens, you're going to have lots of bleeding because after time, you use up all the platelets you have.

    03:22 And so that's where you're going to get the bleeding from the IV site, bleeding from the ears, bleeding from the eyes.

    03:27 So if you have a preeclamptic patient and you begin to notice unusual bleeding, then your first thought needs to be, DIC.

    About the Lecture

    The lecture Symptoms of Eclampsia and Preeclampsia Variants (Nursing) by Jacquelyn McMillian-Bohler, PhD, CNM is from the course Hypertensive Disorders of Pregnancy: Preeclampsia (Nursing).

    Included Quiz Questions

    1. Headaches can occur prior to seizures.
    2. Seizures can occur after delivery of the placenta.
    3. Blurred vision and light sensitivity can occur prior to seizures.
    4. Seizures will only occur before the delivery of the placenta.
    5. Symptoms that indicate impending seizures will always be present.
    1. Generalized petechiae
    2. Elevated platelet count
    3. Decreased liver enzymes
    4. Redness and swelling in an extremity

    Author of lecture Symptoms of Eclampsia and Preeclampsia Variants (Nursing)

     Jacquelyn McMillian-Bohler, PhD, CNM

    Jacquelyn McMillian-Bohler, PhD, CNM

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