Friday, September 11, 2009

Nursing Care Plans for Preeclampsia Pregnancy Induced Hypertension

. Friday, September 11, 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.
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. occure approximately 7% of all pregnant women. Almost preeclampsia case occurs before the fetus is term. primary goals in nursing care plan for preeclampsia is prevent seizures, intracranial hemorrhage, and serious organ damage in the mother and to deliver a healthy term infant. 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 Pregnancy Induced Hypertension PIH and its complications are the most common cause of maternal death in developed countries.

Causes for Preeclampsia
The cause of PIH is unknown. Geographic, ethnic, racial, nutritional, immunologic, and familial factors may contribute to preexisting vascular disease, which, in turn, may contribute to its occurrence. Age is also a factor. Adolescents and primiparas older than age 35 are at higher risk for preeclampsia. Other theories include a long list of potential toxic sources, such as autolysis of placental infarcts, autointoxication, uremia, maternal sensitization to total proteins, and pyelonephritis.

Complications for Preeclampsia
  • Intrauterine growth retardation (or restriction),
  • Placental infarcts, and
  • abruptio placentae.
  • Other possible complications include stillbirth of the neonate, seizures, coma, premature labor, renal failure, and hepatic damage in the mother.
Nursing Assessment Nursing Care Plans for Preeclampsia
  • A patient with mild preeclampsia typically reports a sudden weight gain,
  • The patient's history reveals hypertension
  • Inspection reveals generalized edema, especially of the face. Palpation may reveal pitting edema of the legs and feet.
  • Deep tendon reflexes may indicate hyperreflexia.
  • Oliguria
  • Blurred vision caused by retinal arteriolar spasms,
  • Epigastric pain or heartburn, irritability, and emotional tension.
  • Patient 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.

Diagnostic Highlights Nursing Care Plan For Preeclampsia
Hemolysis, elevated liver enzyme levels, and a low platelet count (HELLP syndrome) characterize severe eclampsia. A unique form of coagulopathy is also associated with this disorder.
  • Urine for protein and creatinine
  • Uric acid
  • Blood urea nitrogen (BUN)
  • Liver enzymes: AST, ALT, LDH,Bilirubin
  • Platelets
  • Coagulation studies
  • RBC (red blood cell)
  • Hgb (hemoglobin)
  • Hct (hematocrit)
Preeclampsia Treatment
Therapy for patients with preeclampsia is intended to halt the progress of the disorder specifically, the early effects of eclampsia, such as seizures, residual hypertension, and renal shutdown and to ensure fetal survival. Some physicians advocate the prompt inducement of labor, especially if the patient is near term; others follow a more conservative approach. Therapy may include:
  • complete bed rest in the preferred left lateral lying position to enhance venous return
  • an antihypertensive, such as methyldopa or hydralazine
  • magnesium sulfate to promote diuresis, reduce blood pressure, and prevent seizures if the patient's blood pressure fails to respond to bed rest and the antihypertensive and persistently rises above 160/100 mm Hg, or if central nervous system irritability increases.
  • If fetal life is endangered cesarean section or oxytocin inducement may be required to terminate the pregnancy.

Nursing diagnoses Nursing Care Plans for Preeclampsia
  • 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, Nursing interventions , Patient teaching , Nursing Care Plans for Preeclampsia Pregnancy Induced Hypertension


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