Hypertensive disorders of pregnancy (also known as pregnancy-associated hypertensive disorders, pregnancy induced hypertension) are the most common complications that occur during pregnancy and are a major cause of maternal and fetal morbidity and mortality. These disorders include gestational hypertension, preeclampsia, eclampsia, chronic hypertension, and chronic hypertension with superimposed preeclampsia. If left untreated, preeclampsia can lead to a life-threatening complication called HELLP (hemolysis, elevated liver enzymes, low platelet count) syndrome. It is estimated that preeclampsia alone complicates 2-8% of pregnancies globally. Show
Hypertensive disorders in pregnancy include five categories of hypertension and are defined as such by the American College of Obstetricians and Gynecologists (ACOG): Nursing care planning and management for pregnant clients with hypertensive disorders or preeclampsia involve early detection, thorough assessment, and prompt treatment of preeclampsia. Another priority is to ensure the mother’s safety and deliver a healthy newborn as close to a full term as possible. Here are six nursing diagnoses for your nursing care plans for pregnant patients with hypertensive disorders, focusing on managing clients with preeclampsia. Decreased Cardiac OutputA decrease in circulating blood volume due to the shifting of fluid from the intravascular to the interstitial spaces occurs in a pregnant client with a hypertensive disorder due to the decrease of the circulating blood volume and the total vascular volume and an increase in the systemic vascular resistance, the heart rate decreases as well as the stroke volume. These mechanisms lead to a decrease in cardiac output seen among clients with hypertensive disorders in pregnancy. Nursing Diagnosis
Related factors may include
Possibly evidenced by
Desired Outcomes
Nursing Assessment and Rationales1. Assess blood pressure and pulse every one (1) hour or as indicated. 2.
Assess the mean arterial pressure (MAP) at 11-13 and 20-24 weeks gestation. A pressure of 90 mm Hg is considered predictive of preeclampsia. 3. Assess for crackles, wheezes, and dyspnea; note respiratory rate/effort. Note client snoring. 4.
Auscultate for the apical pulse and assess the client’s heart rate and rhythm. 5. Assess the client’s neurological status. 6. Assess the client for visual disturbances. 7. Assess the client for indications for an earlier delivery. 8. Monitor and measure the client’s urine output as per protocol. Maintain strict intake and output. 9. Monitor and measure the client’s 24-hour urine for proteinuria. Nursing Interventions and Rationales1. Provide frequent rest periods with bed rest. Restrict activity rather than instituting complete bed rest. 2. Instruct the client to elevate legs when sitting or lying down. 3. Monitor the client’s BP and instruct monitoring of BP at home. 4. Record and graph vital signs, especially BP and pulse. 5. Monitor for invasive hemodynamic parameters such as cardiac output, as indicated. 6. Administer low-dose aspirin as indicated. 7. Administer antihypertensive medications as ordered. Observe for side effects of antihypertensive drugs.
8. Prepare for the birth of fetus by cesarean delivery, labor when severe preeclamptic or eclamptic condition is stabilized, but vaginal delivery is not feasible. Recommended nursing diagnosis and nursing care plan books and resources. Disclosure: Included below are affiliate links from Amazon at no additional cost from you. We may earn a small commission from your purchase. For more information, check out our privacy policy. References and sources for this nursing care plan for hypertensive disorders in pregnancy. Updated and reviewed by M. Belleza, R.N. and M. Vera, BSN, R.N. Which would the nurse implement before administering magnesium sulfate to a client with preeclampsia?The answer is D: The antidote for Magnesium Sulfate is Calcium Gluconate. The nurse should have this on hand in case Magnesium toxicity occurs.
What is the primary action of magnesium sulfate when given in preeclampsia?The mechanism of action of magnesium sulfate is thought to trigger cerebral vasodilation, thus reducing ischemia generated by cerebral vasospasm during an eclamptic event. The substance also acts competitively in blocking the entry of calcium into synaptic endings, thereby altering neuromuscular transmission.
Which condition in a pregnant patient with severe pre eclampsia is an indication for administering magnesium sulfate?Magnesium sulfate is the treatment of choice for women with preeclampsia to prevent eclamptic seizures (NNT = 100) and placental abruption (NNT = 100).
Why do you give magnesium sulfate in pregnancy?Magnesium sulfate is approved to prevent seizures in preeclampsia, a condition in which the pregnant woman develops high blood pressure and protein in the urine, and for control of seizures in eclampsia. Both preeclampsia and eclampsia are life-threatening complications that can occur during pregnancy.
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