Thursday, February 26, 2009

Nursing Care Plan For Pregnancy Induced Hypertension (PIH) Preeclampsia and Eclampsia

. Thursday, February 26, 2009

Pregnancy-induced hypertension (PIH) is a potentially life-threatening disorder that usually develops after the 20th week of pregnancy. It typically occurs in nulliparous women and may be nonconvulsive or convulsive. Preeclampsia, the nonconvulsive form of the disorder, is marked by the onset of hypertension after 20 weeks of gestation. It develops in about 7% of pregnancies and may be mild or severe. The incidence is significantly higher in low socioeconomic groups.
Eclampsia, the convulsive form, occurs between 24 weeks' gestation and the end of the first postpartum week. The incidence increases among women who are pregnant for the first time, have multiple fetuses, and have a history of vascular disease. About 5% of women with preeclampsia develop eclampsia; of these, about 15% die of eclampsia or its complications. Fetal mortality is high because of the increased incidence of premature delivery PIH and its complications are the most common cause of maternal death in developed countries.

Cause of Preeclampsia 
The cause of preeclampsia is unknown, it is often called the “DISEASE OF THEORIES” because many causes have been proposed, yet none has been well established. than how does preeclampsia occur Experts believe that decreased levels of prostaglandins and a decreased resistance to angiotensin II lead to a generalized arterial vasospasm that then causes endothelial damage. The brain, liver, kidney, and blood are particularly susceptible to multiple dysfunctions. Several risk factors have been identified that may predispose a woman to developing preeclampsia: nulliparity; familial history; multiple gestation; patient history of diabetes mellitus, chronic hypertension, renal disease, trophoblastic disease, and malnutrition.

Generalized arteriolar vasoconstriction is thought to produce decreased blood flow through the placenta and maternal organs. This decrease can result in intrauterine growth retardation, placental infarcts, and abruptio placentae. Hemolysis, elevated liver enzyme levels, and a low platelet count characterize severe eclampsia. A unique form of coagulopathy is also associated with this disorder. Other possible complications include stillbirth of the neonate, seizures, coma, premature labor, renal failure, and hepatic damage in the mother.

Assessment Nursing care Plans For Pregnancy Induced Hypertension
A patient with mild preeclampsia typically reports a sudden weight gain of more than 3 lb (1.4 kg) per week during the second trimester or more than 1 lb (0.5 kg) per week during the third trimester.
The patient's history reveals hypertension, as evidenced by elevated blood pressure readings: 140 mm Hg or more systolic, or an increase of 30 mm Hg or more above the patient's normal systolic pressure, measured on two occasions, 6 hours apart; and 90 mm Hg or more diastolic, or an increase of 15 mm Hg or more above the patient's normal diastolic pressure, measured on two occasions, 6 hours apart.
Inspection reveals generalized edema, especially of the face. Palpation may reveal pitting edema of the legs and feet. Deep tendon reflexes may indicate hyperreflexia.
As preeclampsia worsens, the patient may demonstrate oliguria (urine output of 400 ml/day or less), blurred vision caused by retinal arteriolar spasms, epigastric pain or heartburn, irritability, and emotional tension. She may complain of a severe frontal headache.
In a patient with severe preeclampsia, blood pressure readings increase to 160/110 mm Hg or higher on two occasions, 6 hours apart, during bed rest. Also, ophthalmoscopic examination may reveal vascular spasm, papilledema, retinal edema or detachment, and arteriovenous nicking or hemorrhage.
Preeclampsia can suddenly progress to eclampsia with the onset of seizures. The patient with eclampsia may appear to cease breathing, then suddenly take a deep, stertorous breath and resume breathing. The patient may then lapse into a coma, lasting a few minutes to several hours. Awakening from the coma, the patient may have no memory of the seizure. Mild eclampsia may involve more than one seizure; severe eclampsia, up to 20 seizures.
Physical examination findings in a patient with eclampsia are similar to those of a patient with preeclampsia but more severe. Systolic blood pressure may increase to 180 mm Hg and even to 200 mm Hg. Inspection may reveal marked edema, but some patients exhibit no visible edema.

Diagnostic tests
Blood Hematocrit
Renal Function
Serum uric acid
Creatinine clearance
Coagulation Platelets
Fibrin degradation products

Nursing diagnoses Nursing Care Plan For Pregnancy Induced Hypertension

  • Activity intolerance
  • Anxiety
  • Disturbed sensory perception (visual)
  • Disturbed thought processes
  • Excess fluid volume
  • Fear
  • Impaired urinary elimination
  • Ineffective coping
  • Ineffective tissue perfusion: Cerebral, peripheral
  • Risk for injury

Key outcomes

  • The patient will be able to perform activities of daily living without excessive fatigue.
  • The patient will identify strategies to reduce anxiety.
  • The patient will maintain optimal functioning within the confines of the visual impairment.
  • The patient will maintain orientation to environment.
  • The patient's fluid volume will remain within normal parameters.
  • The patient will verbalize fears and concerns.
  • The patient's urine output will remain within normal limits.
  • The patient will demonstrate adaptive coping behaviors.
  • The patient will exhibit signs of adequate cerebral and peripheral perfusion.
  • The patient will avoid complications

Nursing interventions, Rationales  And Patient teaching
Related to nursing diagnosis

Nursing Management Of Preeclampsia


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