PREGNANCY INDUCED HYPERTENSION (PIH) 1.

Gestational Hypertension
 Mother experiences elevation of
HYPERTENSION blood pressure to 140/90mmHg but
 Generally it is a condition of having: without any signs of edema and
 systolic blood pressure of proteinuria.
>140mmHg  NURSING MGT:
 diastolic pressure of >90 mmHg.  Monitoring of blood pressure
to ensure preeclampsia will
not develop.
- The perinatal mortality is not increased.
There is no need for drug therapy. The blood
pressure of the mother will return to normal
after birth.

TYPES OF HYPERTENSIVE DISORDER

 Pregnancy Induced Hypertension
 Transitional Hypertension
 Chronic Hypertension

PREGNANCY INDUCED HYPERTENSION (PIH)

 A condition in which vasospasm occurs
during pregnancy in both small and large
arteries.
- Vasospasm = is the narrowing of blood
vessels w/c causes vasoconstriction
 Originally, referred to as TOXEMIA
because toxins of some kind being
produced by a woman in response to a
foreign protein of the growing fetus later
on not proven as authorities failed to
find any toxins.
 The elevation of blood pressure usually
occurs after 20th weeks of gestation
 CAUSE: Unknown - Perfusion = passage of blood through blood
 Classification vessels
 Gestational Hypertension - Glomeruli Filtration Rate (GFR) = amount of
 Pre-eclampsia blood being filtered by the kidney
 Eclampsia - Increased permeability = natatapon or
- This condition occurs to 5% - 7% of nakakatakas yung protein papunta sa ihi
pregnancy. - Blood Urea Nitrogen (BUN) = a waste
- This is highly correlated with product that your kidneys remove from your
antiphospholipid syndrome (the presence blood
of antiphospholipid antibodies in the - Creatinine = a waste product that comes
maternal blood causes initiation of from the normal wear and tear on muscles
coagulation [blood clot formation] in the of the body.
arteries and veins w/c results to PIH. - Edema = because of fluid shifting.
- This condition tends to occur more
frequently with woman of color, multiple 2. Pre-eclampsia
pregnancies, primipara younger than 20 yrs.
old or older than 40 yrs. of age, woman from RISK FACTORS: (PHLOWED)
low socioeconomic background, 5 or more  P – primiparas younger than 20 years of
pregnancies, hydramnios, those with age or older than 35-40 years old (due to
underlying comorbidity (diabetes with 1st exposure to chorionic villi)
vessels, heart disease, renal involvement),  H – high parity (5 or more)
and essential hypertension.  L – low socio-economic status (due to
poor nutrition of protein, calcium and
magnesium)
  O – obesity, (multiple pregnancy)
 W – With history of hypertension, with
diabetes mellitus, with kidney diseases.
 E – end stage renal disease
 D – diabetes mellitus
TRIAD SIGNS: (HEP)
Mother experiences elevation of BP with signs of
edema, & proteinuria which occurs after 20th
weeks of pregnancy.
 H – Hypertension
 E – Edema
 P - Proteinuria
- Vasospasm occurs because of increase
cardiac output or blood volume required in
pregnancy due to increased fetal demand.
With increased blood volume, it will injure
the endothelial cells of the arteries and can
reduce the action of prostacyclin and xauses
excess production of thromboxane. Also, it
can cause platelet aggregation.
- Prostacyclin = considered as prostaglandin
vasodilator.
- Thromboxane = it is a prostaglandin
vasoconstrictor.
- Oliguria = dreceased urine output
- Scotoma = a part ng vision ay malabo
- Albumin or Protein = it help keeps fluid from
leaking out of blood vessels; prevents fluid
from going to interstitial spaces
- Thrombocytopenia = lowered platelet
count; it occurs as the platelets cluster at the
site of endothelial damage
Types of Pre-eclampsia
1. Mild Pre-eclampsia
2. Severe Pre-eclampsia
3. Eclampsia
1. Mild Pre-eclampsia
 Any status above gestational
hypertension and below a point of
seizures
 ASSESSMENT:
 BP: 140/90mmHg
- It is very important to assess the diastolic
pressure because it is this pressure that
describe the degree of peripheral arterial
spasm present.
 PROTEIN: +1 - +2 or greater or
