6 Preeclampsia & Gestational Hypertensive Disorders Nursing Care Plans

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Hypertensive disorders of pregnancy (also known as pregnancy-associated hypertensive disorders, pregnancy induced hypertension) are the most common complications that occur during pregnancy and are a major cause of maternal and fetal morbidity and mortality. These disorders include gestational hypertension, preeclampsia, eclampsia, chronic hypertension, and chronic hypertension with superimposed preeclampsia. If left untreated, preeclampsia can lead to a life-threatening complication called HELLP (hemolysis, elevated liver enzymes, low platelet count) syndrome. It is estimated that preeclampsia alone complicates 2-8% of pregnancies globally. 

Hypertensive disorders in pregnancy include five categories of hypertension and are defined as such by the American College of Obstetricians and Gynecologists (ACOG): 

Gestational Hypertensive Disorders

  1. Gestational hypertension. Defined as a systolic blood pressure of 140 mm Hg or more, and/or diastolic blood pressure of 90 mm Hg or more on two blood pressure readings at least four (4) hours apart after 20 weeks of gestation in a woman with previously normal blood pressure. Gestational hypertension does not persist longer than 12 weeks postpartum and usually resolves after a week postpartum.
  2. Preeclampsia. Preeclampsia is a pregnancy-specific condition and is defined as a new-onset of hypertension that occurs most often after 20 weeks of gestation. Blood pressure is elevated more than 140 mm Hg systolic, more than 90 mm Hg diastolic. Hypertension is usually accompanied by new-onset proteinuria although other signs and symptoms of preeclampsia (thrombocytopenia, impaired liver function, pulmonary edema, visual disturbance) may present in some women in the absence of proteinuria.
  3. Eclampsia. Eclampsia is the onset of seizure activity or coma in a woman with preeclampsia with no history of preexisting pathology that can result in seizure activity. Seizure leads to severe maternal hypoxia, injury, and aspiration pneumonia. Eclampsia has an increased maternal mortality rate especially in settings with low resources. 

Chronic Hypertensive Disorders

  1. Chronic hypertension. Chronic hypertension as hypertension diagnosed or present before pregnancy or before 20 weeks of gestation. It is more prevalent with increasing late childbearing and in persons with obesity. Additionally, hypertension that is diagnosed for the first time during pregnancy and that does not resolve postpartum is also classified as chronic hypertension. 
  2. Chronic hypertension with superimposed preeclampsia. Preeclampsia is considered superimposed when it complicates preexisting chronic hypertension. About half of women with chronic hypertension may develop superimposed preeclampsia. It is associated with increased maternal or fetal mortality.

Nursing Care Plans

Nursing care planning and management for pregnant clients with hypertensive disorders or preeclampsia involve early detection, thorough assessment, and prompt treatment of preeclampsia. Another priority is to ensure the mother’s safety and deliver a healthy newborn as close to a full term as possible. 

Here are six nursing diagnoses for your nursing care plans for pregnant patients with hypertensive disorders, focusing on managing clients with preeclampsia. 

  1. Decreased Cardiac Output UPDATED!
  2. Risk for Imbalanced Fluid Volume UPDATED!
  3. Ineffective Tissue Perfusion UPDATED!
  4. Risk for Injury UPDATED!
  5. Imbalanced Nutrition: Less Than Body Requirements UPDATED!
  6. Deficient Knowledge UPDATED!
  7. Other Possible Nursing Care Plans NEW!
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Deficient Knowledge

The pregnant client with a hypertensive disorder may not be aware of the processes that can lead to the development of the disease and how it could be prevented or managed. Furthermore, the client and the family members need an understanding of the interventions that are appropriate for this disease process.

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Nursing Diagnosis

May be related to

  • Lack of exposure
  • Unfamiliarity with information resources
  • Information misinterpretation

Possibly evidenced by

  • Request for information
  • Statement of misconceptions
  • Inaccurate follow-through of instructions
  • Development of preventable complications

Desired Outcomes

  • The client identifies signs/symptoms requiring medical evaluation.
  • The client maintains BP within individually acceptable parameters.
  • The client performs the necessary procedures correctly.
  • The client verbalizes understanding of the disease process and appropriate treatment plan.
  • The client initiates lifestyle/behavior changes as indicated.

