PIH

PREGNANCY- INDUCED HYPERTENSION

Hypertensive Disorders of Pregnancy

CLINICAL CHRONIC GESTATIONAL PREECLAMPSIA

FINDINGS HYPERTENSION HYPERTENSION

1. Time of Onset of <20 weeks of Usually in 3rd >20 weeks of

Hypertension gestation trimester gestation

2. Degree of Mild or Severe Mild Mild or Severe

Hypertension
3. Proteinuria Absent Absent Usually present

4. Serum urate Rare Absent Present in almost all

>5.5 mg/dl cases

5.Hemoconcentrati Absent Absent Present in severe

on, disease
thrombocytopenia,
liver dysfunction

6. LVH by ECG May be present Absent Absent

a. Refers to condition unique to pregnancy where vasospastic
hypertension is accompanied by proteinuria and edema;
maternal or fetal condition may be compromised
Probable cause: Gradual loss of normal pregnancy-related
resistance to angiotensin II
May also be related to decreased production of some
vasodilating prostaglandins
b. Onset after 20th week of pregnancy, may appear in labor
or up to 48 hours postpartum.
c. Characterized by widespread vasospasm
d. Cause essentially unknown, but incidence is high in
primigravidas, multiple pregnancies, H. mole, poor
nutrition, essential hypertension; familial tendency.
e. Occurs in 5%-7% of all pregnant women
f. Usual clinical classification of hypertensive
disorders in pregnancy is as follows:
1. Pregnancy-induced hypertension (PIH)
1.1 Hypertension
1.2 Pre-eclampsia
a. Mild
b. Severe
1.3 Eclampsia (with convulsions + PEH)
2. Chronic Hypertension
3. Chronic hypertension with
superimposed PIH
3.1 Superimposed preeclampsia
3.2 Superimposed eclampsia
Toxemia- poisoned condition of the blood
caused by the presence of toxic materials,
usually bacterial but occasionally chemical
or hormonal in nature. When bacteria
themselves find entrance into the
bloodstream, the condition is known as
bacteremia. Toxins are not due to
absorption of putrefied or fermented
foodstuffs, nor are they absorbed from the
colon in conditions of constipation.
The term toxemia is also sometimes applied
to preeclampsia, a condition that
occasionally occurs in late pregnancy and
is characterized by high blood pressure
and kidney malfunction.
• Classic triad of symptoms
includes edema/weight gain,
hypertension and proteinuria.
Eclampsia includes convulsion and
coma
• Possible life threatening
complications. HELLP syndrome
(Hemolysis, elevated liver enzymes,
lowered platelets).
• i. Only known cure is delivery
(caesarean section)
 Cesarean Section, surgical removal of
the fetus through incisions in the
abdominal wall and the uterus.
cesarean section is performed for
cases in which the size of the birth
canal is too small to allow the fetus to
pass. The operation also is used in
cases of abnormal developments
during delivery, such as hemorrhage
or tumors in the mother, failure of the
cervix to dilate, fetal distress (lack of
oxygen), or difficult positioning of the
fetus.
 Causes
The cause of PIH is unknown. Some
conditions may increase the risk of
developing PIH, including the following:
• pre-existing hypertension (high blood
pressure)
• kidney disease
• diabetes
• PIH with a previous pregnancy
• mother's age younger than 20 or older
than 40
• multiple fetuses (twins, triplets)
Risk factor of Preeclampsia
-Nulliparity
-Low socioeconomic status
-older age
-family history
-Diabetes
-Multiple Gestation (twins)
-Chronic Hypertension
-Hydatidiform mole
-Rh imcompability
Diagnosis is often based on the increase in blood
pressure levels, but other symptoms may help
establish PIH as the diagnosis. Tests for
pregnancy-induced hypertension may include the
following:
– blood pressure measurement
– urine testing
– assessment of edema
– frequent weight measurements
– eye examination to check for retinal changes
– liver and kidney function tests
– blood clotting tests

*Possible Nursing Diagnosis

1) Fluid Volume Deficit (isotonic) related to edema
formation
2) Decreased Cardiac Output related to variations in BP
readings and edema
Amniocentesis-a medical procedure generally performed
during the fourth month of pregnancy, approximately one
ounce of the amniotic fluid surrounding the fetus is drawn
off for study. The examination of fetal cells contained in the
sample can provide valuable information about
developmental abnormalities of the fetus. When properly
performed, amniocentesis poses no health risks to either the
developing fetus or the mother.
PATHOPHYSIOLOG
Y
 Preeclampsia

Increased Cardiac Output

Vasospasm

Vascular effects Kidney effects

Interstitial effects

Vasoconstriction Decreased glomeruli filtration

Diffusion of fluid from
Rate & increased permeability blood stream
into
Of glomeruli membrane interstitial tissue

