I. Nursing care

1. Assessment
A. Medical history

1. Common identity mothers
2. Mother's age, whether primi gravida
3. Is hypertension in the family
4. Nutritional status of mothers
5. History of chronic kidney disease
6. Complaints head disease, visual impairment, uluhati pain, nausea and vomiting

B. Obstetric history

1. Has twin
2. Is there a history hiydramnion
3. Is there a history molahidatidosa

C. Physical examination

1. Is there edema
2. an increase in overweight
3. paleness of skin color lembat
4. whether blurred vision, headache, heartburn
5. decrease in urine output
6. checking vital signs
7. Uriah protein
8. serum total protein and albumin decreased
9. hematorik rise, low nemuglobin
10. increased uric acid
11. increased creatinine, urea miningkat
12. SOGT and lactic dehydrogenase increased
13. Decreased blood clotting time

2. Nursing Diagnosis
1. Excess fluid volume related to decreased osmotic pressure, changes in vascular permeability, as well as sodium and water retention.
2. Decrease in cardiac output associated with hypovolemia / decrease in venous return.
3. High risk of injury to the fetus associated with inadequate perfusion of blood to the placenta.
3. Intervention
Diagnosis 1: Excess caiarn associated with a decrease in the osmotic pressure, changes in vascular permeability, fiber and sodium retention nair.
a. Monitor and record intake and output every day.
Rational:
By monitoring intake and output is expected to note the existence of fluid and can diramalkankeadaan keseimbanngan and kerusakanglomerulus.
b. Monitoring TTV
Rational:
With memanatu TTV and capillary refill can be used as guidelines for fluid replacement or assess the response of the cardiovascular.
c. Monitor or weigh the mother.
Rational:
By monitoring the weight of the mother can know that weight is an indicator to determine the proper fluid balance.
d. Observation circumstances edema
Rational:
The state is an indicator of the state of edema fluid in the body.
e. Provide low-salt diet based on the results of collaboration with a nutritionist.
Rational:
Low-salt diet will reduce the excess fluid.
f. Collaboration to diuretic therapy.
Rational:
Kegagaln overloaded or circulation can lead to pulmonary edema requiring aggressive integral. Rather, it is contraindicated indicated when it may cause dehydration.
Diagnosis 2. The decrease in cardiac output associated with hypovolemic or decrease venous return.
a. Pemanataun pulse and blood pressure.
Rational:
Denagn monitor blood pressure and pulse dpat seen an increase in plasma volume, relaxation vaskriferular with decreased peripheral custody
b. Make bed rest in women with left position.
Rational:
Increasing venous return, cardiac output and renal perfusion.
c. Monitoring invasive or hemodynamic parameters (collaboration)
Rational:
Give an accurate picture of changes in vascular volume and vascular cairan.Konstruksi time, improvement and hemoconcentration, and fluid shifts menurunnkan cardiac output.
d. Give antihypertensive medications as needed based on collaboration with Doctors
Rational:
Antihypertensive medications work directly on arteriolar smooth muscle relaxation to improve cardiovascular and helps improve blood supply.
e. Pemanatauan blood pressure and antihypertensive medication.
Rational:
Knowing the side effects occur such as tachycardia, headache, nausea, vomiting, and palpitations.
Diagnosis 3: High risk of injury to the fetus associated with inadequate perfusion of blood to the placenta
a. Rest your mother.
Rational:
With mother menistirahatkan expected decrease metabolism and blood circulation to the placenta so inadequate, so the need of oxygen to the fetus can be met.
b. Encourage the mother to tilt to the left.
Rational:
With the left side sleeping expected vena cava to the right is not depressed by the enlarging uterus, so that blood flow to the placenta so smoothly.
c. Monitor the mother's blood pressure.
Rational:
With memanatau maternal blood pressure can know the state of the blood flow to the placenta such as high blood pressure, blood flow to the placenta is reduced, so that the oxygen supply to the fetus is reduced.
d. Monitor maternal heart sounds
Rational:
By monitoring the fetal heart rate can know the state of the fetal heart is weak or declining indicating reduced oxygen supply to the placenta, which can direncankan further action.
e. Give hypertension medications after collaborating with physicians
Rational:
With antihypertensive drugs will lower the tone of the arteries and causes heart afterload by vasodilation of blood vessels, so blood pressure turun.Dengan decrease in blood pressure, the blood flow to the placenta to be adequate.
4. Implementation of Nursing
Once the plan is composed of nursing, then applied to real action to achieve the desired results in the form of reduction or loss of maternal problems. At the implementation stage consists of several actions the nursing plan validation, writing or document a plan of nursing, And continue collecting data.
In the implementation of nursing, measures should be detailed and clear cukkup that all nursing personnel to run it well within the stipulated time. Nurses can melaksanakn directly or in collaboration with other executive personnel.
5. Evaluation
Evaluation of nursing is the final activity of the nursing process, in which nurses assess the expected outcomes to changes in maternal self and assess the extent of the problem can be solved mother. In addition, nurses also provide feedback or reassessment, if the goals set have not been achieved, so in this case the nursing process can be modified.