Nursing Assessment and Rationales

1. Assess the client’s or family member’s knowledge of the disease process. Provide information about the pathophysiology of preeclampsia, implications for mother and fetus.
Establishes a database and provides information. Provide information about areas in which learning is needed. The pathophysiology of pregnancy-induced hypertension is related to a mechanism of reduced placental perfusion inducing systemic vascular endothelial dysfunction. This arises due to the inability of the uterine spiral arteries to vasodilate, decreasing the fetus’ blood and nutrient supply and increasing the mother’s blood pressure (Braunthal & Brateanu, 2019).

2. Assess the client’s or family member’s knowledge about the rationales for interventions, procedures, and tests, as needed.
Taking information can improve understanding and reduce fear, helping to facilitate the treatment plan for the client. Note: Current research in progress may provide additional treatment options, such as using low-dose (60 mg/day) aspirin to reduce thromboxane generation by platelets, limiting the severity/incidence of preeclampsia (Pradhan et al., 2020).

Nursing Interventions and Rationales

  1. Provide information about signs/symptoms indicating worsening of the condition, and instruct the client when to notify the healthcare provider.
    Helps ensure that the client seeks timely treatment and may prevent worsening of preeclamptic state or additional complications. Instruct the client to report any signs of headaches, new-onset visual changes, new-onset epigastric or RUQ pain, decreased fetal movement, and severe dyspnea. These symptoms are indicative of severe preeclampsia that may progress to eclampsia, and therefore needs immediate intervention.

2. Inform the client of health status, results of tests, and fetal well-being.
Fears and anxieties can be compounded when the client or family members do not have adequate information about the state of the disease process or its impact on the client and fetus. When the client understands the consequences of inadequate intervention and is motivated to achieve health, the client typically participates in treatment interventions.

3. Educate the client on monitoring her weight at home and notify the healthcare provider if the gain is more than 2 lbs (0.9 kg)/wk, or 0.5 lb (0.23 kg)/day. 
A gain of 3.5 lbs (1.59 kg) or greater per month in the second trimester or 1 lb (0.45 kg) or greater per week in the third trimester suggests preeclampsia.

4. Educate and assist family members in learning the procedure for home monitoring of blood pressure.
Encourages cooperation in the treatment regimen, allows immediate intervention as needed, and may reassure that efforts are beneficial. Blood pressure monitoring should be taught to family members two to four times per day in the same arm and the same position.

5. Review techniques for stress management and diet restriction. 
Strengthens the importance of the client’s responsibility in treatment. Healthcare personnel must examine a pregnant woman’s stress levels and recommend practical stress management strategies based on their particular stressors and conditions. Mental stress during pregnancy has associated an increase in the risk for gestational hypertension (Rasouli et al., 2019; Leener et al., 2009).

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6. Educate the client with possible or mild preeclampsia and ensure enough protein in the diet.
Loss of protein through the urine is common among clients with preeclampsia because of glomerular damage, leading to excessive protein excretion. Protein is essential for intravascular and extravascular fluid regulation.

7. Instruct the client to follow the prescribed dietary regimen that includes a diet low in sodium, saturated fat, and cholesterol. 
Excess saturated fats, cholesterol, sodium, and calories have been defined as nutritional risks in preeclampsia. A diet low in fat and high in polyunsaturated fat reduces BP.

8. Review self-testing of urine for protein. Reinforce rationale for and implications of testing. 
A test result of 2+ or greater is vital and needs to be reported to a healthcare provider. Urine specimens contaminated by vaginal discharge or red blood cells may produce positive test results for protein.

9. Reinforce the importance of adhering to treatment regimens and keeping follow-up appointments. 
Lack of engagement in the treatment plan is a common reason for the failure of antihypertensive therapy. Ongoing evaluation for client participation is critical to successful treatment.

