Factors and manifestation of Gestational Hypertension (Pregnancy Induced Hypertension)

FACTORS

 Hypertensive disease during a previous pregnancy

 Chronic Kidney Disease
 Autoimmune diseases such as systemic lupus erythematosus or anti phospholipid syndrome
 Inherited or acquired thrombophia
 Type 1 or Type 2 Diabetes
 Nulliparity
 Age 40 years or older
 Pregnancy Interval of more than 10 years
 Family History of Pre-eclampsia
 Multiple Pregnancy

MANIFESTATIONS

 Non-stop headaches
 Edema (swelling)
 Sudden weight gain
 Vision changes, such as blurred or double vision
 Nausea or Vomiting
 Pain
 Decreased amount of urine

NURSING CARE PLAN

ASSESSMENT DIAGNOSIS PLANNING INTERVENTIO RATIONALE EVALUATION

N
Subjective: Deficient fluid After an hours Estimate or These factors After an hours
Patient volume of nursing measure are used to of nursing
verbalizes related to intervention, traumatic or determine intervention,
feeling of plasma the patient procedural degree of the patient
weakness protein loss as will be able to: traumatic volume was able to:
Objective: evidenced by Maintain fluid losses and note depletion and Maintain fluid
Increased edema volume at a possible routed method of volume at a
Blood pressure formation and functional of insensible fluid functional
Decreased decreased level. fluid losses. replacement. level.
urine output urine output. Verbalizes Determine Verbalized
Increased understanding customary and understanding
body of causative current weight. of causative
temperature factors and factors and
and heart rate. purpose of Assess vital Changes in purpose of
individual signs, noting vital signs are individual
therapeutic blood associated therapeutic
interventions pressure, with fluid interventions
and severe volume loss. and
medications. hypertension, medications.
 rapid
heartbeat, and
thready pulses.

Observe and Helps as a

measure guide in fluid
urinary output. resuscitation
to the patient.

Note changes The signs

in usual indicate
mentation, sufficient
behavior and dehydration
functional to cause poor
abilities. tissue
perfusion.

Note
complaints and
Physical signs
associated
with
dehydration.
To evaluate
Review the body’s
laboratory response to
data. bleeding or
other fluid loss
and to
determine
replacement
needs.
Subjective: Decreased After an hours Assess and May indicate After an hours
Patient Cardiac of Nursing monitor for evolving heart of Nursing
verbalizes that Output intervention, client reports attack; can intervention,
she gained related to the patient of chest pain. also the patient
weight as well decreased will be able to: accompany was able to:
as experiences venous return -Verbalize heart failure. -Verbalize
fatigue. as evidenced knowledge of knowledge of
Objective: by changes in the disease Evaluate client To assess for the disease
Edema blood process, risk reports and signs of poor process, risk
Abnormal Skin pressure and factors, and evidence of ventricular factors, and
Color edema. treatment extreme function or treatment
Restlessness plan. fatigue, impending plan.
Alteration in -Participate in intolerance for cardiac failure. -Participate in
heart rate activities that activity, activities that
reduced the sudden or reduced the
workload of progressive workload of
the heart. weight gain, the heart.
swelling of
extremities
and
progressive
shortness of
breath

Determine Provides a
Vital Signs. baseline for
comparison to
follow trends
and evaluate
response to
intervention.

Review signs of Early

impending detection of
failure/shock, changes in
noting these
decreased parameters
cognition and promotes
unstable or timely
subnormal intervention
blood to limit the
pressure, degree of
labored cardiac
respirations, dysfunction.
changes in
breath sounds,
edema and
reduced
urinary output.

Maintain a This can help

peaceful and to lower
pleasant cardiac
atmosphere contractility
while keeping while also
environmental promoting
activity and relaxation.
noise to a limit.

Limit activity Physical stress

workloads. and tension
are reduced,
both of which
 have an
impact on
blood
pressure and
the
advancement
of
hypertension
in some
people.
Subjective: Altered Tissue After an hour Assess skin Helps in After an hour
Patient perfusion of Nursing color, and determining of Nursing
verbalized related to Intervention, temperature. location and Intervention,
experiences of Interruption the patient type of the patient
pain in of blood flow will be able to: perfusion was able to:
extremities. as evidenced -Verbalize problem. -Verbalized
Objective: by changes in understanding understanding
Decreased heart rate. of risk factors Compare Skin Helps to of risk factors
blood pressure of the temperature differentiate of the
Alteration in condition, and color with type of condition,
skin therapy the other limb problem. therapy
characteristics. regimen. when assessing regimen.
Edema extremity
circulation.

Assess Useful in
presence, identifying or
location, and quantifying
degree of edema in
swelling, or involved
edema extremities.
formation.

Measure To determine
capillary refill. adequacy of
systemic
circulation.

Note client’s Dehydration

nutritional and reduces blood
fluid status. volume.

Palpate arterial To determine

pulses using level of
handled Circulatory
doppler. blockage.

Evaluate pain
reports.

Review To determine
laboratory probability,
studies. location and
degree of
impairment.