4. Objectives
• Understand and define deep tendon reflexes
• Distinguish between hyper and hypo-tonic deep tendon
reflexes
• Gain a basic knowledge of DTR grading
Understand how to do a DTR examination
Identify different DTRs
5. Definition
• Tonic contraction of the muscles in response to a stretching
force, due to stimulation of muscle proprioceptors
6. Assessment of Deep Tendon Reflexes
• Aim:
It helps to evaluate the lower motor neurons/fibers at certain levels
of the body. In case of preeclampsia, absence of or decrease in the
patellar reflex indicates that a toxic blood level (>10 mEq/L of
Mg) has been reached.
7. Grading
• Grading based on varied degree of response
Grade Interpretation
0 Reflex absent
+1 Reflex hypoactive
+2 Normal reflex
+3 Reflex hyperactive (brisk)
+4 non-sustained clonus
(hyperactive with transient
clonus)
8. STEPS FOR ASSESSING DEEP TENDON
REFLEX
• Prepare the necessary equipment (reflex hammer).
14. • Rate the reflex response based on reflex scale.
• Assess each reflex symmetrically and comparing the reflex response
on one side with the reflex response on the other side.
• Evaluate the clonus by counting the number of times the muscle
contracts and relaxes after it has been sharply stretched).
• Record the findings with those previously recorded.
• Remove equipment.
• Dispose gloves and wash hand.
• Reassure mother about findings.
16. clonus assessment is a simple procedure and part of the
whole clinical assessment for preeclampsia
17. CHECKLIST: CLONUS ASSESSMENT
1. Wash hands and wear gloves
2. Welcoming mother and explain the procedure
3. Keep the mothers’ privacy
4. The patient lies in a relaxed supine position
18. 5. Ensure no signs of DVT before the assessment (Redness- Hotness-
Tenderness)
20. 7. Elevate mothers’ leg, support the leg by one hand and the
other hand do sudden foot dorso-flexion
21. 8. Evaluate the clonus by counting the number of times the muscle
contracts and relaxes after it has been sharply stretched).
9.Document the findings:
Negative signs: if there is no rigidity in calf muscle
Positives signs: if there is rigidity in the calf muscle and
rhythmic beats of dorsiflexion and planter flexion
25. Edema
Edema is assessed by distribution, degree, and pitting. If periorbital or
racial edema is not obvious, the pregnant woman is asked if it, was
present when she woke. Edema may be described as dependent or
pitting.
Dependent edema:
Dependent edema is edema of the lower or most dependent parts of the
body, where hydrostatic pressure is greatest. If a person is ambulatory,
this edema may first be evident in the feet and ankles.
26. Pitting edema:
Press suspected edematous areas with the edge of your fingers for 10
seconds, and observe for the depression, within 10 to 30 seconds the pit
normally disappears. Although the amount of edema is difficult to
quantities, the method described in the figure may be used to record
relative degrees of edema formation.
Normal findings: -
Depression recovers quickly
27. Abnormal findings/ Changes from normal:
Depression recovers slowly or remains. Edema indicates fluid retention,
a sign of circulatory disorders.
29. PITTING EDEMAASSESSMENT
1- Greet the mother.
2- Explain the procedure
3- Ask the woman and/or family members if the woman face or hands
appear swollen (non pitting edema may be found in the patient's fingers,
face, and eyelids).
4- Position the mother flat in the bed.
30. PITTING EDEMAASSESSMENT CONT.,
5- Wash hands and wear gloves.
6- Observe for general appearance (skin texture, swelling).
7- Inspect the woman face, extremities, and sacral area for signs of
pitting edema.
32. PITTING EDEMAASSESSMENT CONT.,
9- Evaluate the extensiveness of the edema, the depth of the depression,
and the length of time it takes to clear.
10- Grade the pitting edema based on clinical observation by scoring
scale
