Pregnancy Induced Hypertension

Pregnancy Induced Hypertension PIH Nursing Diagnosis Care Plan

Pregnancy Induced Hypertension PIH Nursing Diagnosis Care Plan NCLEX Review

Pregnancy Induced Hypertension PIH

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

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

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

  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

  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

  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

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 Care Plans

  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.

InterventionRationale
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 Care Plan 1
  • 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.

InterventionRationale
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.
PIH Nursing Care Plan 2

Other Nursing Diagnoses:

  • Altered Uteroplacental Tissue Perfusion
  • Risk for Maternal Injury
  • Risk for Imbalanced Nutrition: Less than Body Requirements
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