pregnancy induced hypertension

Nursing Care Plans for Pregnancy Induced Hypertension PIH

Pregnancy Induced Hypertension PIH Nursing Diagnosis Care Plans

Pregnancy-induced hypertension (PIH) is a medical condition wherein the pregnant mother experiences elevated blood pressure levels during pregnancy.

It is sometimes called gestational hypertension, and can progress to a serious complication known as preeclampsia which can put a life-threatening risk for both the mother and her baby.

Below are 5 effective Pregnancy Induced Hypertension nursing care plans that can be used to deliver excellent nursing care to a pregnant patient with PIH.

  1. Nursing Diagnosis: Altered Uteroplacental Tissue Perfusion related to maternal hypovolemia secondary to pregnancy-induced hypertension, as evidenced by intrauterine fetal growth retardation viewed in the scans, and changes in fetal heart rate

       Desired Outcome: Patient has stable fetal heat rate when subjected to contraction stress test.

InterventionsRationales
Teach the patient and her partner or next of kin on how to perform home assessment which includes noting daily fetal movements and identifying signs of fetal distress and how to get help immediately.Decrease in fetal activity may mean fetal compromise or distress, which requires immediate medical attention.  
Encourage the pregnant patient to follow a healthy lifestyle, such as smoking cessation and avoidance of illegal drug use, proper hydration, enough sleep, and appropriate diet.Fetal movement and activity can be affected by cigarette smoking, drug abuse, dehydration, sleep deprivation, and poor dietary choices.
Educate the patient on the signs of abruptio placenta and instruct to get help immediately if any of these occur.To give the patient enough information on the warning signs of abruptio placentae, which include uterine tenderness, vaginal bleeding, decreased fetal activity, and abdominal pain.  
Monitor fetal growth by measuring the fundus, and check fetal heart rate at each clinic visit.To determine if the baby is experiencing intrauterine growth retardation related to PIH.  
If the baby needs to be delivered prematurely, give IM corticosteroids as prescribed, not more than 7 days prior to expected date of delivery.To enhance the production of surfactants which are necessary to speed up the pulmonary maturity of the fetus and avoid respiratory distress syndrome.
Pregnancy Induced Hypertension Nursing Care Plan 1
  • Nursing Diagnosis: Risk for Maternal Injury related to tissue edema

Desired Outcome: The patient will maintain safety and participate in measures that will protect self during pregnancy.

          Interventions                       Rationale
Assess the patient’s mental status, grading of edema or any CNS involvement (headaches, visual disturbances, or irritability).Persistent PIH may cause vasoconstriction, peripheral edema, and cerebral edema, which may be evidenced by retinal changes, restless behaviors, and severe headaches. All of these increase the patient’s risk for maternal injury.
Monitor the patient’s level of consciousness using AVPU.  Cerebral edema and vasoconstriction reduce the oxygen supply in the brain, which may result to celebral ischemia and is evidences by lower levels of consciousness using AVPU scale (i.e. instead of Alert, the patient is only responsive to Voice, Pain stimuli, or Unresponsive/unconscious).
Prepare the patient for admission if there is any evidence of CNS involvement.To allow the healthcare team to monitor the pregnant mother and her baby, and to provide IV MgSO4 or other prescribed treatments as deemed necessary.
Place the patient in complete bed rest during severe headaches.Stress causes a persistent increase in cortisol levels, which has been linked to people with hypertension. The effects of stress are likely to increase myocardial workload.
Pregnancy Induced Hypertension Nursing Care Plan 2
  • Nursing Diagnosis: Acute Pain related to Increased cerebral vascular pressure as evidenced by  pain score of 8 out of 10, verbalization of severe headache, throbbing pain on the suboccipital region,  blood pressure level of 170/90, nausea, and loss of appetite

Desired Outcome: The patient will demonstrate relief of pain as evidenced by a pain score of 0 out of 10, stable vital signs, and gaining a better appetite.

 Interventions Rationale
Administer prescribed pain medications. Administer anti-hypertensive medications. Check that every medication is safe for the pregnant patient and her baby.To alleviate the severe headache. To treat the underlying cause of acute suboccipital pain, which is hypertension.
Assess the patient’s vital signs and characteristics of pain at least 30 minutes after administration of medication.  To monitor effectiveness of medical treatment for the pain relief. The time of monitoring of vital signs may depend on the peak time of the drug administered.  
Put cool cloth on the forehead and perform gentle back rubs and neck rubs. Educate patient on stress management through deep breathing exercises, and relaxation techniques.To decrease cerebral vascular pressure and promote blocking of sympathetic response
Place the patient in complete bed rest during severe headaches.Stress causes a persistent increase in cortisol levels, which has been linked to people with hypertension. The effects of stress are likely to increase myocardial workload.
Pregnancy Induced Hypertension Nursing Care Plan 3

4. Nursing Diagnosis: Risk for Imbalanced Nutrition: Less than Body Requirements related to insufficient intake to meet metabolic demand

Desired Outcome: The patient will be able to achieve a weight within her normal BMI range, demonstrating healthy eating patterns and choices during pregnancy.

InterventionRationale
Explain to the patient the relationship between PIH and malnutrition. Inform the patient the normal weight gain expected during the different stages of pregnancy.To help the patient understand that malnutrition can contribute to the development of PIH. This involves having a low protein and/or caloric intake and being overweight or underweight by 20% prior to pregnancy.
Create a daily weight chart and a food and fluid chart. Discuss with the patient the short term and long-term goals of achieving/maintaining an ideal weight during pregnancy.To effectively monitory the patient’s daily nutritional intake and progress in weight goal.
Help the patient to select appropriate dietary choices to avoid protein deficiency.A daily intake of 80 to 100g of protein is ideal to achieve stable oncotic pressure and replace any proteins excreted by the body through the passage of urine.
Refer the patient to the dietitian.To provide a more specialized care for the patient in terms of nutrition and diet in relation to PIH.  
Pregnancy Induced Hypertension Nursing Care Plan 4
  • Nursing Diagnosis: Activity Intolerance related to imbalance between oxygen supply and demand secondary to pregnancy-induced hypertension as evidenced by fatigue, overwhelming lack of energy, verbalization of tiredness, and an average blood pressure level of 180/90.

Desired Outcome: The patient will demonstrate alternate periods of desired activities and rest/sleep.

InterventionsRationales
Assess the patient’s activities of daily living, as well as actual and perceived limitations to physical activity. Ask for any form of exercise that he/she used to do or wants to try. Ensure that the exercise is safe to perform during the patient’s current stage of pregnancy.To create a baseline of activity levels and mental status related to fatigue and activity intolerance.
Encourage progressive activity through self-care and exercise as tolerated. Explain the need to reduce sedentary activities such as watching television and using social media in long periods. Alternate periods of physical activity with rest and sleep.To gradually increase the patient’s tolerance to physical activity.
Teach deep breathing exercises and relaxation techniques.   Provide adequate ventilation in the room.To allow the patient to relax while at rest and to facilitate effective stress management. To allow enough oxygenation in the room.
Encourage the next of kin, relative, or carer of the pregnant patient to participate in her care, such as monitoring hydration and diet, and activities of daily living where the patient require a helping hand.PIH may cause fatigue and exhaustion of the pregnant patient, so it is best to have the partner or a carer beside her at all times and ensure her safety and assist her to perform activities of daily living.
Pregnancy Induced Hypertension Nursing Care Plan 5

PIH is a manageable health condition that can be monitored and treated properly with the above nursing care plans. The overall goal is to ensure the safety of both the mother and her baby.

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