Preparing for OB Clinicals: Assessing DTRs and Clonus in Preeclamptic Patients

Assessing Patellar Reflexes Position the woman with her legs hanging over the edge of the bed Briskly strike the patellar tendon, which is located just below the patella Normal response is extension or a thrusting forward of the foot

Patellar Reflex

Lying Down Position If the patient is too critical to sit up at the edge of the bed Raise her leg off the bed by putting your hand under the knee Strike the tendon Assess the reflex

Assessing Bicep Reflexes Flex the woman’s arm 45 degrees at the elbow and place your thumb on her biceps tendon Fingers hold the biceps muscle Strike your own thumb in a slightly downward motion and assess the response Normal response is slight flexion of the arm Only use bicep reflex if unable to assess the patella reflex; patella reflex easier to assess

Bicep Reflex

Documenting Reflexes Reflexes (but not clonus) are graded on a scale of 0 to 4+ as follows: 4+ Hyperactive; very brisk, jerky, or clonic response; abnormal 3+ Brisker than average 2+ Average response; normal 1+ Diminished response; low normal 0 No response; no movement

Assessing Clonus Patient placed in supine position With the woman’s knee flexed and the leg supported, vigorously dorsiflex the foot Maintain the dorsiflexion momentarily, then release With a normal response, the foot returns to its normal position of plantar flexion Assess for clonus by counting the foot “jerks” or beats

Assessing Clonus

Documenting Clonus There should be no beats of clonus Depending on severity of CNS over-stimulation, patient can have anywhere from 1-4 beats of clonus More beats there are, the more over-stimulated the CNS and therefore the greater risk of having a seizure