26 January 2012

Nursing Care Plan Pregnancy-induced Hypertension (PIH)

Pregnancy-induced Hypertension (PIH) is a condition in which vasospasm occurs during pregnancy in both small and large arteries. Despite years of research, the cause of disorder is still unknown. This condition is also called as “Toxemia” in which some kind of toxin is produced by a woman in response to the foreign protein of the growing fetus which leads to typical symptoms.Pregnancy-induced Hypertension (PIH)is classified as gestational hypertension, mild preeclampsia, severe preeclampsia and eclampsia.
Primary treatment goals in PIH
delivery of an uncompromised fetus
psychological support for the client and her family
reduction of vasospasm
prevention of seizures
Cure for PIH
Delivery of the infant and placenta (products of conception)
Labor induction via cervical ripening may be initiated to facilitate labor. In contrast, with worsening PIH or fetal distress may be delivered via cesarean section.
Clients with HELLP syndrome may have their labor induced for a vaginal delivery at 32 or more week’s gestation.
For clients with HELLP syndrome who are at less than 32 weeks gestation, a cesarean delivery may be considered.
If a client’s disease progresses to the point of eclampsia (maternal seizure), delivery is generally postponed for 1 to 3 hours if fetal status allows.
Ideally, once vital signs are stabilized with improved urinary output and decreased acidosis/hypoxia, delivery is pursued.
Potential non-medication treatments for pre-eclampsia
activity reduction,
lying on the left side
increased dietary protein (supplemental 90 g/day),
psychosocial therapy
and biofeedback.

Nursing diagnoses Nursing Care Plan For Pregnancy Induced Hypertension
•Activity intolerance
•Disturbed sensory perception (visual)
•Disturbed thought processes
•Excess fluid volume
•Impaired urinary elimination
•Ineffective coping
•Ineffective tissue perfusion: Cerebral, peripheral
•Risk for injury
Nursing Care goal Pregnancy-induced Hypertension (PIH)
The patient will:
•be able to perform activities of daily living without excessive fatigue.
•identify strategies to reduce anxiety.
•maintain optimal functioning within the confines of the visual impairment.
•maintain orientation to environment.
•The patient's fluid volume will remain within normal parameters.
•verbalize fears and concerns.
•The patient's urine output will remain within normal limits.
•demonstrate adaptive coping behaviors.
•exhibit signs of adequate cerebral and peripheral perfusion.
•avoid complications

Nursing Intervention and Rationale Pregnancy-induced Hypertension (PIH)
 Monitor blood pressure of the patient.
  • Monitoring helps to identify whether the patient is hypertensive, as well as to have a baseline data.
  • Measure BP in both arms and thighs 3 times with 3-5 minutes apart while the patient is at rest, then sitting and standing for initial evaluation.
  • Comparison of pressure provides a more comprehensive vascular involvement or scope of the problem.
  • Observe skin color, moisture, temperature and capillary refill.
  • Presence of pallor and delayed capillary refill may be due to peripheral vasoconstriction.
  • Note and assess for edema.
  • Edema may indicate heart failure, renal or vascular impairment.
  • Provide rest full environment and minimize noise.
  • It helps to reduce sympathetic stimulation and promotes relaxation.
  • Maintain activity restrictions.
  • It reduces physical stress and tension that affect blood pressure.
  • Instruct relaxation techniques and guided imagery.
  • It can reduce stressful stimuli and produces calming effect which resolve BP.
  • Advise patient to avoid foods high in sodium, such as dried fish, sea foods and salt.
  • High sodium intake may cause water retention which can lead to increase BP.
  • Dependent
  • Administer medications as prescribed, such as Methyldopa (Aldomet) 25mg tablet 2x/day orally.
  • Methyldopa is an antihypertensive drug which reduces BP.
  • Interdependent
  • Refer patient to dietician about dietary plan.
  • Dietician is a person who finds alternative food preparation to meet the patient needs.