Nursing Care Plan - Pregnancy Induced Hypertension (PIH; Preeclampsia and Eclampsia)

Preeclampsia is a common problem during pregnancy. The condition — sometimes referred to as pregnancy-induced hypertension — is defined by high blood pressure and excess protein in the urine after 20 weeks of pregnancy. Often, preeclampsia causes only modest increases in blood pressure. Left untreated, however, preeclampsia can lead to serious — even fatal — complications for both mother and baby.

A. Mild Preeclampsia

BP of 140/90
1+ to 2+ proteinuria on random
weight gain of 2 lbs per week on the 2nd trimester and 1 lb per week on the 3rd trimester
Slight edema in upper extremities and face

B. Severe Preeclampsia

BP of 160/110
3-4+ protenuria on random
Oliguria (less than 500 ml/24 hrs)
Cerebral or visual disturbances
Epigastric pain
Pulmonary edema
Peripheral edema
Hepatic dysfunction

Eclampsia is an extension of preeclampsia and is characterized by the client experiencing seizures.

NURSING MANAGEMENT

Monitor for, and promote the resolution of, complications.

Monitor vital signs and FHR.
Minimize external stimuli; promote rest and relaxation
Measure and record urine output, protein level, and specific gravity.
Assess for edema of face, arms, hands, legs, ankles, and feet. Also assess for pulmonary edema.
Weigh the client daily.
Assess deep tendon reflexes every 4 hours.
Assess for placental separation, headache and visual disturbance, epigastric pain, and altered level of consciousness.

Test

Findings

Blood
Hematocrit

Renal Function
Serum uric acid

Creatinine

Creatinine clearance

BUN

Coagulation
Platelets
Fibrin degradation products

>40%

?5.5 mg/dL
>6.0 mg/dL (severe PIH)

?1.0 mg/dL
2.0-3.0 md/dL (severe PIH)

<150 mL/min

8-10 mg/dL (severe PIH)
10-16 mg/dL (severe PIH)

<100,000 mL (severe PIH)
?16 µg/mL (severe PIH)

Provide treatment as prescribed.
- Mild preeclampsia treatment consists of bed rest in left lateral recumbent position, balanced diet with moderate to high protein and low to moderate sodium, and administration of magnesium sulfate
- Severe preeclampsia treatment consists of complete bed rest, balanced diet with high protein and low to moderate sodium, administration of sulfate, fluid and electrolyte replacements and sedative hypertensives such as diazepam or phenobarbital or an anticonvulsant such as phenytoin
- Eclampsia treatment consists of administration of magnesium sulfate intravenously
Institute seizure precautions. Seizures may occur up to 72 hours after delivery.
Address emotional and psychosocial needs.