equal to 300 mg/liter on a 24hour
urine collection
 Increased in weight (first sign)
 2nd tri: 2-3lb/week
 3rd tri: 4.5lb/week
- Weight gain happens because nagkakaroon
ng increased kidney tubular reabsorption
(sodium retention).
 IDEAL WEIGHT GAIN:
 1st tri: 1.5-3 lbs (1lb /month)
 2nd tri: 10-12lbs (4lbs/ month)
 3rd tri: 10-12 lbs (4lbs/ month)
 Total wt.gain: 20-25 lbs
 MANAGEMENT:
 Monitoring antiplatelet therapy
(low dose aspirin)
- Kapag sumobra yung ginagamit na Aspirin,
magccause ng maternal bleeding.
 Close monitoring of BP
 Provide well-balanced diet with
high protein
 Bed rest in left-lateral position
(para maavoid yung pressure sa
inferior vena cava para hindi
magkaroon ng supine
hypertension)
- Also promotes increase evacuation of
sodium (mababawasan yung pamamanas)
2. Severe Pre-eclampsia
 When BP rises to 160 mmHg systolic and
110 mmHg diastolic on at least two
occasions 6 hours apart at bed rest
 ASSESSMENT: (BEEHIND POWER PET)
 BP: >/= 160/110
  Epigastric pain (hepatic  +2: Normal Reflex
dysfunction), Edema of the hands  +3: Brisker than average reflex
and feet  +4: Hyperactive reflex; clonus
 Headache that is persistent may also be present (A type of
(Possible cerebral edema) neurological condition that
 Irritability creates involuntary muscle
 Nausea & vomiting contraction, this results in an
 Deep tendon reflex: hypereflexia uncontrollable rhythmic shaking
(happens because the increasing movements that is very evident)
blood pressure will lead to
overactive reflexes)
 Proteinura: +3 - +4
 Oliguria: <500 ml /24 hrs
 Weight gain >5lbs/week
 Edema of the liver
 Right upper quadrant pain and
retinal edema
 Pulmonary edema
 Evidence of hemolysis
 Thrombocytopenia
 MANAGEMENT:
 Hospitalization (CBR) (Stimulus
can lead to seizure attacks)
 Monitor maternal and fetal vital
signs (Monitor BP at least every
4hrs)
 Monitor for DTR (Deep Tendon
Reflexes)
 Antihypertensives (Hydralazine –
by peripheral dilatation; does not
interfere with placental
circulation but can cause MAGNESIUM SULFATE
maternal tachycardia)  Assess for MAGNESIUM TOXICITY
 Administer MgSO4/ Magnesium - If severe oliguria happens, the patient’s
Sulfate (to prevent/limit urinary output is <100ml/hr the normal is
seizures) – this medication is 30ml/hr and magnesium is excreted almost
considered cathartic, it reduces entriely through the urine.
edema by causing shift in fluid  Respirations < 12/MIN
from extracellular spaces or  Maternal Oximeter reading< than
interstitial spaces into the 95%
intestine. It also has CNS  Hyporeflexia or absent DTR
depressant action w/c lessens (patella)
the possibility of seizure.  Decrease Urinary Output
 Calcium gluconate (in case of  Toxic serum level ≥ 8 mg/dL (The
MgSO4 toxicity) therapeutic level of MgSO4
 Initiate seizure precaution: should be 5-8mg/100ml)
o Promote bed rest  Fetal Distress or drop in fetal HR
o Maintain quiet, non-  Significant drop in maternal pulse
stressful (darken) or BP
environment to minimize
stimuli, 3. Eclampsia
 Restrict visitors  Most severe form of PIH
 Assessing Deep Tendon Reflexes  BP: ↑160/110mmHg
 Deep Tendon Reflex Scale  Degeneration of the woman’s condition
 0: Reflex absent
 +1: Reflex present, hypoactive
  Happens when cerebral edema is so HELLP SYNDROME
acute that a grand-mal seizure (tonic- (Hemolysis, Elevated Liver Enzymes, Low
clonic) occurs Platelet)
- Aura or Manifestations:  a variation of gestational hypertension
 Tonic: stiffening or rigidity of muscles of that is named for the common symptoms
the arms and legs usually lasts for about that occur
20 seconds followed by loss of  Potential life threatening complication.
consciousness.  Manifestation that leads to
 Clonic: hyperventilation and jerking of microvascular endothelial damage and
the extremities that usually lasts for intravascular platelet activation
about 30 seconds & recovery may take - Occurs in both primigravidas and
several hours after seizure. multigravidas and associated with
- Postictal stage = in w/c the patient is antiphospholipid antibodies.
unconscious.

