Gestational Hypertension, also known as pregnancy-induced hypertension, is a situation when a person has elevated blood pressure during the patient’s pregnancy and is usually diagnosed after 20 weeks of pregnancy or close to delivery.
Gestational hypertension occurs in about 6 percent of all pregnancies and can progress into preeclampsia.
Gestational hypertension happens when the patient’s blood pressure reading is higher than normal or higher than 140/90 mmHg in a woman who had normal blood pressure before 20 weeks of pregnancy and has no proteinuria or protein in the urine.
Signs and Symptoms of Gestational Hypertension
The following are the common symptoms of high blood pressure during pregnancy and may vary for pregnant women and gestational hypertension may be asymptomatic.
- elevated blood pressure
- absence or presence of protein in the patient’s urine
- swelling or edema
- a sudden increase in weight
- visual changes and disturbances such as blurred or double vision
- abdominal pain at the right upper side or pain around the stomach
- a small amount of urination
- changes in the liver and kidney function tests
Causes of Gestational Hypertension
The exact cause of gestational hypertension is unknown and some conditions may increase the risk of causing the conditions which include the following:
- Pre-existing hypertension. If the patient has a history of increased blood pressure there is an increase in the resistance of the blood vessels which may hinder blood flow in many different organs of the body in the expectant mother including the patient’s liver, kidneys brain, uterus, and placenta.
- Kidney disease. Kidney disease can increase the development of preeclampsia due to co-morbid conditions such as hypertension and it is associated with impaired glycocalyx integrity and alterations in the complement renin-angiotensin-aldosterone system.
- Diabetes. Gestational diabetes increases the risk of gestational hypertension and is associated with a high incidence of essential hypertension.
- Age. Having an age younger than 20 or older than 40increases the risk of gestational hypertension because advanced maternal age has low nitric oxide levels and high oxidative stress that will adversely affect the relaxation of the endothelium.
- Parents of multiples such as twins or triplets. They have a 2 to 3 times greater risk of developing gestational hypertension, which happens sooner or faster.
- Race. African Americanshave an increased risk of having gestational hypertension due to increased stress and unhealthy lifestyles.
Risk Factors to Gestational Hypertension
Several factors that contribute to gestational hypertension include:
- Women of color. Gestational hypertension is common in these women because of the genetic makeup of the person’s race. Blood pressure in women has been higher for African- American which leads to higher rates of stroke, end-stage renal disease, and congestive heart failure.
- Multiple pregnancies. A woman who has multiple pregnancies increases the risk for gestational hypertension. Multiple pregnancies are pregnancies with more than one fetus which can be twins or triplets.
- Primiparas aged 20 years and older. Women at this age have an increased risk for gestational hypertension than women aged 40 years and above. A person’s blood pressure tends to increase because of the person’s age because the person’s blood vessels naturally thicken over time.
- Women that have low socioeconomic backgrounds and status. Women with low socioeconomic backgrounds have a poor diet which increases the risk for gestational hypertension. A person’s socioeconomic status including income, education, or occupation can affect the person’s health, these may cause low birth weight, cardiovascular disease, arthritis, diabetes, cancer, and hypertension. The person’s socioeconomic status may affect the person’s overall body functioning and health.
- Women with an underlying disease. A person with an underlying disease may contribute to and cause the occurrence of gestational hypertension. Underlying diseases including hyperlipidemia, obesity, and diabetes are common diseases that may lead to hypertension and have an increased risk for cardiovascular complications.
Complications of Gestational Hypertension
High blood pressure during pregnancy can cause complications for the mother and the infant, these complications may include the following:
- Preeclampsia. Preeclampsia is an increase in blood pressure and indicates liver or kidney damage that happens in women after the 20th week of pregnancy and may also occur in women after delivery of the newborn often happens within 48 hours which is called postpartum preeclampsia. Preeclampsia is thought to start in the placenta that may be caused by an autoimmune disorder, blood vessel problems, diet, and genes.
