Nursing care plans, Pregnancy Induced Hypertension (PIH) is a potentially life-threatening disorder that usually develops after the 20th week of pregnancy. It typically occurs in Nulliparity women and may be nonconvulsive or convulsive.Preeclampsia continues to have a massive impact on maternal and prenatal morbidity/mortality
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
- 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,
- 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.
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
- 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
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