 MANAGEMENT:
 Seizure Precautions:
o Maintaining a patent
airway.
 Hemolysis results from erythrocyte
o During seizure: turn the
changes as they pass through damaged
woman’s head on her side
blood vessels
to allow secretions to
 The elevation of liver enzyme is due to
drain
obstruction of hepatic blood flow from
o Protect the patient from
fibrin deposits.
injury particularly the
 Low platelets are due to vascular
head
damage from vasospasms;
o Padded side rails always
 CAUSE: unknown
up
 ASSESSMENT: (AS THE GARDENER)
o Emergency equipment
 A – Anemia (hemolysis of the
should always be
RBC)
available (O2, suction,
 S - Seizures (due to increased CNS
padded tongue
irritability form cerebral
depressor, ET
vasospasm)
[endotracheal tube] set)
 T – Thrombocytopenia (low
platelets) due to destruction of
platelets secondary to DIC
(Disseminated Intravascular
Coagulation)
 H – Hyperbilirubinemia &
Jaundice (due to excess bilirubin
produced by the breakdown of
RBC
 E – Edema is severe in the

Minimize stimuli. Darken room pulmonary (due to increased of

MgSO4 bolus of 4-6g TIV over fluid in the lung tissue)
5min (control convulsions)  G – General Malaise (due to
 Administer Diazepam (sedative) anemia) – feeling of discomfort
 COMPLICATIONS:  A – Abruptio Placenta (due to
 Intracerebral hemorrhage decrease in placental circulation)
 Death
  R – Ruptured liver (due to  Prevent abdominal palpation if
obstructed blood flow) there are signs of liver
 D – Disseminated Intravascular inflammation/hematoma to
Coagulation (usually occurs after prevent further bleeding to
fetal death causing the release of happen.
thromboplastin, a clotting factor
that activates widespread TRANSITIONAL HYPERTENSION
clotting in small vessels  Hypertension between 20-24 weeks
throughout the body resulting to
the “use up” or decreased of the CHRONIC HYPERTENSION
clotting factors – fibronigen and  Hypertension before 20 weeks and not
platelets. solved 6 weeks postpartum.
 E – Epigastric pain (related to  MANAGEMENT:
liver ischemia and distention.)  Magnesium Sulfate (MgSO4)
 N – Nausea and Vomiting (due to o CNS depressant and
vascular congestion of the liver) anticonvulsant
 E – Elevated liver enzymes (due o Causes smooth muscle
to damaged liver) relaxation
 R – Right Upper Quadrant o STOCK DOSE: 250 mg/ml
abdominal pain and tenderness in 10-20ml/vial
(due to liver inflammation) o DOSAGES: Given in 3
 FETAL RISK doses
 Prematurity o ANTIDOTE: Calcium
 Small for gestational age Gluconate
 Hypermagnesemia (due to large
doses of MgSO4 administration)
Mg Toxicity
 DIAGNOSTICS:
 CBC: low platelet below
100,000/mm3
 Elevated SGPT/ALT and
SGOT/AST
- serum glutamic-pyruvic transaminase/
alanine aminotransferase and serum
glutamic-oxaloacetic transaminase/
aspartate aminotransferase  Hydralazine (Apresoline)
 MANAGEMENT: o Antihypertensive
 Monitor patient for signs and (peripheral vasodilator)
symptoms of bleeding o ADMINISTRATION: 5-10
 Assess maternal vital signs and mg/IV as ordered
fetal heart rate frequently.
 Transfusion of fresh frozen
plasma (clotting factors) or
platelets to reverse the
thrombocytopenia as per
doctor’s order.
 MANAGEMENT:
 Administer MgSO4 to reduce
blood pressure and prevent
seizure.
 Diazepam (Valium)
 Hospitalization with strict bed o Anti-seizure
rest. o ADMINISTRATION: 5-10
 Maintain quiet, calm, dimly lit mg/IV
environment to reduce the risk of
seizures.
ASSESSMENT OF PITTING EDEMA

- Non pitting edema = walang nangyaring

indentation sa skin after pisilin
- Pitting edema = nagkaron ng indentation sa
skin after pisilin

ASSESSMENT OF EDEMA
CHARACTERISTICS GRADE
Minimal edema of lower
+1
extremities
Marked edema of lower
+2
extremities
Edema of lower extremities, face,
+3
hands, and sacral area
Generalized massive edema that
includes ascites (accumulation of
fluid in peritoneal cavity) (also +4
known as Anasarca or Generalized
edema)