Pregnancy Induced Hypertension PIH Nursing Diagnosis Care Plan

Pregnancy Induced Hypertension PIH Nursing Care Plans Diagnosis and Interventions

Pregnancy Induced Hypertension PIH NCLEX Review and Nursing Care Plans

Pregnancy-induced hypertension (PIH), also known as gestational hypertension, is defined as the occurrence of hypertension during pregnancy.

While PIH requires simple methods of treatment and monitoring, it can lead to a serious complication called preeclampsia, which begins on the 20th week of pregnancy and is diagnosed if there is proteinuria or presence of protein in the urine ,in addition to hypertension.

Preeclampsia can put the mother and the baby at fatal risks, which why early detection and strict monitoring is important for pregnant women with PIH. Gestational hypertension can be found in about 7 to 10 percent pregnancies in the U.S. Once the baby is delivered, the mother’s blood pressure is expected to normalize within 6 weeks postpartum.

Signs and Symptoms Pregnancy Induced Hypertension PIH

Some pregnant women may not present with any signs and symptoms of PIH. The most common symptoms of PIH include:

  • persistent headaches
  • blurred vision
  • sensitivity to light
  • abdominal pain
  • fatigue
  • nausea and/or vomiting
  • edema or swelling in extremities
  • weight gain

Causes of Pregnancy Induced Hypertension PIH

PIH has an unknown cause. However, there are some risk factors that may contribute to the development of PIH, including:

  • PIH with a previous pregnancy
  • pre-existing hypertension
  • diabetes
  • kidney disease
  • Age of the mother (younger than 20 or older than 40)
  • multiple fetuses (such as twins, triplets, etc.)


Complications of Pregnancy Induced Hypertension PIH

  1. Pre-eclampsia. This complication of PIH is mainly characterized by high blood pressure and proteinuria. There can also be some dysfunction in the organs of the mother, such as elevated liver enzymes, thrombocytopenia (low platelet count) or renal insufficiency. This is due to the increased resistance in the blood vessels as blood pressure elevates, resulting to a lesser supply of blood to the liver, kidneys, brain, placenta, and uterus. If left untreated, it may lead to eclampsia, which involves the development of seizures, or coma.
  2. Uteroplacental dysfunction. Uncontrolled PIH may lead to restriction of fetal growth or stillbirth.

Diagnostic Tests of Pregnancy Induced Hypertension PIH

  1. Blood pressure monitoring – consistently high blood pressure levels during 2-3 monthly checkups
  2. Urinalysis – to check for proteinuria
  3. Weight monitoring – weight gain is one of the symptoms of PIH
  4. Physical assessment – to check for edema, visual changes, etc.
  5. Retinal examination
  6. Ultrasound transducer and non-stress test – to monitor the heart rate of the baby

Treatment of Pregnancy Induced Hypertension PIH

  1. Antihypertensive medications. The doctor may prescribe appropriate anti-hypertensives such as magnesium sulfate to control the blood pressure levels.
  2. Blood pressure monitoring. Part of the treatment plan is to closely monitor the blood pressure levels. The mother or a family member may be instructed on how to perform blood pressure monitoring at home.
  3. Fetal health monitoring. The healthcare team may use different methods to monitor the baby, including biophysical profile, non-stress test, and Doppler flow studies.
  4. Corticosteroids. This may be required to make the baby’s lung development go faster.
  5. Delivery. PIH usually resolves after the delivery of the baby.
  6. Bedrest and stress management. To ensure that blood pressure levels are well-controlled.
  7. Adequate hydration, low salt diet, and regular prenatal checkups are also important.

Prevention of Pregnancy Induced Hypertension PIH

Encourage the mother to drink at least 8 glasses of fluids a day and consume less salt in her meals. Low impact exercises for 30 minutes a day is also recommended to prevent PIH.

If not contraindicated by the physician. Advise the mother to put up her feet on a stack of 2 pillows while sleeping to improve blood circulation and reduce edema of the legs and feet.

Nursing Diagnosis for Pregnancy Induced Hypertension PIH

Pregnancy Induced Hypertension PIH Nursing Care Plan 1

Nursing Diagnosis: Deficient Fluid Volume related to osmotic pressure secondary to pregnancy induced hypertension, as evidenced by an average blood pressure level of 180/90, grade 1 pitting ankle edema, persistent headaches, sudden weight gain over the last 4 weeks, and epigastric pain

Desired Outcome: The patient will participate in the therapeutic regimen and close monitoring, and will be free from the signs of deficient fluid volume such as edema, headaches, and epigastric pain.

