Pregnancy-induced hypertension (PIH), also known as gestational hypertension, is a condition characterized by high blood pressure that develops during pregnancy, typically after 20 weeks of gestation.
This condition can pose significant risks to both the mother and the fetus, making it crucial for healthcare providers to promptly diagnose and manage it effectively.
This article will explore the nursing diagnosis, assessment, interventions, and care plans for patients with pregnancy-induced hypertension.
Understanding Pregnancy-Induced Hypertension
Pregnancy-induced hypertension is defined as a systolic blood pressure ≥ 140 mmHg and diastolic blood pressure ≥ 90 mmHg on two occasions at least 4 hours apart in a previously normotensive woman after 20 weeks of gestation.
PIH can progress to preeclampsia if left untreated, which is characterized by the presence of proteinuria or other signs of end-organ damage.
Causes and Risk Factors
The exact cause of pregnancy-induced hypertension remains unknown. However, several risk factors have been identified:
- First pregnancy
- Age (younger than 20 or older than 35)
- Family history of PIH or preeclampsia
- Multiple gestation
- Chronic hypertension
- Diabetes mellitus
- Kidney disease
- Obesity
- Autoimmune disorders
Signs and Symptoms
Patients with pregnancy-induced hypertension may present with the following signs and symptoms:
Subjective (Patient reports):
- Headaches
- Visual disturbances (blurred vision, seeing spots)
- Upper abdominal pain
- Shortness of breath
- Rapid weight gain
Objective (Nurse assesses):
- Elevated blood pressure (≥ 140/90 mmHg)
- Edema, particularly in the face, hands, and feet
- Hyperreflexia
- Proteinuria (in cases progressing to preeclampsia)
- Decreased urine output
- Abnormal liver function tests
- Low platelet count
Nursing Assessment
A thorough nursing assessment is crucial for early detection and management of pregnancy-induced hypertension. The following steps should be included in the evaluation:
Obtain a comprehensive health history, including:
- Current pregnancy details
- Previous pregnancies and outcomes
- Family history of hypertensive disorders
- Pre-existing medical conditions
Perform a physical examination:
- Monitor vital signs, especially blood pressure
- Assess for edema (face, hands, feet, and sacral area)
- Check for hyperreflexia
- Evaluate respiratory status
- Assess for signs of fetal distress
Review laboratory results:
- Urine protein levels
- Complete blood count (CBC)
- Liver function tests
- Renal function tests
Evaluate fetal well-being:
- Fetal heart rate monitoring
- Ultrasound for growth assessment
- Amniotic fluid index
Assess the patient’s knowledge of PIH and its potential complications
Evaluate the patient’s support system and resources
Nursing Interventions
Effective nursing interventions are critical in managing pregnancy-induced hypertension and preventing complications. Key interventions include:
Monitor blood pressure frequently:
- At least every 4 hours in mild cases
- More regularly in severe cases or during labor
Administer antihypertensive medications as prescribed:
- Common medications include labetalol, nifedipine, and methyldopa
Monitor fetal well-being:
- Perform non-stress tests or biophysical profiles as ordered
- Track fetal movement counts
Implement seizure precautions:
- Ensure a safe environment
- Have seizure equipment readily available
Administer magnesium sulfate as prescribed for seizure prophylaxis
Monitor fluid intake and output:
- Maintain accurate intake and output records
- Assess for signs of fluid overload or dehydration
Provide bed rest or limited activity as prescribed:
- Encourage left lateral positioning to improve uteroplacental blood flow
Educate the patient and family about:
- Signs and symptoms of worsening PIH
- Importance of medication adherence
- Dietary recommendations (low sodium diet)
- Stress reduction techniques
Prepare for possible early delivery:
- Educate about the possibility of preterm birth
- Arrange for neonatal intensive care unit (NICU) consultation if needed
Provide emotional support:
Nursing Care Plans
The following nursing care plans address common issues associated with pregnancy induced hypertension:
Care Plan 1: Risk for Maternal Injury
Nursing Diagnosis Statement:
Risk for Maternal Injury related to increased intracranial pressure secondary to pregnancy-induced hypertension.
Related factors/causes:
- Elevated blood pressure
- Cerebral edema
- Potential for seizures
Nursing Interventions and Rationales:
- Monitor blood pressure every 1-2 hours or as ordered.
Rationale: Frequent monitoring allows for early detection of significant changes in blood pressure. - Administer antihypertensive medications as prescribed.
Rationale: Proper medication management helps control blood pressure and reduce the risk of complications. - Implement seizure precautions (padded side rails, bed in low position).
Rationale: These measures ensure patient safety in case of a seizure. - Assess neurological status every 2-4 hours, including level of consciousness and presence of headaches.
Rationale: Regular neurological checks help detect early signs of increased intracranial pressure or impending eclampsia. - Educate the patient about signs and symptoms to report immediately (severe headache, visual changes, epigastric pain).
Rationale: Patient awareness promotes early reporting of potentially serious symptoms.
Desired Outcomes:
- The patient will remain free from injury throughout the hospital stay.
- The patient will demonstrate stable blood pressure readings within the target range.
- The patient will verbalize understanding of signs and symptoms to report.
Care Plan 2: Ineffective Uteroplacental Tissue Perfusion
Nursing Diagnosis Statement:
Ineffective Uteroplacental Tissue Perfusion related to vasoconstriction secondary to pregnancy-induced hypertension.
