6 Pregnancy Induced Hypertension Nursing Care Plans

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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.

Here are six (6) nursing diagnosis for your nursing care plans on Gestational Hypertension or Pregnancy Induced Hypertension

  1. Deficient Fluid Volume
  2. Decreased Cardiac Output
  3. Altered Tissue Perfusion (Uteroplacental)
  4. Risk for Maternal Injury
  5. Risk for Imbalanced Nutrition: Less Than Body Requirements
  6. Deficient Knowledge
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Altered Tissue Perfusion (Uteroplacental)

Nursing Diagnosis

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  • Impaired Tissue Perfusion

May be related to

  • Maternal hypovolemia
  • Interruption of blood flow (progressive vasospasm of spiral arteries)

Possibly evidenced by

  • Intrauterine growth retardation
  • Changes in fetal activity/heart rate
  • Premature delivery
  • Fetal demise

Desired Outcomes

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  • Patient demonstrates normal CNS reactivity on nonstress test (NST)
  • Patient is free of late decelerations;
  • Patient has no decrease in FHR on contraction stress test/oxytocin challenge test (CST/OCT).
  • Patient is full-term, AGA.
Nursing Interventions Rationale
Present information to patient/couple concerning home assessment or noting daily fetal movements and when to seek immediate medical attention. Decrease in placental blood flow results in reduced gas exchange and impaired nutritional functioning of the placenta. Potential outcomes of poor placental perfusion include a malnourished, LBW infant, and prematurity associated with early delivery, abruptio placentae, and fetal death. Reduced fetal activity means fetal compromise (occurs before detectable alteration in FHR and indicates demand for immediate evaluation/intervention.
Name factors affecting fetal activity. Cigarette smoking, medication/drug use, serum glucose levels, environmental sounds, time of day,and sleep-wake cycle of the fetus can increase or decrease fetal movement.
Report signs of abruptio placentae (i.e., vaginal the bleeding, uterine tenderness, abdominal pain, and decreased fetal activity). Immediate attention and intervention increases the likelihood of a positive outcome.
Present contact number for patient to direct questions, address changes in daily fetal movements, and so forth. Provides chance to address concerns/misconceptions and intervene in a timely manner, as indicated.
Evaluate fetal growth; measure progressive fundal accompany growth at each office visit or periodically during stress home visits, as appropriate. Reduced placental functioning may accompany PIH, resulting in IUGR. Chronic intrauterine stress and uteroplacental insufficiency decrease amount of fetal contribution to amniotic fluid pool.
Note fetal response to medications such as MgSO4, phenobarbital, and diazepam. Depressant effects of medication reduce fetal respiratory and cardiac function and fetal activity level, even though placental circulation may be adequate.
Check FHR manually or electronically, as indicated. Helps evaluate fetal well-being. An elevated FHR may show a compensatory response to hypoxia, prematurity, or abruptio placentae.
Assess fetal response to BPP criteria or CST, as maternal status indicates. BPP helps evaluate fetus and fetal environment on five specific parameters to assess CNS function and fetal contribution to amniotic fluid volume. CST assesses placental functioning and reserves.
Assist with assessment of fetal maturity and well-being using L/S ratio, presence of PG, estriol levels, FBM, and sequential sonography beginning at 20–26 weeks’ gestation. In the event of declining maternal/fetal condition, risks of delivering a preterm infant are weighed against the risks of continuing the pregnancy, using results from evaluative studies of lung and kidney maturity, fetal growth, and placental functioning. IUGR is associated with reduced maternal volume and vascular changes.
Assist with assessment of maternal plasma volume at 24–26 weeks’ gestation using Evans’ blue dye when indicated. Identifies fetus at risk for IUGR or intrauterine fetal demise associated with reduced plasma volume and reduced placental perfusion.
Utilizing an ultrasonography, assist with assessment of placental size. Reduced placental function and size are associated with PIH.
Give corticosteroid (dexamethasone, betamethasone) IM for at least 24–48 hr, but not more than 7 days before delivery, when severe PIH necessitates premature delivery between 28 and 34 weeks’ gestation. Corticosteroids are thought to induce fetal pulmonary maturity (surfactant production) and prevent respiratory distress syndrome, at least in a fetus delivered prematurely because of condition or inadequate placental functioning. Best results are obtained when fetus is less than 34 weeks’ gestation and delivery occurs within a week of corticosteroid administration
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See Also

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Maternal and Newborn Care Plans

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Nursing care plans related to the care of the pregnant mother and her infant. See care plans for maternity and obstetric nursing:

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