University:
University of Nottingham
Course:
B723 | Midwifery
Academic year:

2024
Views:

436

Pages:

4
Author:

Christy C.

MANAGEMENT OF SEVERE PRE-ECLAMPSIA/ECLAMPSIA (COLLABORATION SKILLS IN HOSPITAL) PROGRAM MIDWIFERY tools preparation STEPS / ACTIVITIES Pressure meter Watch Stethoscope Metlin Doppler personal protective equipment (PPD). Spatel barrel Urine protein examination set Clean gloves An alcohol swab Infusion set and infusion fluid (RL and NaCl) Standard infusion Ventilator and oxygen Catheter set Hammer (patellar reflex) 3 cc syringe: 2 Drug Preparation MgSO4 40% or 20% Calcium bicarbonate 10% (1 gr) Antihypertensive: Nifediphine 5 -10 mg Patient Preparation 1 Greet your mother in a friendly and polite manner 2 Tell the mother what will be done and give her the opportunity to ask questions 3 Listen to what mother says 4 Provide emotional support and service assurance Implementation 1 Use PPD 2 Washing hands 3 Use gloves 4 Make sure the indications, signs and symptoms of preeclampsia are mild (headache, high BP, extremity edema) 5 Perform a physical examination and vital signs (watch out for diastolic BP >90 mmHg, systolic 140 mmHg, presence of proteinuria) 6 Explain the results of the inspection and the actions to be taken 7 Ask for approval for medical treatment 8 Regular diet 9 Monitor blood pressure twice a day 10 Observe urine protein once a day 11 No need for medication or deuritics 12 Give anti-convulsants (RR requirements > 16x/min, positive patellar reflex, minimum urine > 30 ml/hour in the last 4 hours, 10% bicarbonate antidote (1gr) is available Loading dose Mg SO4 4 gr 20% give IV for 5 minutes (if available MgSO4 40% give 10cc diluted with 10cc aquabidest. Give IM if IV cannot be done give IM (MgSO4 40%cc slowly, respectively on the right buttock and left give 5 grams (12.5cc). Maintenance dose Give IM 5 gr (MgSO4 40%) 12.5 cc slowly to the buttocks every 6 hours. Give every 4 hours 5 g 50% IM buttocks Adding dose If there are repeated seizures, give 2 grams of MgSO4 40% IV Prepare an antidote. If breathing stops, carry out ventilation. (mask, balloon, ventilator) give 10% calcium bicarbonate 1 gr (20 ml in 10% solution) IV Slowly until breathing improves, give IV fluids (NaCl or RL 1 lt/hour) 13 Install oxygen 4-6 lt/min 14 Install the spatle barrel if a seizure occurs 15 Position the patient on his left side to prevent aspiration of vomit 16 If the diastolic pressure is <110 mHg, give antihypertensives: nifedipine 5 mg (can be repeated if the condition has not improved in 10 minutes and methyldopa 3 x 250 to 500 mg per day 17 Install an IV 18 Insert a catheter to calculate fluid balance (minimum 30 ml/hour or 400 ml/24 hours) 19 Monitor the occurrence of pulmonary edema by auscultating the lungs. If edema occurs, give furosemide 40 mg IV once. 20 Ask your family to accompany you, to avoid aspiration of vomit 21 Monitor blood pressure, patellar reflex and FHR every hour 22 Washing hands 23 Provide information to the mother about the results of the action 24 Document the results of actions