Poor organ perfusion Increased serum Blood Urea Nitrogen,

Uric acid & Creatinine

Increased blood Pressure Decreased urine output Edema &

Proteinuria
 Signs and Symptoms
The following are the most common symptoms of high
blood pressure in pregnancy. However, each woman
may experience symptoms differently. Signs &
Symptoms may include:
- increased blood pressure (HPN)
- protein in the urine (proteinuria)
- edema (swelling)
- sudden weight gain
- visual changes such as blurred or double vision
- nausea, vomiting
- right-sided upper abdominal pain or pain around the
stomach
- urinating small amounts
- changes in liver or kidney function tests
 Complications
Preeclampsia is a development of
HPN accompanied by proteinuria,
edema, or both after 2 weeks
gestation. Further complication of
pre- eclampsia is chronic HPN and if
not treated nor controlled may
increase the risk of placental
insufficiency, abruptio placentae and
superimposed pre- eclampsia &
eclampsia.
 Prevention
Early identification of women at risk
for pregnancy-induced hypertension
may help prevent some
complications of the disease.
Education about the warning
symptoms is also important because
early recognition may help women
receive treatment and prevent
worsening of the disease.
Medical Management: Magnesium Sulfate
• Magnesium sulfate acts upon the
myoneural junction, diminishing
neuromuscular transmission.
• It promotes maternal vasodilatation,
better tissue perfusion and has
anticonvulsant effect
Nursing responsibilities
• Monitor client’s respirations, blood
pressure and reflexes, as well as urinary
output frequently.
• Administer medications either IV or IM
• Antidote for excess levels of magnesium
sulfate is calcium gluconate or calcium
chloride
• Mnemonic 4 A’s: Aldomet, Apresoline,
Atenolol, Adalat.
Drugs (4 A’s)
Adalat (Nifedipine)- a Calcium channel
blocker that lowers BP by decreasing the
cardiac rate and contractility. It blocks the
influx of calcium in the smooth muscles
resulting to relaxation in the heart and
blood vessels.
WATCH OUT for: Hypotension and
tachycardia
Aldomet (Methyldopa)- a Central acting anti-
adrenergics that decrease sympathetic
nervous system activity in the brain.
Apresoline (Hydralazine)- A direct
vasodilator which acts directly to
relax vascular smooth muscle thus
causing decrease peripheral
resistance.

Atenolol- A type of beta-blocker that

inhibits sympathetic stimulation beta
adrenergic receptor thus it decreases
cardiac rate and contractility.
WATCH OUT for: Hypotension and
Bradycardia
 Nursing interventions
• Promote complete bed rest, side-lying.
• Carefully monitor maternal/fetal vital signs
• Monitor I&O, results of laboratory tests
• Take daily weights
• Do daily fundoscopic examination
• Institute seizure precautions
• Instruct client about appropriate diet
• Continue to monitor 24-48 hours post
delivery
• Administer medications as ordered;
Peripheral vasodilator of choice usually
Hydralazine (Apresoline)
 Nursing Management

1. Bed rest & hospitalization until fetus is

mature and delivery can be accomplished
as usual.
2. Intravenous access and at least two (2)
units of blood should be available at all
times.
3. Continuous maternal & fetal monitoring.
4. Amniocentesis may be done to determine
fetal maturity for possible delivery.
5.Caesarian section is often indicated if there
is excessive bleeding.
6. Diet: Low salt (Na), High Calcium diet.
NCP and Drug study
Hypertension
ASSESSMENT
S > “Tumataas ang presyon ko” as verbalized by the patient
O> Fatigue
>Dyspnea
>Palpitations
>Anxiety
> Chest pain
>Syncope

NURSING DIAGNOSIS: Cardiac Output, risk for decreased r/t vasoconstriction,

hypovolemia, cerebrovascular pressure and ventricular rigidity AMB hypertension
PLANNING: Diet and weight reduction, Lifestyle changing: alcohol moderation, exercise
regimen, cessation of smoking,
Anti- hypertensive drug therapy

NURSING INTERVENTION: Continuous blood pressure monitoring and its changes in BP

(positioning, restlessness).
Provide client teaching and discharge planning such as risk factors, dietary instructions,
compliance of anti- HPN medications, as well as exercise regimen.

RATIONALE: To assess any variables in BP changes.

To improve the patient’s condition thru health teaching and proper medication intake.
To help the patient to control and help relieve stress that increases BP
Magnesium Sulfate
INDICATION: To prevent or control seizures in preeclampsia or eclampsia
Seizures, hypertension, and encephalopathy with acute nephritis in children

ACTION: May decrease acetylcholine released by nerve impulses, but its

anticonvulsant mechanism is unknown

CONTRAINDICATION: Contraindicated with patients with toxemia of pregnancy

during 2 hours p receding delivery.
- Used cautiously in pregnant women during labor.

SIDE EFFECTS: CV: Bradycardia

  Respiratory: Respiratory paralysis

ROUTE AND DOSAGE: Route: IV, I.M.

  Onset: 1-2 min/ 1 hr.
  Peak: Rapid or unknown
  Duration: 30 min or 3-4 hr.

NURSING IMPLICATION: Alert: Watch for respiratory depression and signs and
symptoms of heart block
Hydralazine HCL (Apresoline)
INDICATION: Essential hypertension, severe essential HPN.
Adults: Initially, 10mg P.O. qid; gradually increased to 50mg qid, PRN

ACTION: Unknown- a direct- acting vasodilator that relaxes arteriolar smooth muscle

CONTRAINDICATION: Contraindicated in those with CAD or mitral valvular RHD

Use cautiously in patients with suspected cardiac disease, CVA or severe renal
impairment and in those taking other anti- Hypertensive drugs.

SIDE EFFECTS: CNS: peripheral neuritis, dizziness

CV: orthostatic hypertension, tachycardia, edema, angina pectoris
Hematologic: Thrombocytopenia with or without purpura

ROUTE AND DOSAGE: Route: PO, IV, IM

  Onset: 10-30 min.
  Peak:1-2 hr
  Duration: 2-6 hr.

NURSING IMPLICATION: Monitor the patient’s BP, PR & body weight frequently.
Hydralazine may be given with diuretics & beta- blockers to decrease Sodium
retention & tachycardia & to prevent angina attacks
The Middleearth Group
GABRIEL, JOY
GARCIA, JOHN DIEGO
GAYO, JACQUELINE
ILUMIN, JEFFREY
JACINTO, JAYSON
JUGO, DOMINGO
JUNATAS, BENJO ROY
LAGRATA, VENESSE
LANDINGIN, ALVIN
LEYVA, MARK PHILIP
LIWANAG, MARK LOUIE
MAGLIBA, VERONICA