Preeclampsia, the nonconvulsive form of the disorder, is marked by the onset of hypertension after 20 weeks of gestation. It develops in about 7% of pregnancies and may be mild or severe. The incidence is significantly higher in low socioeconomic groups.  The classic diagnostic triad included hypertension, proteinuria, and edema. Recently, the National High Blood Pressure Education Working Group recommended eliminating edema as a diagnostic criterion because it is too frequent an observation during normal pregnancy to be useful in diagnosing preeclampsia

Eclampsia, preeclampsia with seizures, the occurrence of seizures defines eclampsia. It is a manifestation of severe central nervous system involvement. The convulsive form occurs between 24 weeks’ gestation and the end of the first postpartum week. The incidence increases among women who are pregnant for the first time, have multiple fetuses, and have a history of vascular disease.

Cause of preeclampsia

The cause of preeclampsia is unknown, it is often called the “disease of theories” because many causes have been proposed, yet none has been well established. Geographic, ethnic, racial, nutritional, immunologic, and familial factors may contribute to preexisting vascular disease, which, in turn, may contribute to its occurrence. Age is also a factor. Adolescents and primiparas older than age 35 are at higher risk for preeclampsia. However, a growing body of evidence suggests that maternal vascular endothelial injury plays a central role in the disorder. Other theories include a long list of potential toxic sources, such as autolysis of placental infarcts, autointoxication, uremia, maternal sensitization to total proteins, and pyelonephritis.

Risk Factors for Preeclampsia

• Age less than 20 years or more than 35 years
• Nulliparity
• Multiple gestation
• Hydatidiform mole
• Diabetes mellitus
• Thyroid disease
• Chronic hypertension
• Renal disease
• Collagen vascular disease
• Antiphospholipid syndrome
• Family history of preeclampsia

Complications of Preeclampsia

Generalized arteriolar vasoconstriction is thought to produce decreased blood flow through the placenta and maternal organs. This decrease can result in:

• Intrauterine growth retardation (or restriction),
• Placental infarcts, and
• Abruptio placentae.

Other possible complications include

• Stillbirth of the neonate,
• Seizures,
• Coma,
• Premature labor,
• Renal failure
• Hepatic damage in the mother.

Treatment for Preeclampsia

Early recognition is the key to Preeclampsia treatment. Therapy for patients with preeclampsia is intended to halt the progress of the disorder specifically, the early effects of eclampsia, such as seizures, residual hypertension, and renal shutdown, and to ensure fetal survival. Some physicians advocate the prompt inducement of labor, especially if the patient is near term; others follow a more conservative approach. Therapy may include:

• Complete bed res.
• An antihypertensive, such as methyldopa or hydralazine
• Magnesium sulfate to promote diuresis, and reduce blood pressure.

Nursing diagnosis

Common nursing diagnosis found in Nursing care plans Preeclampsia-Eclampsia Pregnancy Induced Hypertension PIH

• Activity intolerance
• Disturbed sensory perception (visual)
• Disturbed thought processes
• Excess fluid volume
• Fear
• Impaired urinary elimination
• Ineffective coping
• Ineffective tissue perfusion: Cerebral, peripheral
• Excess Fluid Volume related to pathophysiologic changes of gestational hypertension and increased risk of fluid overload
• Ineffective Tissue Perfusion: Fetal Cardiac and Cerebral related to altered placental blood flow caused by vasospasm and thrombosis

• Risk for Injury related to seizures or to prolonged bed rest or other therapeutic regimens
• Anxiety related to diagnosis and concern for self and fetus
• Decreased Cardiac Output related to decreased preload or antihypertensive therapy

Nursing outcome nursing interventions and patient teaching Nursing care plans Preeclampsia-Eclampsia Pregnancy Induced Hypertension PIH

There are two kinds of hypertension; they are primary hypertension, meaning that the reason for the elevation in blood pressure cannot be identified.  Also known as essential hypertension. These terms mean simply that the hypertension is of unknown origin. In some patients with primary hypertension, there is a strong hereditary tendency.

And, Secondary hypertension or malignant hypertension is the term used to signify high blood pressure from an identified cause. The elevation of blood pressure results from some other disorder Such as kidney disease, renal artery stenosis.

