Pregnancy induced hypertension, also known as gestational hypertension, is a potentially life-threatening disorder that usually develops late in the second trimester or in the third trimester. The non-convulsive form of PIH is termed as preeclampsia ranging from mild to severe. The convulsive form is eclampsia. The cause of this disorder is unknown but geographic, ethnic, racial, nutritional, immunologic, and familial factors and preexisting vascular disease may contribute to its development.
Nursing Care Plans
Nursing care for PIH involves providing adequate nutrition, good prenatal care, and control of pre-existing hypertension during pregnancy decrease the incidence and severity of preeclampsia. Early recognition and prompt treatment of preeclampsia can prevent progression to eclampsia.
- Deficient Fluid Volume
- Decreased Cardiac Output
- Altered Tissue Perfusion (Uteroplacental)
- Risk for Maternal Injury
- Risk for Imbalanced Nutrition: Less Than Body Requirements
- Deficient Knowledge
Decreased Cardiac Output
- Decreased Cardiac Output
May be related to
- Hypovolemia/decreased venous return
- Increased systemic vascular resistance
Possibly evidenced by
- Change in blood pressure/hemodynamic readings
- Shortness of breath
- Alteration in mental status
- Patient remains normotensive throughout remainder of pregnancy.
- Patient reports absence and/or decreased episodes of dyspnea.
- Patient alters activity level as condition warrants.
|Record and graph vital signs especially BP and pulse.||The patient with PIH does not display the normal cardiovascular response to pregnancy (left ventricular hypertrophy, increase in plasma volume, vascular relaxation with decreased peripheral resistance). Hypertension (the second manifestation of PIH after edema) occurs owing to increased sensitization to angiotensin II, which increases BP, promotes aldosterone release to increase sodium/water reabsorption from the renal tubules, and constricts blood vessels.|
|Assess MAP at 22 weeks’ gestation. A pressure of 90 mm Hg is considered predictive of PIH. Assess for crackles, wheezes, and dyspnea; note respiratory rate/effort.||Pulmonary edema may transpire, with modification in peripheral vascular resistance and drop in plasma colloid osmotic pressure.|
|Institute bedrest with patient in lateral position.||Improves venous return, cardiac output, and renal/placental perfusion.|
|Check for invasive hemodynamic parameters.||Provides precise picture of vascular changes and fluid volume. Prolonged vascular constriction, increased hemoconcentration, and fluid shifts decrease cardiac output.|
|Give antihypertensive drug such as hydralazine (Apresoline) PO/IV, so that diastolic readings are between 90 and 105 mm Hg. Begin maintenance therapy as needed, e.g., methyldopa (Aldomet) or nifedipine (Procardia).||If BP does not respond to conservative measures, short-term medication may be needed in conjunction with other therapies, e.g., fluid replacement and MgSO4. Antihypertensive drugs work directly on arterioles to promote relaxation of cardiovascular smooth muscle and help increase blood supply to cerebrum, kidneys, uterus, and placenta. Hydralazine is the drug of choice because it does not produce effects on the fetus. Sodium nitroprusside is being used with some success to lower BP (especially in HELLP syndrome).|
|Check on BP and side effects of antihypertensive drugs. Administer propranolol (Inderal), as appropriate.||Side effects such as tachycardia, headache, nausea, and vomiting, and palpitations may be treated with propranolol.|
|Prepare for birth of fetus by cesarean delivery, labor when severe PIH/eclamptic condition is stabilised, but vaginal delivery is not feasible.||If conservative treatment is ineffective and labor induction is ruled out, then surgical procedure is the only means of halting the hypertensive problems.|
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Maternal and Newborn Care Plans
Nursing care plans related to the care of the pregnant mother and her infant. See care plans for maternity and obstetric nursing:
- Abruptio Placenta| 3 Care Plan
- Cesarean Birth | 10 Care Plans
- Cleft Palate and Cleft Lip | 6 Care Plans
- Dysfunctional Labor (Dystocia) | 4 Care Plans
- Elective Termination | 6 Care Plans
- Gestational Diabetes Mellitus | 4 Care Plans
- Hyperbilirubinemia | 4 Care Plans
- Labor Stages, Induced and Augmented Labor | 36 Care Plans
- Neonatal Sepsis | 5 Care Plans
- Perinatal Loss | 5 Care Plans
- Placenta Previa | 3 Care Plans
- Postpartum Hemorrhage | 8 Care Plans
- Postpartum Thrombophlebitis | 4 Care Plans
- Prenatal Hemorrhage | 7 Care Plans
- Prenatal Substance Dependence/Abuse | 6 Care Plans
- Precipitous Labor | 3 Care Plans
- Pregnancy Induced Hypertension | 6 Care Plans
- Premature Dilation of the Cervix | 3 Care Plans
- Prenatal Infection | 3 Care Plans
- Preterm Labor | 6 Care Plans
- Puerperal Infection | 4 Care Plans