PREGNANCY INDUCED

HYPERTENSION
ALSO CALLED: TOXEMIA OR PRE-ECLAMPSIA OR
GESTATIONAL HYPERTENSION
 OBJECTIVES:
• AFTER LEARNING THIS MODULE ON PIH, YOU ARE
EXPECTED TO:

* BE UPDATED AND ABLE TO DISCUSS THE CONCEPTS OF

PREGNANCY INDUCED HYPERTENSION WITH ITS OTHER
CONCEPTS.
* EXPLAIN THE CHANGES ON THE PREGNANT MOTHER WITH
PIH, HOW PIH OCCURS AND PIH PHATOPHYSIOLOGY.
* BE ABLE TO DEFINE THE SIGNS AND SYMPTOMS, CAUSE AND
RISK FACTORS, NURSING DIAGNOSIS, DIAGNOSTIC AND NURSING
INTERVENTION AND TREATMENT.
PREGNANCY INDUCED HYPERTENSION
• is a form of high blood pressure in pregnancy.
• occurs in about 7-10 percent of all pregnancies.
• occurs after 20 weeks of gestation in women with
previously normal blood pressure.
• defines as systolic blood pressure (SBP) >140 mmHg and
diastolic blood pressure of (DBP) > 90 mmHg. It is
classified as mild (SBP 140-149 and DBP 90-99 mmHg),
Moderate (SBP 150-159 and DBP 100-109 mmHg) and
severe (SBP >160 and DBP > 110 mmHg).
COMPREHENSIVE PHATOPHYSIOLOGY (on the
other file)
PHATOPHYSIOLOGY OF PIH

PLACENTAL ISCHEMIA IS THOUGHT TO LEAD TO

WIDESPREAD ACTIVATIONS OR DYSFUNCTIONS OF
THE MATERNAL VASCULAR ENDOTHELIUM THAT
RESULTS IN ENHANCED FORMATION OF ENDOTHELIN
AND THROMBOXANE, INCREASED VASCULAR
SENSITIVITY TO ANGIOTENSIN II, AND DECREASED
FORMATION OF VASODILATORS SUCH AS NITRIC
OXIDE AND PROSTACYLIN.
SIGNS AND SYMPTOMS OF PIH

• High blood pressure

• Protein in the urine
• Headaches
• Dizziness
• Fatigue
• Blurred vision
• Nausea
• right sided upper abdominal pain or pain around the
stomach
• Oedema or swelling
• Breathing problems
• Intense abdominal pain
• Fatigue
• visual changes such as blurred or double vision
• Light flashes or spots in front of your eyes
• Vomiting
• sudden weight gain
• urinating in small amount
TRIAD SYMPTOMS OF PIH

P- proteinuria
I- idema/edema
H - hypertension
CAUSES AND RISK FACTORS OF PIH
• CAUSES OF PIH
– The cause of PIH or Gestational Hypertensio is
unknown
* No study or research that proves the main
cause of PIH but some condition may increase the
risk of developing this condition.
RISK FACTOR OF PIH
• PRE-EXISTING HYPERTENSION (HIGH BLOOD
PRESSURE)
• KIDNEY DISEASE
• DIABETES
• PIH WITH PREVIOUS PREGNANCY
• MOTHER’S AGE YOUNGER THAN 20 OR OLDER
THAN 40
• MULTIPLE FETUSES (TWINS, TRIPLETS)
NURSING DIAGNOSIS
• INCREASE BLOOD PRESSURE
• RISK FOR DEVELOPING ECLAMPSIA RELATED TO
SEVERE PRE-ECLAMPSIA
• EXCESS FLUID VOLUME
• ACTIVITY INTOLERANCE
• RISK FOR INJURY OR FALL
• RISK FOR INFECTION
• INEFFECTIVE AIRWAY CLEARANCE
• ACTUAL/ RISK FOR ASPIRATION
• ALTERED FAMILY PROCESS
• ACTUAL OR RISK FOR ALTERED PARENTING
• HEALTH SEEKING BEHAVIOR
• ANXIETY
• DISTURB BODY IMAGE
• INEFFECTIVE TISSUE PERFUSION
• INEFFECTIVE HEALTH MAINTENANCE
• SLEEP DISTURBED PATTERN
• FATIGUE
• INSOMIA
TREATMENT:
• MAGNESIUM SULFATE
• THIRD GENERATION RETINOIDS (EG. TRETINOIN)
• HYDRALAZINE
• CORTECOSTEROIDS
• SYNTHETIC TOPICAL AGENTS
– ADAPELENE
– TAZAROTENE
MANAGEMENT
• BED REST
• HOSPITALIZATION
• FETAL MONITORING
• MODERATE CHON AND NA
• LOW SALT LOW FAT DIET
DIAGNOSTIC
• BLOOD PRESSURE MEASUREMENT
• URINE TESTING
• WEIGHT
• LAB INVESTIGATIONS
COMPLETE BLOOD COUNT
PLATELET COUNT
LFT
RFT
URINE ANALYSIS
• SERUM ELECTROLYTES
• PHERIPHERAL BLOOD SMEAR
• PROTHROMBIN TIME
• TYPE AND SCREEN ANTIBODY IF PRESENT
• ANGIOTENSIN II TEST: A DOSE OF 8 MK/KG BODY WEIGHT TO
INCREASE DIASTOLIC BLOOD PRESSURE BY 20 MMHG IS TAKEN
AS POSITIVE
THERAPEUTIC
• ALLOW THE PATIENT TO HAVE BED REST
• ASSISTED THE PATIENT TO DO SOME DIVERTIONAL
ACTIVITIES
• PROVIDED SAFE AND COMFORTABLE RESTING
ROOM FOR THE PATIENT
• DEEMED THE LIGHT DURING RESTING HOUR
• MONITORED THE PATIENT CLOSELY
• ENSURED CALMING ENVIRONMENT
EDUCATIVE
• INSTRUCTED THE PATIENT TO MAINTAIN HEALTHY
WEIGHT, LIMIT SALT INTAKE, AVOIDING EXCESS
ALCOHOL USE, AND EXERCISING REGULARLY.
• ENCOURAGED TO DO SOME DIVERTIONAL
ACTIVITIES TO LESSEN ANXIETY.
• EDUCATED TO REGULARLY DO SOME CHECK-UPS
WITH THEIR OWN OBYGYNE OR PHYSICIANS.
• REITERATED TO MAINTAIN CALMING, SAFE AND
COMFORTABLE ENVIRONMENT FOR THE PREGNANT
• ENCOURAGED KIN TO SHOW OR STRENGTHEN
SUPPORT SYSTEM OF THE PREGNANT.
PREVENTION:
• USE LITTLE OR NO ADDED SALT IN YOUR MEALS
• DRINK 6-8 GLASSES OF WATER A DAY
• AVOID FRIED FOODS AND JUNK FOODS
• GET ENOUGH REST
• EXERCISE REGULARY
• ELEVATE YOUR FEET SEVERAL TIMES DURING THE
DAY
• AVOID DRINKING ALCOHOL
• AVOID BEVERAGES CONTAINING CAFFEINE
• EAT HEALTHY FOODS SUCH AS VEGETABLES AND