Pregnancy Induced

Hypertension
(PIH)
 Case Study
• Patient X came was admitted with complaints of headache and shortness of
breath. She is 42 years old, G3P2, and at 26 weeks gestation. She was mildly
preeclamptic during her previous pregnancy. With a height of 5’4” and a
weight of 145 lbs, she’s overweight for her stature and doesn’t tolerate activity
very well. She’s also experiencing edema of her fingers and face. Her vital
signs are as follows: T: 37.5 P: 100 bpm R: 30 breaths per minute and b/p:
160/110mmHg. Urinalysis reveals marked 3+ proteinuria. CBC reveals a low
platelet count and elevated liver enzymes. Patient X is afraid and wants to
know about the baby’s well being. She asks questions about how her baby is
doing and what she can do to ensure that her baby will be safe. She verbalizes
“I’m afraid to do this alone. My husband is a sea farer on duty and my
daughters are studying abroad. I have nobody.”
 What is PIH
• Condition in which vasospasm occurs during pregnancy in
both small and large arteries
• Vasospasm: sudden contraction of a blood vessel,
reducing its diameter and flow rate.
• Separate from chronic hypertension — only occurs during
pregnancy
 Maternal Risk Factors:
1. Obesity 6. Diabetes
2. Nulliparity 7. Renal disease
3. Age: <20 or >40 y.o 8. Multiple gestation
4. Previous 9. Genetics
preeclampsia 10. Thrombophilias
5. Chronic
hypertension
Pathophysiology
 Classic Signs & Symptoms

Hypertension Proteinuria Edema

 Diagnostic Lab Tests
• Urinalysis
• Determines the presence of protein
in the urine, indicative of PIH
• Blood test
• Check liver and kidney functions;
measure platelets
• Fetal ultrasound
• Close monitoring of baby’s growth
 Classifications of PIH
1. Gestational
hypertension
2. Mild preeclampsia
3. Severe preeclampsia
4. Eclampsia
 Gestational Hypertension
• Elevated blood pressure
(140/90 mmHg) after 20
weeks gestation
• No proteinuria
• No edema
• No drug therapy is necessary
Mild Pre-eclampsia
• 140/90 mmHG taken on 2
occasions at least 6 hours apart
• Proteinuria 1-2+ on a random
sample
• Mild edema in upper
extremities or face
 Severe Pre-eclampsia
• 160/110 mmHG or above taken
on 2 occasions at least 6 hours
apart
• Proteinuria 3-4+ on a random
sample
• Oliguria
• Elevated serum creatinine
• Severe epigastric pain
• Shortness of breath
• Visual disturbances
• Extensive peripheral edema
 “HELLP SYNDROME”
• “HELLP Syndrome”
• H- Hemolysis of RBCs: Anemia
• Elevated Liver Enzymes: epigastric
pain
• Low Platelet count: abnormal
bleeding, clotting, and petechia
 Eclampsia
• Most severe • Fetal prognosis poor
classification of • Hypoxia
PIH • Fetal acidosis
• Tonic-clonic • Possible premature
seizures separation of
• placenta
Coma
 Medical Management
• Anti-platelet therapy
• There is an increased tendency
for platelets to cluster along
the vessel walls, so a mild anti
platelet agent is ordered by the
physician
• Administer medications to
prevent preeclampsia
• Hydralazine, Nifedipine,
labetalol
 Surgical Management
• No surgical
interventions are
needed to manage PIH.
They can be managed
by medications and
interventions imposed
or ordered by health
care providers
Nursing Management: Mild Preeclampsia
• Monitor vital signs
• Monitor anti-platelet therapy
• Intake of low dose aspirin
• Promote bed rest
• Recumbent position exerts sodium at a quicker rate
• Promote good nutrition
• Continue usual pregnancy nutrition.
• Don’t restrict salt intake
Nursing Management: Severe Preeclampsia
• Monitor maternal
well being
• Monitor fetal well being
• B/P q 4hr • Doppler auscultation q
4hr
• Hematocrit levels • External fetal monitoring
• Daily weights • Administer medications
• Support bed rest to prevent Eclampsia
• Limit visitors • Hydralazine
• Minimize light • Magnesium sulfate
Nursing Management: Eclampsia
• During Tonic-clonic seizures
• Maintain patent airway- Prevent
aspiration
• Turn to her side- allow secretions to
drain from her mouth
• Administer oxygen- to protect fetal
oxygenation
• Magnesium sulfate or Diazepam-
emergency measure
• Apply external fetal monitor- assess FHR
 NURSING DIAGNOSIS RATIONALE DESIRED GOAL BEHAVIORAL OBJECT NURSING ACTION RATIONALE EVALUATION

