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1、Ecalmpsia,gynaecology and obstetrics liming,case,Assessment,1 Seizure typically begins with twithcing around the mouth. 2 Body then becomes rigid in a state of tonic muscular contrctions that last is to 15 to 20 seconds 3 Faciaol muscles and then all body muscles alternately contract and realx in ra
2、pid succession (clonic phase may last about1minute) 4Respiration ceases during seizure because diaphragm tends to remain fixed (breathing rusumes shortly after the seizure). 5 Postictal sleep occures.,The side lying position permits greater circulation through the placecta and may help prevent aspir
3、ation The nurse ensures an open airway.,. The nurse administers oxygen by face mask at 8 to 10L /minute to ensure adequate pacental oxygenation.,Monitor fetal heart rate patterns.,Administer medications to control the seizures as prescribed.,After the seizure had ended,insert an oral airway and suct
4、ion the client Mouth as needed. 6 Prepare for delivery of the fetus after stablizationg of the client, if warranted. 7 document occurrence, clients response, and outcome.,Eclampsia refers to the occurrence of a seizure. It is a potentially preventable extension of s evere preec lmpsia; earl y identi
5、fication of preeclampsia in a pregnant client allows intervention before the condition reaches the seizure state. If eclampsia occurs, the nurse remains with the client and calls for help. If the client is not on her side already,the nurse attempts to turn the client on her side .,The nurse also not
6、es the time about the seizure began and the duration of the serzure and protects the cllient from injury during the event. The nurse Monitors fetal heart rate patterns closely and administers medication as prescribed(magnesium sulfate may be prescribed).After the seizure has ended,the nurese inserts
7、 an oral airway to maintain airway patency and suctions the clients mouth as needed. If warranted,the nurse prepares for the delivery of the fetus after stabilization of the client. The nurse documents the occurrence,the clients response,and the outcome.,Primigravida Women younger than 19 years olde
8、r than 40 years Chronic renal disease Chronic hepertension Diabetes mellitus Rh incompatility History of or family history of gestational hypertension,Predisposing conditions,Complication,1 A bruptio placentae 2 Disseminated intravascular coagulation(DIC) 3 Thrombocytopenia 4 placental insufficiency
9、 5 Intrauterine fetal death 6 HELLP syndrome ( a laboratory diagnosis for severe preeclampsia characterized by hemolysis, elevated liver enzyme levels, and low platelet count),1Monitor vital signs :blood pressure., administer antihypertensives as prescribed 2 monitor fetal activity and fetal heart r
10、ate 3 Maintain bed rest. 4 Administer magnesium sulfate (use a controolled infusion device) monitor for signs of magnesium toxicity,including flushing,sweating, hypotensin,depeessed deep tendon reflexs, and central nervous system Depression including respiratory depression; Keep antidote (calcium gl
11、uconate ) available for immediate use, if necessary+,Monitor intake and output. Monitor laboratory data : for renal fucation blood urea nitrogen,serum creatinine,and 24-hour urine levels for creatinine clearance and protein. a urinary output of 30ml/hour indicates adequate renal perfusion. Increase
12、dietary protein and carbohydrates with no added salt. Monitor deep tendon reflexes and for the presence of hyperreflexia or clonus , bucause hyperreflexia indicates increased central nervous system Irritability,目 录 一、概念 二、病因 三、病理生理变化 四、临床表现 五、诊断与鉴别诊断 六、治疗原则 七、急救护理措施 八、先兆子痫患者病例,查 房 目 标,掌握,熟悉,了解,先兆子痫概
13、念、临床表现、 护理问题及护理措施,先兆子痫的诊断与鉴别诊断,先兆子痫的病因及病理生 理变化,先兆子痫：除高血压、水肿、尿蛋白外，还出现头痛、眼花、胃区疼痛、恶心、呕吐等，可能随时发生抽搐。 子痫：先兆子痫出现痉挛性和强直性抽搐时称子痫。子痫为严重妊娠期高血压疾病时，全身小血管痉挛加重脑部病变的表现。根据抽搐发生在分娩前、分娩时、分娩后将子痫分为产前、产时、产后子痫。,概 念,妊娠高血压综合症（PIH）：妊娠20周以后出现的高血压、水肿、蛋白三大症候群，严重时可有抽搐、昏迷、心肾功能衰竭、甚至发生母婴死亡。 重度妊娠高血压综合症：BP160/100mmHg, 尿蛋白（+）（+）: ：0.21g
14、/24h ：12g/24h ：3g/24h 可有不同程度的水肿，并有自觉症状，分为先兆子痫、子痫。,病因,好发因素： 寒冷季节或气温变化过大、气压升高时 精神过分紧张或受刺激 年龄18岁或40岁 有慢性高血压、肾炎、糖尿病等病史 营养不良 如贫血、低蛋白血症者 矮胖 体重指数24 子宫张力大 如羊水过多、双胎妊娠、巨大儿 家族史,病理生理变化,全身小动脉痉挛为本病的基本病变 周围小血管阻力增加 血压增髙 全身小动脉痉挛 肾小A及毛细管缺氧 肾小球通透性增加 蛋白尿 肾小球血管内皮细胞损伤 滤过率下降 水肿,主要脏器的病理变化,脑： 脑动脉痉挛、缺血、缺氧、水肿，微血 管内血栓形成、脑组织软化
15、、颅内压升高、脑内出血 心脏 ：心肌缺血、间质水肿、点状出血坏死 肾脏：肾小球肿胀、血管狭窄、肾小球梗死 肝脏：缺血缺氧、肝细胞坏死 胎盘：血供不足、胎儿缺血缺氧，发育迟缓，胎盘绒毛退行性变、出血、梗死导致早剥、胎死宫内、DIC,子痫的临床表现,眼球固定，瞳孔放大 牙关紧闭，口角及面部肌肉颤动 全身及四肢肌肉强直，双手紧握，双臂伸直。 抽搐时呼吸暂停，面色青紫。 持续时间约1-2分钟 患者可陷入深昏迷状态。 在抽搐过程中易发生唇舌咬伤、摔伤甚至骨折等 昏迷时呕吐可造成窒息或吸入性肺炎。,诊断与鉴别诊断,诊断：子痫前期基础上发生不能用其它原因解释的抽搐。尽管子痫临床表现和化验检查的特异性不强，可
16、以与其它多种能引起抽搐的疾病互相混淆，但子痫是在妊娠期及产后短时内、最常见的与高血压有关的抽搐病因。,鉴别诊断：需要与其它强直性-痉挛性抽搐疾病进行鉴别，如癔病、高血压脑病、脑血管意外（包括出血、血栓、畸形血管破裂等）、癫痫、颅内肿瘤、代谢性疾病（低血糖、低血钙）、脑白质病变、脑血管炎等相鉴别,子痫的治疗原则,一般处理 控制抽搐 控制血压 脱水利尿 纠正酸中毒 终止妊娠 静脉液体治疗,1.一般处理,置病人于安静暗室，专人护理，加用床围栏防止跌伤。禁食、输液、吸氧，保持呼吸道通畅，留置导尿，记神志、血压、脉搏、呼吸、体温、出入量等。抽搐时应将包有纱布的压舌板自臼齿间插入，以防咬伤舌头；低头侧卧以防误吸。,2.控制抽搐,首次以25%硫酸镁1620ml加入5%葡萄糖20ml静脉推注，大于10分钟。或加入5%葡萄糖100ml内30分钟滴入。再以25%硫