- Eclampsia. Eclampsia is a severe condition caused by preeclampsia where high blood pressure causes seizures during pregnancy. If the patient experiences seizures the patient’s brain activity is disturbed that causing episodes of staring, decreased alertness, and violent shaking. The exact cause of eclampsia is unknown but factors may cause eclampsia including blood vessel problems, brain and nervous system problems, diet, and genes.
- Stroke. Stroke also known as brain attack is the most common cause of death in the United States and it is also the major cause of disability for adults. A stroke happens when something blocks the blood supply to a person’s part of the brain or when the person’s blood vessel in the brain bursts and in either case the person’s brain become damaged or dies.
- Preterm delivery. Preterm delivery happens before 37 weeks of pregnancy and the newborn’s weight is less than 5 pounds, 8 ounces. Gestational hypertension will make it more difficult for the newborn to get enough oxygen and nutrients to grow.
Diagnosis of Gestational Hypertension
- Blood pressure measurement. Measuring the patient’s blood pressure is important for clinical management and it should be obtained accurately using a validated device. Regular blood pressure measurement is important for the diagnosis and management of hypertensive disorders such as pre-eclampsia.
- Urine test. A urine test will help in ruling out preeclampsia and is done to make sure the kidneys are healthy. A urine test is used to detect protein in the urine and the patient may be asked to collect the urine for 24 hours for additional needed testing. If there is the presence of protein in the urine over 300 mg in a day this may indicate preeclampsia.
- Assessment of edema. If a patient has the presence of extra fluids during pregnancy and has the presence of pressure from the growing fetus, this may cause swelling or edema. Edema is common because of the increased blood pressure associated with the leakage of fluids from the blood vessels that supply the brain and may be a sign of preeclampsia.
- Frequent weight measurement. The patient’s weight should be assessed and tracked to make sure that the patient hasn’t gained more than 3 to 5 pounds a week. A sudden increase in weight may indicate excess fluid retention.
- Liver and kidney function test. A liver and kidney function test is done to diagnose and detect abnormal liver and kidney function. Increased blood pressure can constrict and narrow the blood vessels that would damage and weaken the body including the liver and kidneys.
- Blood clotting test. Blood clotting time is assessed to evaluate blood clotting and this test can help in assessing the risk of excessive bleeding and the development of clots in the patient’s blood vessels.
Treatment of Gestational Hypertension
The treatment of gestational hypertension will be done by a physician that would be based on the pregnancy, overall health, medical history, patient’s preference, and the extent of the disease.
The goal of treatment for gestational hypertension is to prevent the worsening of the condition and prevent complications. The treatment and management of gestational hypertension include:
- Bedrest is advised to the patient which can be done at home or in a hospital.
- Advise the patient to lie on her left side to take the baby’s weight off her major blood vessels.
- Hospitalization in a facility with specialized personnel and equipment may be needed.
- Antihypertensive medications can be used and given to patients with gestational hypertension.
- Fetal monitoring, fetal movement counting, non-stress testing, biophysical profile, and Doppler flow studies to check and assess the fetus’ movement and to assess if the fetus is under stress.
- Continued laboratory testing of the patient’s urine and blood and monitor changes that may indicate worsening of gestational hypertension.
- Medications that help to mature the lungs of the fetus can be given to the mother.
- Delivery of the baby if treatment and medications do not control gestational hypertension or if the patient is in danger cesarean delivery may be advised in some cases.
Prevention of Gestational Hypertension
Prevention of gestational hypertension includes early detection and identification of women at risk for gestational hypertension may help in the prevention of complications of diseases.
Knowledge about warning signs and symptoms is also important for the treatment and prevention of the worsening of the disease.
The pregnant woman should follow the doctor’s instructions and advice about her diet and exercise. Prevention of gestational hypertension also includes:
- use salt as needed for taste
- consume or drink at least 8 glasses of water a day
- increase the quantity of protein intake and reduce or decrease the number of fried and junk food intake
- have enough rest
- regularly exercise
- elevate feet several times during the day
- avoid consumption of beverages containing caffeine
Nursing Diagnosis for Gestational Hypertension
Nursing Care Plan for Gestational Hypertension 1
Nursing Diagnosis: Deficient Knowledge related to misinterpretation of information secondary to gestational hypertension as evidenced by statements of misconceptions, inaccurate response to instructions, and the presence of complications.