Readiness for A pattern of After 2 days of nursing Within 2 hours of · Verify pt’s level of Provides opportunity to
enhanced therapeutic regulating and intervention pt will be be nursing understanding of assure accuracy and
therapeutic regimen. completeness of
management integrating into daily able to remain free of implementation pt will Note specific health knowledge base for
Cues: living a program for preventable be able to: goals future learning.
treatment of illness complications/progression · Demonstrate
and its sequelae that of illness and sequelae proactive · Teach pt the
Subjective: is sufficient for management by classification and Correct and sufficient
mechanism of action, knowledge regarding the
Verbalizes “How can meeting health- anticipating and contraindications and medicines prescribed
I manage my related goals and can planning for indications and facilitates better
hypertension during be strengthened. eventualities of side/adverse effects of
understanding and
pregnancy in order to condition/ the drug prescribed by
promotes cooperation &
the physician.
keep my baby safe” potential participation.
complications · Accept pt’s evaluation of
· Assume own strengths/
Promotes sense of self-
responsibility for limitations while
esteem and confidence to
Objective: managing working together to
improve abilities. continue efforts.
-Asks questions treatment
regarding her health regime. · Acknowledge individual Provides positive
status efforts/ capabilities to reinforcement
reinforce movement encouraging continued
toward attainment of progress toward desired
desired outcomes. goals.
NURSING DIAGNOSIS RATIONALE DESIRED GOAL BEHAVIORAL OBJECT NURSING ACTION RATIONALE EVALUATION

Risk for hemorrhage DIC occurs when the Within 2 days of Within 2 hours of ➢ Educate the patient about - Help the patent be
body’s clotting her status and let her aware of her status and
related to low platelet implementing effective nursing intervention, understand her risk for
mechanism are plan or think of some
count secondary to health teachings and she will be able to hemorrhage due to her preventive measures to
disseminated activated throughout performing understand and be low platelet count each avoid herslf from any
the body in response to time a hazardous situation
intravascular precautionary aware that she’s at risk is present or foreseen potential injuries
coagulation (DIC) an injury or a disorder, measures to prevent for hemorrhage; and potential risk.
instead of being injury, the patient will will participate in ➢ Let the patient or her - Analyzing and
isolated to the area of significant others think or discussing with the
Cues: be able to put into measures to prevent analyze some preventive patient promotes
Subjective: initial onset. Platelets action or perform injury and also to take measures or actions such nurse-patient
-Complaints of circulating throughout some preventive precautionary as removing all sharp/ interaction. Removing
headache the body from small measures such as measures. pointed objects that might sharp objects helps
blood clots (thrombi) contribute to an injury or ensure the patient’s
removing sharp wound. safety.
primarily in the area of objects (e.g. nails) that ➢ Make sure that she does
Objective: the capillaries. might harm her or not wound herself by
(Oncology limiting her activities that - To prevent further
RR: 30 breaths/min Encyclopedia, by Lind wound and be free of require physical contact. injuries or
hazards and avoid ➢ Educate the patient that if complications
K. Bennington, C.N.S., external hemorrhage
M.S.N hazardous activities occurs, they must apply
that involves physical pressure directly to the - To help control the
contact. wound. bleeding
➢ Encourage the patient to
visit a doctor if serious
bleeding or hemorrhage
might occur as soon as
possible. - To provide and give
emergency or medical
treatment to the
patient.
 NURSING DIAGNOSIS RATIONALE DESRIED GOAL BEHAVIORAL OBJECTIVE NURSING ACTION RATIONALE EVALUATION
Ineffective tissue Increased cardiac After 2 days of nursing After 8 hours of ➢ Promote early - Short frequent
perfusion related to output that injures the intervention, body nursing intervention, ambulation as soon as walks are
arteriolar vasospasm endothelial cells of the temperature will the patient will client is able and with determined to be
physician’s approval. better for
secondary to arteries and the action remain within normal demonstrate ➢ Elevate legs when in extremities and
pregnancy induced of prostaglandins. range (36.7 to 37.8 C), improved perfusion as bed or chair as prevention of
hypertension Vasoconstriction be able to walk evidence by peripheral indicated. pulmonary
Cues: occurs and blood unaided, free of tissue pulses present/equal, ➢ Initiate active or complications than
pressure increases. edema, strong pink skin color, passive exercise s one long walk. If
Subjective: peripheral pulses, and temperature decrease while in bed (e.g. client is confined to
flex/extend/rotate bed, ensure ROM
N/A display increasing to 37.8 C, moist oral foot periodically). exercises.
tolerance to activity. mucosa, and absence Assist with gradual - Reduces tissue
of tissue edema. resumption of swelling and rapidly
ambulation (e.g. empties superficial
Objective: walking 10 min/hr) as and tibial veins
• Blood pressure: soon as client is preventing
permitted out of bed. overdistention and
160/110 mmHG ➢ Instruct client to avoid thereby increase
• Anasarca rubbing/massaging
• Activity intolerance the affected extremity. - Dehydration
➢ Increase fluid intake to increases blood
at least 2000 mL/day, viscosity and venous
within cardiac stasis, predisposing
tolerance to thrombus
formation
 NCP 4: Fear related to separation from support system.
NURSING DIAGNOSIS RATIONALE DESRIED GOAL BEHAVIORAL OBJECTIVE NURSING ACTION RATIONALE