10. Explain prescribed medications and their rationale, dosage, expected and adverse side effects, and particular traits. 
Adequate information and understanding about the side effects can enhance the client’s commitment to the treatment plan. Medications for preeclampsia are listed under Decreased Cardiac Output

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Recommended Resources

Recommended nursing diagnosis and nursing care plan books and resources.

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See also

Other recommended site resources for this nursing care plan:

Other care plans related to the care of the pregnant mother and her infant:

References and Sources

References and sources for this nursing care plan for hypertensive disorders in pregnancy.

  1. Abais-Battad, J. M., Lund, H., Fehrenbach, D. J., Dasinger, J. H., Alsheikh, A. J., & Mattson, D. L. (2018, 31 December). Parental Dietary Protein Source and the Role of CMKLR1 in Determining the Severity of Dahl Salt-Sensitive Hypertension. Hypertension, 73(2).
  2. American College of Obstetricians and Gynecologists (ACOG) Committee on Obstetric Practice. (2020). Practice Bulletin #222: Gestational Hypertension and Preeclampsia. Obstetrics & Gynecology, 135, 237-260.
  3. Arulkumaran, N., & Lightstone, L. (2013). Severe pre-eclampsia and hypertensive crises. Best Practice & Research Clinical Obstetrics & Gynaecology, 27(6), 877-884.
  4. Benigni, A., Gregorini, G., Frusca, T., Chiabrando, C., Ballerini, S., Valcamonico, A., … & Remuzzi, G. (1989). Effect of low-dose aspirin on fetal and maternal generation of thromboxane by platelets in women at risk for pregnancy-induced hypertension. New England Journal of Medicine, 321(6), 357-362.
  5. Braunthal, S., & Brateanu, A. (2019, April 10). Hypertension in pregnancy: Pathophysiology and treatment. SAGE, 7.Chakraborty, A., & Can, A. S. (2021, July 2). Calcium Gluconate – StatPearls. NCBI. Retrieved December 14, 2021.
  6. El Allani, L., Benlamkaddem, S., Berdai, M. A., & Harandou, M. (2020, June 9). A case of massive hepatic infarction in severe preeclampsia as part of the HELLP syndrome. The Pan African Medical Journal, 36(78).
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  9. Fox, R., Kitt, J., Leeson, P., Aye, C. Y.L., & Lewandowski, A. J. (2019, October 4). Preeclampsia: Risk Factors, Diagnosis, Management, and the Cardiovascular Impact on the Offspring. Journal of Clinical Medicine, 8(10), 5-6. MDPI.
  10. Fróes, N. B. M., Lopes, M. V. D. O., Pontes, C. M., Ferreira, G. L., & Aquino, P. D. S. (2020). Middle range theory for the nursing diagnosis Excess Fluid Volume in pregnant women. Revista Brasileira de Enfermagem, 73.
  11. Gallo, D., Poon, L. C., Fernandez, M., Wright, D., & Nicolaides, K. H. (2014, April 15). Prediction of Preeclampsia by Mean Arterial Pressure at 11–13 and 20–24 Weeks’ Gestation. Fetal Diagnosis and Therapy.
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  14. Johnson, R. J., Kanbay, M., Kang, D.-H., Lozada, L. G. S.-., & Feig, D. (2011, August 29). Uric Acid A Clinically Useful Marker to Distinguish Preeclampsia From Gestational Hypertension. Hypertension, 58(4), 704-708.
  15. Khooshideh, M., Ghaffarpour, M., & Bitarafan, S. (2017, July 6). The comparison of anti-seizure and tocolytic effects of phenytoin and magnesium sulfate in the treatment of eclampsia and preeclampsia: A randomised clinical trial. Iranian Journal of Neurology, 16(3), 125-129.
  16. Leeners, B., Wagner, P. N.-., Kuse, S., Stiller, R., & Rath, W. (2009, July 07). Emotional Stress and the Risk to Develop Hypertensive Diseases in Pregnancy. Hypertension in Pregnancy, 26(2), 211-226.
  17. Leifer, G. (2018). Introduction to Maternity and Pediatric Nursing (8th ed., Vol. 1). Elsevier.