- The patient will be able to identify signs and symptoms that will require medical evaluation and management.
- The patient’s blood pressure will remain within acceptable and normal parameters.
- The patient will be able to show and perform the necessary procedure correctly.
- The patient will be able to express knowledge about the disease process and appropriate treatment and management plan.
Nursing Interventions for Gestational Hypertension
Assess the patient and the family member’s knowledge about the disease process and provide appropriate information about the pathophysiology of the condition. Evaluating the knowledge of the patient and the family members about gestational hypertension will help in establishing a database and it will also help provide information on which part of learning is needed.
Give proper information about the signs and symptoms of gestational hypertension and instruct the pregnant women when to inform and notify the nurse or the caregiver. This intervention will help ensure that the patient will seek timely treatment that would prevent complications from gestational hypertension.
Advise and encourage the family members about the proper ways of monitoring the patient and the patient’s blood pressure at home. Encouraging the family’s participation in the treatment regimen helps for providing immediate intervention as needed by the patient.
Instruct and teach the patient to follow a strict dietary regimen which includes low sodium, saturated fat, and cholesterol diet. If a patient has excess saturated fats, cholesterol, sodium, and calories in her diet the patient may be at risk of gestational hypertension, and a low-fat diet and an increase in polyunsaturated fat help in lowering the patient’s blood pressure.
Nursing Care Plan for Gestational Hypertension 2
Nursing Diagnosis: Decreased Cardiac Output related to increased systemic vascular resistance and decreased venous return secondary to gestational hypertension as evidenced by changes in blood pressure, edema, and decreased urine output.
- The patient will be able to perform activities in good condition and her blood pressure will remain normal.
- The patient will demonstrate and show adequate cardiac output as evidenced by blood pressure and pulse rate and rhythm within normal limits and the patient will have the ability to tolerate activities without symptoms of dyspnea, syncope, and chest pain.
Nursing Interventions for Gestational Hypertension
Evaluate and monitor the patient’s blood pressure and the patient’s pulse every hour or as indicated accurately. The patient’s blood pressure should be assessed and monitored accurately to detect hypertensive disorders and problems early.
Auscultate and evaluate the patient’s apical pulse and evaluate the patient’s heart rate and rhythm accurately. The presence of tachycardia may be present when the patient’s body compensates for the decrease in circulating volume that would be difficult to reach into the peripheries and distant tissues.
Assess and evaluate the patient’s neurological status and alterations in the patient’s sensorium. Evaluating the patient’s neurological status of the patient with gestational hypertension is important because decreased cardiac output may cause alteration in the patient’s sensorium due to inadequate cerebral perfusion.
Evaluate and assess the patient for indications for an emergency early delivery. If the patient experiences worsening gestational hypertension that may progress to preeclampsia that would mean a need for an emergency early delivery.
Assess and monitor the patient’s urine output accurately and instruct the patient to maintain strict monitoring of intake and output. If a patient experiences preeclampsia the patient’s kidneys respond by reducing the cardiac output and retaining water and sodium. Oliguria may happen due to intra-renal vasospasms in severe preeclampsia because of the reduction in the glomerular filtration rate.
Nursing Care Plan for Gestational Hypertension 3
Nursing Diagnosis: Risk for Imbalanced Excess Fluid Volume related to a fluid shift from intravascular space to the interstitial space and hormonal alterations in pregnancy secondary to gestational hypertension.
- The patient will be able to adhere to the therapeutic regimen and plan and the patient will participate in the regular monitoring of her condition as indicated.
- The patient will be able to express knowledge and understanding of the importance and need for close monitoring of weight, blood pressure, urine protein, and edema.
- The patient will be able to be free from the signs of generalized, pulmonary, and cerebral edema.
Nursing Interventions for Gestational Hypertension
Check and auscultate the patient’s lungs including the respiratory rate and respiratory effort accurately. If the patient experiences dyspnea and there is the presence of crackles this may indicate pulmonary edema that will need immediate treatment.
