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

preeclampsia PIHPreeclampsia 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

  1. 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)

  2. 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
  3. Institute seizure precautions. Seizures may occur up to 72 hours after delivery.
  4. Address emotional and psychosocial needs.

NCP – Pregnancy Induced Hypertension (PIH; Preeclampsia and Eclampsia)

Daisy Jane Antipuesto RN MN

Currently a Nursing Local Board Examination Reviewer. Subjects handled are Pediatric, Obstetric and Psychiatric Nursing. Previous work experiences include: Clinical instructor/lecturer, clinical coordinator (Level II), caregiver instructor/lecturer, NC2 examination reviewer and staff/clinic nurse. Areas of specialization: Emergency room, Orthopedic Ward and Delivery Room. Also an IELTS passer.

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