References

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H. Management

Governance preeclampsia and eclampsia:
a. Conservative
1. Isolation:
Insert the catheter
2. Drugs:
Dextr-infusion 5%

• Valium 120gr/24jam
• MgSO4
• Litik cocktail:
• Largatil 50
• Pethidin 100
• Promethazine 50

3. observation:
Da n-convulsive coma

• Reaction to medication
• Diuresis
• Physical awareness

Eden-criteria
- Duration of 2 × 24 hours
4. consultation:

• Diseases in
• Eye disease
• Anesthesia
• Pediatrician

b. Active Therapy
beerdasarkan clinical judgment labor induction
Drip-oxytoksin
Solved amniotic
-Cesarean section
c. obstetric therapy

• 36 weeks or more after 24-48 hours if there is no obvious improvement of labor induction membranes break, drop oxytoksin.
• During labor: acceleration of labor, the membranes break, drop oxytoksin, forceps or vacuum delivery.
• Be dangerous to the fetus, placenta insuvisiensi, acute or chronic: amnioscopy, fetal monitoring records. Cesarean section after only the indication of fetal loss eclampsia.

d. Anticonvulsant therapy
Bine-Magnor (magnesium ascorbate) 20%, 20ml IM or IV.
-Magnesium can be given up to 5gr every 5-6 hours
Mg therapy stopped when the patellar tendon reflexes disappear or respiratory depression.

I. Nursing care

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D. Clinical Manifestations

Mild preeclampsia:
A. Hypertension between 140/90 or an increase in systolic and diastolic 30mmhg/15mmhg.
B. Edema of the feet, hands or face or rising 1kg/minggu BB.
C. Proteinuria 0.3 gr/24 hour or plus 1-2.
D. Oliguria
Severe preeclampsia:
A. Hypertension 160/110mmhg.
B. Proteinuria 5gr/24 hour or plus 4-5.
C. Oliguria 400cc/24 hours.
D. Edema can only be accompanied by cyanosis.
E. Subjective complaints:

• frontal headache
• Impaired vision
• Epigastric pain

Eclampsia:
A. Symptoms of preeclampsia.
B. With coma or convulsions.
C. Accompanied by IUGR or IUFD intrauterine asphyxia?
F. Diagnostic Examination
Mild preeclampsia: Urine complete
Severe preeclampsia and eclampsia: hemoglobin, hematocrit, complete Urine, uric acid, platelet counts, liver function, kidney function.
Measurement of blood pressures
Examination edema
Fundal height measurement
Inspection fuduskopik
Renal function tests (urea, creatinine)
G. Complication
Below Complications usually occur in preeclampsia and eclampsia:

1. Solutio placenta
2. Crummy: kidneys, heart, lungs caused by edema, necrosis of the liver due
3. Cerebral hemorrhage
4. Siendrom HELLP: hemolysis, eleved enzyms liver, low platelet
5. Maternal and fetal deaths.
6. Hypofibrinogenemia
7. Eye Disorders
8. Nekrosif heart.
9. Renal insufficiency.
10. Prematurity, dismaturitas, and fetal death intrauterina

H. Management

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pre-eclampsia and eclampsia (a complication of hypertension in pregnant women)