Pregnancy Induced Hypertension PIH Nursing InterventionsRationale
Assess vital signs, conduct physical examination, and commence daily weight monitoring.Edema, headaches, visual disturbances, and epigastric pain are associated with the patient’s high blood pressure level. Weight gain is an important symptom of PIH. Fluid retention may be evident if the mother has a weight gain of more than 1.5kg/month during the 2nd trimester, or more than 0.5 kg/week during the 3rd trimester.
Start input and output monitoring. Perform urine dipstick analysis using a midstream urine (MSU).To monitor circulatory blood volume. To ensure that the mother has adequate oral hydration or if there is a need to commence IV hydration therapy. To check for the presence of protein in the urine.
Provide a schedule of at least every weeks for prenatal visit of a pregnant woman with mild PIH, and weekly visits if PIH is severe. Consider hospitalization for severe PIH.To closely monitor the symptoms of PIH and deficient fluid volume in the appropriate setting.
  Refer the patient to a dietitian for proper monitoring and advice of salt, caloric and protein intake.  Low calories and protein in the diet may worsen PIH and indirectly cause edema formation. Consuming salt between 2 to 4 g per day is ideal as very low salt intake may increase dehydration, while high salt intake may cause edema formation.

Pregnancy Induced Hypertension PIH Nursing Care Plan 2

Nursing Diagnosis: Decreased cardiac output related to increased systemic vascular resistance secondary to PIH, as evidenced by an average blood pressure level of 180/90, shortness of breath, and bilateral leg edema

Desired Outcome: The patient will have an improved cardiac output through well-controlled blood pressure levels throughout the remainder of her pregnancy.

Pregnancy Induced Hypertension PIH Nursing InterventionsRationale
Assess vital signs, conduct physical examination, and commence daily weight monitoring.Edema, headaches, visual disturbances, and epigastric pain are associated with the patient’s high blood pressure level. Weight gain is an important symptom of PIH. Fluid retention may be evident if the mother has a weight gain of more than 1.5kg/month during the 2nd trimester, or more than 0.5 kg/week during the 3rd trimester.
Instruct the patient to have bedrest and avoid environmental stressors.To lower blood pressure levels, improve cardiac rate, and enhance renal-placental perfusion.
Administer hypertensives as prescribed.To lower blood pressure levels. Common antihypertensives for PIH include hydralazine, MgSO4, and nifedipine.
Prepare to deliver the baby either by labor induction or Cesarean section.PIH usually goes away 6 months post partum. The baby may be delivered earlier than expected if the risks for the mother and the baby become higher.

Pregnancy Induced Hypertension PIH Nursing Care Plan 3

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.

Pregnancy Induced Hypertension PIH Nursing 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 PIH Nursing Care Plan 4

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.

          Pregnancy Induced Hypertension PIH Nursing 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 PIH Nursing Care Plan 5

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.

          Pregnancy Induced Hypertension PIH Nursing 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 PIH Nursing Care Plan 6

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.

Pregnancy Induced Hypertension PIH Nursing InterventionsRationale
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 PIH Nursing Care Plan 7

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.

Pregnancy Induced Hypertension PIH Nursing 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 caregiver 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 caregiver beside her at all times and ensure her safety and assist her to perform activities of daily living.

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.

Nursing References

Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier.  Buy on Amazon

Gulanick, M., & Myers, J. L. (2022). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon

Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2018). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier.  Buy on Amazon

Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier.  Buy on Amazon

Disclaimer:

Please follow your facilities guidelines, policies, and procedures.

The medical information on this site is provided as an information resource only and is not to be used or relied on for any diagnostic or treatment purposes.

This information is intended to be nursing education and should not be used as a substitute for professional diagnosis and treatment.

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Anna C. RN, BSN, PHN

Anna C. RN, BSN, PHN
Clinical Nurse Instructor

Emergency Room Registered Nurse
Critical Care Transport Nurse
Clinical Nurse Instructor for LVN and BSN students

Anna began writing extra materials to help her BSN and LVN students with their studies. She takes the topics that the students are learning and expands on them to try to help with their understanding of the nursing process.

Her experience spans almost 30 years in nursing, starting as an LVN in 1993. She received her RN license in 1997. She has worked in Medical-Surgical, Telemetry, ICU and the ER. She found a passion in the ER and has stayed in this department for 30 years.

She is a clinical instructor for LVN and BSN students along with a critical care transport nurse.

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