Pregnancy- Induced Hypertension
(PIH; preeclampsia and eclampsia)
Nursing Care Plan & Management
Description
1. Preeclampsia is a hypertensive disorder of pregnancy
developing after 20 weeks’ gestation and characterized by
oedema, hypertension, and proteinuria.
2. Eclampsia is an extension of preeclampsia and is
characterized by the client experiencing seizures.
Aetiology
1. The cause of preeclampsia is unknown.
2. Possible contributing factors include:
▪ Genetic or immunologic
▪ Primigravid status
▪ Conditions that create excess trophoblastic tissue, such
as multiple gestation, diabetes, or hydatidiform mole.
▪ Age younger than 18 or older than 35 years.
Pathophysiology
,▪ Preeclampsia is a multisystem, vasospastic disease process
characterized by haemoconcentration, hypertension, and
proteinuria.
Assessment Findings
1. Clinical manifestations of mild preeclampsia
▪ Blood pressure exceeding 140/90 mmHg; or increase
above baseline of 30 mm Hg in systolic pressure or 15
mmHg in diastolic pressure on two readings taken 6
hours apart.
▪ Generalized oedema in the face, hands, and ankles (a
classic sign)
▪ Weight gain of about 1.5 kg (3.3 lb) per month in the
second trimester or more than 1.3 to 2.3 kg (3 to 5 lb) per
week in the third trimester
▪ Proteinuria 1+ to 2+, or 300 mg/dL, in a 24 hour sample
2. Warning signs of worsening preeclampsia
▪ Rapid rise in blood pressure
▪ Rapid weight gain
▪ Generalized oedema
▪ Increased proteinuria
▪ Epigastric pain, marked hyperreflexia, and severe
headache, which usually precede convulsions in
eclampsia
▪ Visual disturbances
▪ Oliguria (<120 mL in 4 hours)
▪ Irritability
▪ Severe nausea and vomiting
3. Clinical manifestations of severe preeclampsia
▪ Blood pressure exceeding 160/110 mm Hg noted on two
readings taken 6 hours apart with the client on bed rest.
▪ Proteinuria exceeding 5 g/24 hours
▪ Oliguria (less than 400 mL/24 hours)
▪ Headache
▪ Blurred vision, spots before eyes, and retinal oedema
▪ Pitting oedema of the sacrum, face, and upper
extremities
, ▪ Dyspnoea
▪ Epigastric pain
▪ Nausea and vomiting
▪ Hyperreflexia
4. Eclampsia exists once the patient has experienced a grand
mal seizure. The patient may progress o more serious
complications such as cerebral haemorrhage, liver rupture,
and coma.
5. Laboratory and diagnostic study findings. Abdominal test
results are provided in Table.
TEST FINDINGS
Blood
Haematocrit >40%
>5.5 mg/dL
Renal Function >6.0 mg/dL (severe pregnancy-
Serum uric acid induced hypertension (PIH)
>1.0 mg/dL
Creatinine 2.0-3.0 mg/dL (severe PIH)
Creatinine clearance <150 mL/min
8-10 mg/dL
BUN 10-16 mg/dL (severe PIH)
Coagulation
Platelets
Fibrin degradation <100,000 mL (severe PIH)
products >16 mg/mL (severe PIH)
Classification Of Hypertensive Disorders Of Pregnancy
Disorder Symptoms Onset
Blood pressure
Gestational elevated > 140/90 mm
hypertension Hg >20 weeks pregnancy
(PIH; preeclampsia and eclampsia)
Nursing Care Plan & Management
Description
1. Preeclampsia is a hypertensive disorder of pregnancy
developing after 20 weeks’ gestation and characterized by
oedema, hypertension, and proteinuria.
2. Eclampsia is an extension of preeclampsia and is
characterized by the client experiencing seizures.
Aetiology
1. The cause of preeclampsia is unknown.
2. Possible contributing factors include:
▪ Genetic or immunologic
▪ Primigravid status
▪ Conditions that create excess trophoblastic tissue, such
as multiple gestation, diabetes, or hydatidiform mole.
▪ Age younger than 18 or older than 35 years.
Pathophysiology
,▪ Preeclampsia is a multisystem, vasospastic disease process
characterized by haemoconcentration, hypertension, and
proteinuria.
Assessment Findings
1. Clinical manifestations of mild preeclampsia
▪ Blood pressure exceeding 140/90 mmHg; or increase
above baseline of 30 mm Hg in systolic pressure or 15
mmHg in diastolic pressure on two readings taken 6
hours apart.
▪ Generalized oedema in the face, hands, and ankles (a
classic sign)
▪ Weight gain of about 1.5 kg (3.3 lb) per month in the
second trimester or more than 1.3 to 2.3 kg (3 to 5 lb) per
week in the third trimester
▪ Proteinuria 1+ to 2+, or 300 mg/dL, in a 24 hour sample
2. Warning signs of worsening preeclampsia
▪ Rapid rise in blood pressure
▪ Rapid weight gain
▪ Generalized oedema
▪ Increased proteinuria
▪ Epigastric pain, marked hyperreflexia, and severe
headache, which usually precede convulsions in
eclampsia
▪ Visual disturbances
▪ Oliguria (<120 mL in 4 hours)
▪ Irritability
▪ Severe nausea and vomiting
3. Clinical manifestations of severe preeclampsia
▪ Blood pressure exceeding 160/110 mm Hg noted on two
readings taken 6 hours apart with the client on bed rest.
▪ Proteinuria exceeding 5 g/24 hours
▪ Oliguria (less than 400 mL/24 hours)
▪ Headache
▪ Blurred vision, spots before eyes, and retinal oedema
▪ Pitting oedema of the sacrum, face, and upper
extremities
, ▪ Dyspnoea
▪ Epigastric pain
▪ Nausea and vomiting
▪ Hyperreflexia
4. Eclampsia exists once the patient has experienced a grand
mal seizure. The patient may progress o more serious
complications such as cerebral haemorrhage, liver rupture,
and coma.
5. Laboratory and diagnostic study findings. Abdominal test
results are provided in Table.
TEST FINDINGS
Blood
Haematocrit >40%
>5.5 mg/dL
Renal Function >6.0 mg/dL (severe pregnancy-
Serum uric acid induced hypertension (PIH)
>1.0 mg/dL
Creatinine 2.0-3.0 mg/dL (severe PIH)
Creatinine clearance <150 mL/min
8-10 mg/dL
BUN 10-16 mg/dL (severe PIH)
Coagulation
Platelets
Fibrin degradation <100,000 mL (severe PIH)
products >16 mg/mL (severe PIH)
Classification Of Hypertensive Disorders Of Pregnancy
Disorder Symptoms Onset
Blood pressure
Gestational elevated > 140/90 mm
hypertension Hg >20 weeks pregnancy
