LaGuardia Community College
City University of New York
Department of Natural & Applied Science
Practical Nursing Program
Written Report: Preelampsia a.k.a Pregnancy Induced Hypertension
By
Anaise E. Ikama
Course: SCL 115 – Maternal Child Nursing Clinical
Professor: H. Mckenize
Diagnosis: Pregnancy Induced Hypertension
also known as Pre-Eclampsia
Definition/ Explanation of the diagnosis: PIH is a disease that only occurs during pregnancy. Hypertension is onsidered moderate if
the systolic reading is between 140 and 160mm Hg and the diastolic reading is below 110mm Hg. However, an increase over baseline
BP of 30 mm Hg or more systolic and 15 mm Hg diastolic and protein in uria will place the women at a high risk of developing PIH.
Etiology/Risk Factor: the causative agent of PIH remains unknown. Current researches believe that the “disease is a type of
immunological response to the products of conception (embryo, placenta, membranes, etc.). This means that perhaps the woman's
body becomes "allergic" to the baby and the placenta… [This] can appear suddenly, and no matter how ill you become with this
disease, whether it's sudden or gradual, the only cure is delivery of the baby” (WebMD.com).
Incidences among Sexes/Ethnicity: Preeclampsia is a disease of pregnant women, more commonly found in black women and it
has been related to a higher rate of hypertensive disorders found in the black population. Among the clinical risk factors for the
development of preeclampsia are maternal age of 20 and those that are 35-40 years. Those who are at the greatest risk of developing
GD are primigravida. If you had preeclampsia with your first baby or should a family member has a history of preeclampsia (for
example, if your mother or sister had preeclampsia with a pregnancy), your risk also increases.
Prognosis: within days to weeks after delivery, blood pressure usually returns to baseline.
Signs and Symptoms include: hypertension and the presence of excess protein in your urine (proteinuria) after 20 weeks of
pregnancy, severe headaches, changes in vision, including temporary loss of vision, blurred vision or light sensitivity, upper
abdominal pain, usually under the ribs on the right side, nausea or vomiting, dizziness, decreased urine output, and sudden weight
gain, typically more than 2 pounds a week.
Diagnosis tests:
Test
Hemoglobin and hematocrit (increase)
Platelets (decrease in the level of platelets)
Urinalysis to detect proteinuria
Serum creatinine (increase)
Rationales
Indicate severity of GH.
Thrombocytopenia suggest GH
Confirms GH when hypotension is present
Suggest GH when elevate
1
Serum uric acid (increase)
Serum transaminase
Suggest GH when elevate
confirms liver involvement in GH
Medical Treatment: includes antihypertensive drugs (aldomet, nifedipine and labetalol); Magnesium sulfate, and oxygen. As a
nurse, you should administer drugs as prescribed, elevate edematous arms or legs (sudden weigh gain), provide a quiet darkened room,
and enforce bed rest. Monitor vital signs (BP and respiration), urine output, fetal heart rate, vision, deep tendon reflexes and the level
of consciousness.
Surgical Treatment: a possible cesarean delivery may be required to address increasing maternal disease severity and minimize
maternal and fetal-neonatal morbidity and mortality. The nursing interventions for this type of treatment include: Prepare for
emergency cesarean. Alert the anesthesiologist and pediatrician. Assist with or insert an indwelling urinary catheter, if necessary after
the surgery and provide emotional support. Monitor intake and output.
Prevention: Prevention of GH will depend on whether the risk factors are modifiable or non-modifiable. Improving the pregnant
woman’s diet can prevent GH and help in a normal fetal growth. Non-modifiable risk factors, on the other hand cannot be changed,
but early and regular prenatal care will help in diagnosing GH so that it is more managed.
Complications of GH include: high blood pressure; poor kidney function; poor liver function; HELLP (hemolysis, elevated liver
enzyme, low blood platelet); pulmonary edema, and possible seizure.
Discharge and client teaching:
Nursing Diagnosis
Outcomes
Deficiency knowledge related The woman will restate correct
to home care of mild GH.
home care measures related to
GH.
Nursing Interventions
1. Ask the woman what she
knows about hypertension
during pregnancy; include
family members if present.
Rationales
1. Allows the nurse to reinforce
and
correct
any
misunderstanding
of
the
woman of family.
2. Teach the woman the 2. GH can quickly become
importance of keeping prenatal more severe between prenatal
appointments, which will be care visits. Understanding why
2
more frequent because she has she should keep appointments,
mild GH.
the woman is more likely to do
so.
The
woman
will
keep 1. Reinforce to the woman the 1. By understanding these
prescribed
prenatal prescribed measures to care for measures that limit the severity
appointments.
herself at home.
of GH, the woman may be
more motivated to maintain
them.
Delivery of a healthy baby
a. Remain on bed rest; a. Reduces the flow of blood to
spending most time on her side. the skeletal muscles, thus
making it more available to the
placenta; enhancing fetal 02
Patient will be in a stable b. Eat a well-balanced, high
condition after delivery
protein diet; limit high sodium
foods; include high-fiber foods
and drink at least 8 glasses of
noncafeinated drinks each day.
b. Woman with GH lose
protein in their urine, which
must be replaced to maintain
nutrition and fluid balance.
High Na intake may worsen
hypertension and decrease the
woman’s blood volume. Fibers
will help reduce constipation.
2. Teach the woman to report
signs that indicate worsening
GH:
headache;
visual
disturbances
(blurring);
gastrointestinal
symptoms
(nausea,
pain);
edema,
especially of the face and
fingers; noticible drop in urine
output.
2. GH can worsen despite
careful home management and
pt. Compliance, if the woman
has these symptoms, she needs
to be evaluated to prevent
progression of preclampsia.
3
4