  18. Lu, Y., Chen, R., Cai, J., Huang, Z., & Hong Yuan. (2018, October 29). The management of hypertension in women planning for pregnancy. British Medical Bulletin, 128(1), 75-84.
  19. Luger, R. K., & Knight, B. P. (2021, October 9). Hypertension In Pregnancy. Statpearls. Retrieved December 8, 2021.
  20. Mayrink, J., Souza, R. T., Feitosa, F. E., Rocha Filho, E. A., Leite, D. F., Vettorazzi, J., … & Cecatti, J. G. (2019). Mean arterial blood pressure: potential predictive tool for preeclampsia in a cohort of healthy nulliparous pregnant women. BMC pregnancy and childbirth, 19(1), 1-8.
  21. O’Brien, L. M., Bullough, A. S., Owusu, J. T., Tremblay, K. A., Brincat, C. A., Chames, M. C., … & Chervin, R. D. (2012). Pregnancy-onset habitual snoring, gestational hypertension, and preeclampsia: prospective cohort study. American journal of obstetrics and gynecology, 207(6), 487-e1. 
  22. Pradhan, M., Kishore, S.V., & Champatiray, J. (2020, April 4). Effect of low dose aspirin on maternal outcome in women at risk for developing pregnancy-induced hypertension. International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 9(4), 1590+.
  23. Perry, S. E., Hockenberry, M. J., Lowdermilk, D. L., Wilson, D., Alden, K. R., & Cashion, M. C. (2017). Maternal child nursing care-E-Book. Elsevier Health Sciences.
  24. Rasouli, M., Pourheidari, M., & Gardesh, Z. H. (2019, February 12). Effect of Self-care Before and During Pregnancy to Prevention and Control Preeclampsia in High-risk Women. International Journal of Preventive Medicine, 10(21).
  25. ​​Schiff, E., Peleg, E., Goldenberg, M., Rosenthal, T., Ruppin, E., Tamarkin, M., … & Mashiach, S. (1989). The Use of Aspirin to Prevent Pregnancy-Induced Hypertension and Lower the Ratio of Thromboxane A2 to Prostcyclin in Relatively High-Risk Pregnancies. New England Journal of Medicine, 321(6), 351-356.
  26. Schmidt P, Skelly CL, Raines DA. Placental Abruption. [Updated 2021 Jul 5]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing.
  27. Sinkey, R. G., Battarbee, A. N., Bello, N. A., Ives, C. W., Oparil, S., & Tita, A. T.N. (2020, August 27). Prevention, Diagnosis, and Management of Hypertensive Disorders of Pregnancy: a Comparison of International Guidelines. Current Hypertension Reports, 22(66), 2. Topical Collection on Preeclampsia.
  28. Weight Gain During Pregnancy | Pregnancy | Maternal and Infant Health. (2021, May 26). CDC.
  29. Wisner, K. (2019). Gestational hypertension and preeclampsia. MCN: The American Journal of Maternal/Child Nursing, 44(3), 170.
  30. Xu, T. T., Zhou, F., Deng, C. Y., Huang, G. Q., Li, J. K., & Wang, X. D. (2015). Low‐Dose aspirin for preventing preeclampsia and its complications: a meta‐analysis. The Journal of Clinical Hypertension, 17(7), 567-573. 
  31. Zelalem, A., Endeshaw, M., Ayenew, M., Shiferaw, S., & Yirgu, R. (2017, July 25). Effect of Nutrition Education on Pregnancy Specific Nutrition Knowledge and Healthy Dietary Practice among Pregnant Women in Addis Ababa. Clinics in Mother and Child Health.

With contributions by Marianne B., and Matt V.

Gil Wayne graduated in 2008 with a bachelor of science in nursing. He earned his license to practice as a registered nurse during the same year. His drive for educating people stemmed from working as a community health nurse. He conducted first aid training and health seminars and workshops for teachers, community members, and local groups. Wanting to reach a bigger audience in teaching, he is now a writer and contributor for Nurseslabs since 2012 while working part-time as a nurse instructor. His goal is to expand his horizon in nursing-related topics. He wants to guide the next generation of nurses to achieve their goals and empower the nursing profession.
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