Fear related to Fear is a response to a In 3 days of nursing care, In 8 hours duty, Patient X
separation from support perceived threat that is Patient X will will: Independent:
system during recognized as a danger. demonstrate • communicate feelings • Assses patient’s • Perceptions may be
hospitalization. Patient X fears being understanding through about separation from understanding of the erroneously based.
hospitalized without her use of effective coping support system situation
Subjective: support system around. behaviors and resources.
“I’m afraid to go through • Use situational
this alone. My husband is supports to reduce • Help patient maintain • Help patient
a sea farer and my fear daily contact with reestablish and
daughters are studying family via telephone maintain social
abroad. I have nobody.” • Perform relaxation calls relationships
techniques • Teach deep breathing, • Reduce symptoms of
imagery, and sympathetic
Objective: progressive muscle stimulation
-shortness of breath relaxation
-HR: 100 bpm
-RR: 30 breaths/min
Dependent:
Drug therapy as indicated To help patient cope with
separation
NCP 5
 Drug study: hydralazine

Date Brand Name Generic Name DOSAGE Route & CLASSFICATION: INDICATION CONTRAINDIC NURSING
Ordered Frequency MECHANISM OF ATION RESPONSIBILITIES
ACTION
Dec 9, 2019 Apresoline hydralazine · 10mg · P.O Q.I.D Antihypertensive: -Hypertension -Hypersensitivity -Monitor CBC
· 25mg · P.O. Relaxes vascular to drug or -Monitor blood
· 50mg Q.I.D. smooth muscles of tartrazine pressure, pulse rate,
· P.O. arteries and -Coronary artery daily weight
Q.I.D. up arterioles, causing disease -Tell patient to take
to peripheral -Mitral valvular tablets with food
300mg/d vasodilation and rheumatic heart -Instruct patient to
ay. decreasing peripheral disease immediately report
vascular resistance. fever, muscle and joint
These actions aches or sore throat
decrease blood -Caution patient not to
pressure and discontinue abruptly
increase heart rate, because severe
stroke volume, and hypertension may
cardiac output result.
 Drug study: nifedipine
Date Brand Name Generic name Dosage Route & Classification & MOA Indication Contraindication Nursing responsibility
Ordered frequency
Procardia nifedipine · 10mg · P.O. Antianginal, Anti -Vasospastic - -Monitor vital signs
Dec 9, · 20mg T.I.D. -hypertensive: (Prinzmetal’s) Hypersensitivi and cardiovascular
2019 · 30 to 60 · T.I.D. Inhibits calcium angina; ty to drug status. Stay alert for
mg · P.O. transport into chronic stable chest pain and
myocardial and angina edema
vascular smooth -Hypertension -Watch for rashes
muscle cells, -tell patient she may
suppressing take immediate
contractions. release form with or
Dilates main without meals.
coronary arteries -Caution patient not
and arterioles and to crush or break
inhibits coronary extended-release
artery spasm, tablets. Tell her to
increasing oxygen swallow them whole.
delivery to heart Advise her to take
and decreasing on empty stomach.
frequency and -Inform patient that
severity of angina angina attack may
attacks occur 30 min. after
the dose.
 Drug Study: labetalol
Date Brand Name Generic name Dosage Route & Classification & Indication Contraindicatio Nursing responsibility
Ordered frequency MOA n
Dec 9, 2019 Normodyne labetalol · 100mg · P.O. Antihypertensive: -Hypertension - -Monitor ECG and
· 20 mg B.I,.D. Blocks stimulation of -Hypertensive Hypersensitivity vitals signs especially
· 50 to 200 · I.V. beta1- and beta 2- crisis to drug blood pressure.
mg · I.V. adrenergic receptor -Conversion - -Assess
sites and alpha1- from I.V. to Bronchospastic cardiovascular,
adrenergic receptors P.O. dosing disease respiratory, and
decreasing -Overt heart neurologic status
myocardial failure closely to detect
contractile force and -Severe adverse reactions
enhancing coronary bradycardia -Monitor CBC, blood
artery blood flow and -Conditions glucose level, and liver
myocardial associated with function tests.
perfusion. Net effect severe and -Instruct client to
is decreased heart prolonged immediately report
rate and blood hypotension. adverse reactions
pressure such as easy bruising
or bleeding or
respiratory problems.
-Caution patient to
avoid to avoid driving
and other hazardous
activities until she
knows how drug
affects concentration,
vision, and alertness