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Outline
Pathophysiology
Gestational hypertension is having high blood pressure during the second half of pregnancy in women who have never had high blood pressure before. This is diagnosed when blood pressure exceeds 140/90. Gestational hypertension normally resolves within about 6 weeks after delivery.
Preeclampsia is high blood pressure during pregnancy that damages other organs, usually the kidneys and liver. Preeclampsia can be a serious complication and is often characterized by swelling of the face and hands and protein in the urine.
Eclampsia results when preeclampsia is left undiagnosed or treated and can be fatal. Eclampsia is diagnosed when patients with preeclampsia begin having seizures. These seizures can occur, even if the patient does not have a history of them.
Etiology
Gestational hypertension – The cause is generally unknown, but is more common in patients who have kidney disease or diabetes prior to pregnancy, or those who have had gestational hypertension in previous pregnancies. Other risk factors include being pregnant with twins (or triplets), maternal age younger than 20 years old or older than 40 years old and being African American.
Preeclampsia – The blood vessels within the placenta do not develop properly and are narrower than normal. This extra pressure within the blood vessels puts stress on the maternal liver and kidneys. Certain genetic factors, immune system response and damage to the blood vessels may contribute to this abnormal development. This complication can result in growth restriction of the fetus, placental abruption or even preterm birth.
Eclampsia – Eclampsia is basically severe preeclampsia that results in seizures. When preeclampsia becomes severe and is not treated, it can result in seizures and could be fatal to mother and fetus. This usually results in having to terminate the pregnancy and deliver the fetus, regardless of gestational age.
Desired Outcome
Patient will have controlled blood pressure at or below 140/90; patient will have optimal functioning of organ systems without chronic damage; patient will carry pregnancy to term
Gestational Hypertension, Preeclampsia, Eclampsia Nursing Care Plan
Subjective Data:
- Headache
- Vision changes
- Nausea
- Stomach pain (upper right side of abdomen)
Objective Data:
- BP over 140/90
- Swelling of face, hands, feet
- Sudden weight gain
- Vomiting
- Decreased urine output
- Proteinuria
Nursing Interventions and Rationales
- Monitor vital signs, particularly blood pressure
Blood pressure may fluctuate and spike quickly; monitor for changes and elevations
- Assess for edema; note location and determine degree of pitting
Some swelling is normal in pregnancy, but pitting edema is different and can be a significant sign of decreased cardiac output.
- Weigh patient regularly
Sudden increase in weight indicates fluid retention and may signify progression of disease and impaired renal function
- Auscultate heart and lungs; note rate and rhythm; administer oxygen as necessary
- Monitor for signs of fluid overload and pulmonary edema which puts strain on the cardiopulmonary system
- Listen for crackles and note presence of dyspnea
- Oxygen supplementation may be given to relieve dyspnea and improve maternal-fetal oxygenation and tissue perfusion
- Administer IV fluids and medications as appropriate
- Antihypertensives(hydralazine) may help decrease diastolic pressure and increase blood flow to vital organs
- Antiepileptic drugs and magnesium sulfate for seizures
- Monitor fetal heart rate
Observe for signs and symptoms of fetal distress due to maternal blood pressure, decreased placental blood flow and lack of oxygenation
- Assess for vision disturbances and cognitive function
- Preeclampsia may progress over time or suddenly to eclampsia and result in seizures.
- Note any changes in mentation or vision as an exacerbation of preeclampsia.
- Monitor labs and diagnostic test results
Observe for proteinuria, blood glucose level, elevated liver enzymes and decreased renal function.
- Provide nutrition and lifestyle education
- Low sodium diet to help reduce edema
- Bedrest and elevation of the feet to reduce blood pressure
- Encourage patient to rest on left side to prevent compression of vena cava
References
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