Related factors/causes:
- Vasospasm of uterine arteries
- Reduced blood flow to the placenta
- Potential for fetal distress
Nursing Interventions and Rationales:
- Monitor fetal heart rate and reactivity as ordered.
Rationale: Fetal heart rate patterns can indicate adequacy of uteroplacental perfusion. - Encourage left lateral positioning when the patient is in bed.
Rationale: This position optimizes uteroplacental blood flow by reducing pressure on the inferior vena cava. - Assess fetal movement counts and educate the patient on how to perform them.
Rationale: Decreased fetal movement can be an early sign of fetal distress due to inadequate perfusion. - Administer oxygen as prescribed.
Rationale: Oxygen therapy can improve fetal oxygenation in cases of compromised uteroplacental perfusion. - Prepare for possible emergency cesarean delivery.
Rationale: Severe uteroplacental insufficiency may necessitate immediate delivery to ensure fetal well-being.
Desired Outcomes:
- Fetal heart rate will remain within normal parameters.
- The patient will report adequate fetal movement.
- Fetal growth will remain within expected ranges for gestational age.
Care Plan 3: Excess Fluid Volume
Nursing Diagnosis Statement:
Excess Fluid Volume related to sodium and water retention secondary to pregnancy-induced hypertension.
Related factors/causes:
- Altered regulatory mechanisms
- Decreased plasma osmotic pressure
- Capillary leak syndrome
Nursing Interventions and Rationales:
- Monitor daily weights and compare them to pre-pregnancy weight.
Rationale: Rapid weight gain can indicate fluid retention. - Assess for edema, especially in dependent areas and the face.
Rationale: Edema is a common sign of excess fluid volume in PIH. - Monitor intake and output strictly.
Rationale: Accurate fluid balance assessment helps guide management. - Administer diuretics as prescribed.
Rationale: Diuretics may be used to manage severe fluid retention. - Educate the patient on a sodium-restricted diet.
Rationale: Reducing sodium intake can help manage fluid retention.
Desired Outcomes:
- The patient will demonstrate stable weight without rapid increases.
- The patient will show reduced edema.
- The patient will maintain urine output within normal limits (30-50 mL/hour).
Care Plan 4: Anxiety
Nursing Diagnosis Statement:
Anxiety related to concerns about maternal and fetal well-being secondary to pregnancy-induced hypertension diagnosis.
Related factors/causes:
- Uncertainty about pregnancy outcome
- Fear of complications
- Lack of knowledge about the condition
Nursing Interventions and Rationales:
- Assess the patient’s level of anxiety and understanding of the condition.
Rationale: This helps tailor interventions to the patient’s specific needs and concerns. - Provide clear, concise information about PIH, its management, and potential outcomes.
Rationale: Knowledge can help reduce anxiety and promote compliance with treatment. - Teach relaxation techniques such as deep breathing and guided imagery.
Rationale: These techniques can help manage stress and potentially lower blood pressure. - Encourage expression of feelings and concerns.
Rationale: Emotional support can help reduce anxiety and improve coping. - Involve the patient’s support person in care and education when appropriate.
Rationale: Family involvement can provide additional emotional support and reinforce teaching.
Desired Outcomes:
- The patient will verbalize decreased anxiety levels.
- The patient will demonstrate the use of relaxation techniques when feeling anxious.
- The patient will express an understanding of the condition and its management.
Care Plan 5: Risk for Impaired Fetal Growth and Development
Nursing Diagnosis Statement:
Risk for Impaired Fetal Growth and Development related to placental insufficiency secondary to pregnancy-induced hypertension.
Related factors/causes:
- Reduced uteroplacental blood flow
- Potential for preterm delivery
- Maternal complications affecting fetal well-being
Nursing Interventions and Rationales:
- Monitor fetal growth through serial ultrasounds as ordered.
Rationale: Regular growth assessments can detect intrauterine growth restriction early. - Perform daily fetal movement counts and educate the patient on how to do them.
Rationale: Decreased fetal movement can indicate fetal distress. - Administer corticosteroids as prescribed if preterm delivery is anticipated.
Rationale: Corticosteroids promote fetal lung maturity in case of preterm birth. - Ensure adequate maternal nutrition and supplement intake as prescribed.
Rationale: Proper nutrition supports optimal fetal growth and development. - Prepare for the possible need for neonatal intensive care.
Rationale: Infants born to mothers with PIH may require specialized care after delivery.
Desired Outcomes:
- Fetal growth measurements will remain within expected ranges for gestational age.
- The patient will report consistent fetal movement patterns.
- If preterm delivery occurs, the infant will show minimal complications related to prematurity.
Expected Outcomes
With proper nursing care and management, patients with pregnancy-induced hypertension can expect the following outcomes:
- Maintenance of blood pressure within the target range
- Absence of progression to severe preeclampsia or eclampsia
- Adequate fetal growth and well-being
- Delivery of a healthy infant at or near term
- Minimal maternal complications
- Return to normotensive state postpartum
Conclusion
Pregnancy-induced hypertension requires vigilant nursing care to ensure the best possible outcomes for both mother and baby.
References
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- Creasy, R. K., Resnik, R., Iams, J. D., Lockwood, C. J., Moore, T. R., & Greene, M. F. (2019). Creasy and Resnik’s maternal-fetal medicine: principles and practice. Elsevier Health Sciences.
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- Norwitz, E. R., & Repke, J. T. (2019). Management of preeclampsia. UpToDate. Retrieved from https://www.uptodate.com/contents/management-of-preeclampsia
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