Check and monitor the patient’s weight regularly and accurately during her hospital visits and advise the patient to record her weight at home in between her visits. Accurate weight measurement is important and the same weighing scale should be used. The patient should use the same type of clothing at the same time of the day to detect a fluid shift from the vascular to the interstitial space, which would result in generalized edema.
Check and monitor the patient’s vital signs closely including the patient’s blood pressure and pulse rate accurately. If the patient’s blood pressure and pulse rate increase the fluid retention will increase and will cause a decrease in hydrostatic pressure that will inhibit fluid circulation and congestion of the lungs.
Assess and evaluate for progressive or excessive edema and assess for possible eclampsia. The nurse should assess the patient for signs of eclampsia which include epigastric pain, cerebral symptoms, nausea, and vomiting.
Nursing Care Plan for Gestational Hypertension 4
Nursing Diagnosis: Risk for Injury related to abnormal blood profile and clotting factors and tissue edema secondary to gestational hypertension.
- The patient will be able to participate in treatments and environmental modifications to protect herself and the patient’s safety will be enhanced.
- The patient will be able to demonstrate and show normal levels of clotting factors and liver enzymes.
- The patient will be able to maintain and follow a treatment regimen that will help control and eliminate seizure activity.
Nursing Interventions for Gestational Hypertension
Assess and evaluate the patient’s central nervous system involvement with the condition. A patient with cerebral edema who experiences vasoconstriction can be evaluated in terms of symptoms, behaviors, and changes in the retina. A patient with preeclampsia that experiences increase blood pressure may experience hypo perfusion, endothelial damage, or edema.
Check and evaluate the patient’s deep tendon reflexes and ankle clonus as indicated. The patient’s deep tendon reflexes become hyperactive due to the irritability of the central nervous system. Assess the deep tendon reflexes and ankle clonus accurately.
Check and evaluate for signs of labor at the patient’s every visit and ask the patient for the presence of contractions, vaginal bleeding, or leaking of fluid. It is important to assess for signs of labor during prenatal checkups to determine any pregnancy complications and to provide early interventions as needed.
Teach the patient about the measures that will help lessen the like hood or occurrence of seizures. To lessen the occurrence of seizures it is important to keep the room quiet and dim, limit visitors, plan and coordinate care and promote rest to lessen environmental factors that will help stimulate irritable cerebrum that causes a convulsive state.
Nursing Care Plan for Gestational Hypertension 5
Nursing Diagnosis: Imbalanced Nutrition: Less Than Body Requirements related to insufficient intake to meet metabolic demands and replace losses secondary to gestational hypertension as evidenced by proteinuria, disproportionate weight gains with gestational age, and edema.
- The patient will express and verbalize understanding about her individual dietary needs.
- The patient will be able to demonstrate knowledge of her proper diet as evidenced by developing a dietary plan considering the patient’s financial resources.
Nursing Interventions for Gestational Hypertension
Assess and evaluate the patient’s nutritional status, dietary intake, condition of the patient’s hair, nails, and height, and the patient’s pre-gravid weight. The nurse should establish guidelines to determine dietary needs and determine possible contributing factors to the onset of pre-eclampsia.
Assess and evaluate the patient’s nutritional status by taking the patient’s weight properly daily preferably before breakfast. Weighing the patient daily on the same weighing scale and with the same amount of clothes at the same time is important to assess the patient’s nutritional status accurately.
Instruct the patient about the proper information regarding normal weight gain pregnancy and adjust the information to meet the patient’s needs. Body mass index (BMI) should be checked and the patient should be advised that normal weight is important throughout pregnancy because it will reduce the risk of complications for the mother and the fetus. BMI is important to assess during pregnancy because it also helps the nurse in formulating proper interventions for nutrition.
Advise and instruct the patient to have frequent rest periods and limit activity to conserve which will help in conserving protein requirements. Bedrest and limited activity will help decrease metabolic rate and will limit the activity that reduces protein needs. Advising enough rest and instructing the patient about the appropriate dietary plans can help the patient conserve protein requirements.
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