A. Background

Preeclampsia and eclampsia is a complication of hypertension in pregnant women. And preeclampsia can be further divided into mild and severe preeclampsia. In Indonesia, after bleeding and infection preeclampsia remains a major cause of maternal and perinatal cause of death is high. Therefore, early diagnosis of preeclampsia eclampsia which is the introductory level, as well as the treatment needs to be done to reduce maternal and child mortality.
Malnutrition is still a big problem for the third world, including Indonesia. Nutrition became a serious problem because it would have an impact on the nation's weakening competitiveness due to high morbidity and mortality, as well as intelligence and cognitive impaired children. Groups who are most vulnerable to malnutrition are pregnant women, infants, and toddlers. The tendency of the high number of protein-energy malnutrition in pregnant women increases the risk of maternal morbidity and mortality as well as the mothers who gave birth to babies with low birth weight. Babies born weighing 2500 grams vulnerable to impaired growth and intelligence. Children who are malnourished at birth or during the baby's risk for heart and blood vessel disease, and diabetes mellitus in adulthood. The risk of death from malnutrition is also greater, precisely in the productive age. In pregnancy, besides psychological changes, as well as physiology.
Therefore, early diagnosis of pre-eclampsia and prevent progression to eclampsia should not be the goal of treatment. Estimated pre-eclampsia occurs 5% of pregnancies, is more common in first pregnancies. Also in women who previously suffered from high blood pressure or blood vessel disease.

THEORY REVIEW
A. Definition
Pre-eclampsia is a disease with signs of hypertension, edema, and proteinuria caused by pregnancy (Prof. Dr. Hanifa wiknjosastro, DSOG, et al, 1999:282)
Ekslampsia an acute illness with convulsions and coma in pregnant women and women during childbirth is accompanied by hypertension, edema, and proteinuria (Pusdiknakes, MOH, 1990; 9).
Pre-eclampsia is a complication of pregnancy and ekslampsia the third tri-mester with clinical symptoms of hypertension, edema, protein Uriah, convulsions and coma. (Manuaba, Prof.dr.Ida Gde.Penuntun Registrar Good Clinical Obstetrics And Ginekologi.1993.EGC.Jakarta ).
B. Etiology
The cause of preeclampsia and eclampsia are definitely not in the know.
The theory stout at present as the cause was was placental ischemia or lack of O2 to the placental circulation.
predisposing factors or the occurrence of preeclampsia and eclampsia, among others:

1. Diabetes mellitus
2. Chronic renal impairment
3. Hypertension
4. Molahydatidosa
5. Polyhydramnion
6. Primi old grapida

C. Pathophysiology

        Mild preeclampsia rarely cause death. No changes characteristic of preeclampsia and eclampsia. Bleeding, infak, and thrombosis of small blood vessels in this disease can be found in various organs. The changes are most likely caused by vasospasmus arterioles. Accumulation of fibrin in blood vessels is also an important factor in the pathogenesis of these disorders.
Fundamental changes in preeclampsia is obtained spasmus blood vessels accompanied by salt and water retention. In some cases lumenarteriol so small, so it can only be traversed by a single red blood cells only. Raised blood pressure is the pressure of coping with rising peripheral, to be adequate tissue oxygenation. Weight gain and edema due to accumulation of excess fluid in the interstitial space is not known why. In preeclampsia found that low levels of aldosterone and prolactin concentrations were higher than in normal pregnancy. Aldosterone is important to maintain plasma volume and regulate water and sodium retention. In preeclampsia permeabelitas blood vessels to increase protein.
Decreased blood flow to impact the body's organs. In the placenta, resulting in decreased blood flow impaired placental function. In a rather long hypertension, impaired fetal growth. In hypertensive shorter fetal distress can occur until his death from lack of oxygenation.
Lack of blood to the kidneys resulting in reduced glomerular filtration. Abnormalities is important in relation to proteinuria and the retention of salt and water. Glomerular filtration rate decreased to 50% of normal, causing diuresis down, on the state of information can happen olliguri or anuria.
In preeclampsia appear retinal edema, local or generalized spasmus in one or more arteries. Diplopia and amblyopia in cases of preeclampsia symptoms that indicate the occurrence of eclampsia. It is caused by changes in blood flow in the cerebral cortex of vision centers.
Pulmonary edema is a major cause of death of patients pre-eclampsia and eclampsia. These complications are usually caused by the left cardiac decompensation.
High hemoconcentration in preeclampsia and eclampsia is not known why. A shift of water from the intravascular to the interstitial space. An increase hemotokrit, increased serum protein, and increased edema causes decreased blood volume, increased blood viscosity, and time will be more lam circulation direction. Blood flow to different parts of the body is reduced resulting in hypoxia.

D. Clinical Manifestations

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