Cause for Hypertension

Although the precise cause for most cases of hypertension cannot be identified, it is understood that hypertension is a multifactorial condition. Because hypertension is a sign, it is most likely to have many causes, just like fever has many causes. For hypertension to occur there must be a change in one or more factors affecting peripheral resistance or cardiac output. In addition, there must also be a problem with the control systems that monitor or regulate pressure.

1. Primary hypertension or essential hypertension (90% to 95% of Cases) Precise cause unknown
2. Secondary Hypertension or malignant hypertension causes by:

RENAL:  Acute glomerulonephritis, Chronic renal disease, Polycystic disease, Renal artery stenosis, Renal vasculitis,Renin-producing tumors.

CARDIOVASCULAR: Coarctation of aorta , Increased intravascular volume , Increased cardiac output, Rigidity of the aorta

ENDOCRINE:  Adrenocortical hyperfunction, Exogenous hormones e.g (glucocorticoids, estrogen including pregnancy-induced and oral contraceptives), Pheochromocytoma, Hypothyroidism, Hyperthyroidism, Pregnancy-induced

NEUROLOGIC:  Psychogenic, Increased intracranial pressure, Sleep apnea, Acute stress, including surgery

Complications for Hypertension

Hypertension is a major cause of stroke, cardiac disease, and renal failure. Complications occur late in the disease and can attack any organ system.

Cardiac complications include

• Coronary artery disease
• Angina
• Myocardial infarction
• Heart failure
• Arrhythmias
• Sudden death.

Neurologic complications:

• Cerebral infarctions and
• Hypertensive encephalopathy can cause blindness.
• Renovascular hypertension can lead to renal failure.

Treatment of Hypertension

Although essential hypertension has no cure, drug therapy and diet and lifestyle modifications can control it. Current guidelines for treating hypertension recommend, as a first step, lifestyle modifications that are aimed at increasing physical activity and weight loss in most patients. Unfortunately, many patients are unable to lose weight, and pharmacological treatment with antihypertensive drugs must be initiated.

Two general classes of drugs are used to treat hypertension:

• Vasodilator drugs that increase renal blood flow
• Natriuretic or diuretic drugs that decrease tubular reabsorption of salt and water.

Nursing Assessment Nursing care plans for Hypertension

Nursing History

• Family history of high Blood Pressure
• Previous episodes of high Blood Pressure
• Dietary habits and salt intake
• Target organ disease or other disease processes that may place the patient in a high-risk group  diabetes, CAD, kidney disease
• Cigarette smoking
• Episodes of headache, weakness, muscle cramp, tingling, palpitations, sweating, vision disturbances
• Medication that could elevate Blood Pressure:
  • Hormonal contraceptives, steroids
  • NSAIDs
  • Nasal decongestants, appetite suppressants, tricyclic antidepressants
• Other disease processes, such as gout, migraines, asthma, heart failure, and benign prostatic hyperplasia, which may be helped or worsened by particular hypertension drugs.

Physical Examination

• Auscultate heart rate and palpate peripheral pulses; determine respirations.
• If skilled in doing so, perform funduscopic examination of the eyes for the purpose of noting vascular changes. Look for edema, spasm, and hemorrhage of the eye vessels. Refer to ophthalmologist for definitive diagnosis.
• Examine the heart for a shift of the point of maximal impulse to the left, which occurs in heart enlargement.
• Auscultate for bruits over peripheral arteries to determine the presence of atherosclerosis, which may be manifested as obstructed blood flow.
• Determine mentation status by asking patient about memory, ability to concentrate, and ability to perform simple mathematical calculations.

• Blood Pressure Determination, Auscultate and record precisely the systolic and diastolic.

Nursing Diagnoses Nursing care plans for Hypertension

Common nursing diagnosis found in patient with hypertension

• Deficient Knowledge regarding the relationship between the treatment regimen and control of the disease process
• Ineffective Therapeutic Regimen Management related to medication adverse effects and difficult lifestyle adjustments

• Deficient knowledge (lifestyle modifications)
• Fatigue
• Ineffective coping
• Ineffective tissue perfusion: Cardiopulmonary
• Noncompliance: Therapeutic regimen
• Risk for injury

Nursing outcome nursing interventions and patients teaching Nursing care plans for Hypertension