Gestational Hypertension: Preeclampsia, Eclampsia [Nursing Diagnosis & Care Plan]

Pregnancy is a time of joy and excitement but can also be filled with worry. One of the biggest concerns for pregnant women is gestational hypertension, preeclampsia, or eclampsia.

Hypertension may be present before or during pregnancy. Generally, pregnant women experience increased blood pressure during the latter half of gestation. This occurs in around 10% of pregnancies.

Preeclampsia is a type of hypertension that affects 3.4% of expectant mothers in the US. It can also lead to eclampsia, characterized by convulsions, in 0.3% of cases globally.

These conditions can cause severe complications during pregnancy and put both mother and baby at risk. This post will discuss the symptoms, diagnosis, and treatment of gestational hypertension, preeclampsia, and eclampsia. Also, preeclampsia care plan management will be addressed.

What is Gestational Hypertension?

Gestational hypertension is a condition that causes high blood pressure during pregnancy. It typically occurs after 20 weeks and can range from mild to severe. If left untreated, it can lead to preeclampsia or eclampsia.

Gestational hypertension can potentially lead to preeclampsia, which is most common in young women with their first pregnancy. Women of advanced age, African-American women, and those with chronic hypertension or diabetes are at higher risk of developing this condition than those expecting twins.

Gestational hypertension is diagnosed when a woman’s blood pressure readings are higher than 140/90 mmHg, and she had normal blood pressure before 20 weeks of pregnancy without having proteinuria (the presence of excess protein in the urine).

What is Preeclampsia?

Preeclampsia, also known as toxemia of pregnancy, is a condition characterized by high blood pressure and protein in the urine. It can occur anytime after 20 weeks gestation and cause severe complications for the mother and baby if left untreated. Women with preeclampsia are at higher risk for developing seizures (eclampsia) and require close monitoring of their blood pressure and urine protein levels.

What is Eclampsia?

Eclampsia is a potentially life-threatening complication of preeclampsia. It is characterized by seizures, which can be caused by high blood pressure or other factors like low magnesium levels. Treatment includes anti-seizure medications and sometimes delivery of the baby if necessary.

What Causes Gestational Hypertension?

The actual cause of gestational hypertension is unknown, but several risk factors may increase a woman’s chances of developing the condition. These include:

• Advanced maternal age,
• Kidney disease
• pre-existing medical conditions like diabetes or chronic hypertension.
• Mother’s age younger than 20 or older than 40
• Kidney disease
• high body mass index (BMI)
• Diabetes
• Multiple fetuses (twins, triplets)
• Hypertension from a previous pregnancy
• African-American race

Who is more likely to develop high blood pressure (hypertension) during pregnancy?

Older women, overweight, have chronic hypertension or diabetes, or have experienced high blood pressure in a previous pregnancy are at higher risk of developing gestational hypertension. African-American women and those carrying multiple fetuses (twins, triplets) are also at increased risk.

What are the symptoms of gestational hypertension?

The most common symptom of gestational hypertension is high blood pressure. Other symptoms may include:

• Swelling in the face
• Hands
• Feet
• Headaches
• Blurred vision
• Upper abdominal pain
• Nausea or vomiting
• Sudden weight gain.

It is essential to consult healthcare if these symptoms are experienced during pregnancy.

How is Gestational Hypertension Diagnosed?

Gestational hypertension is typically diagnosed based on the results of a physical exam, urine tests, and blood pressure readings. An ultrasound may also be done to check for any signs of preeclampsia or eclampsia.

Why is Gestational Hypertension a Concern?

Gestational hypertension can increase the risk of developing preeclampsia, an even more severe condition. Preeclampsia can lead to complications such as premature labor, delivery, or even stillbirth. If left untreated, it can also be life-threatening for both mother and baby. Therefore, women diagnosed with gestational hypertension must receive proper monitoring and treatment.

It is also essential for pregnant women to be aware of the symptoms of gestational hypertension so that they can seek medical attention as soon as possible.

How is Gestational Hypertension Treated?

The primary goal of treatment for gestational hypertension is to prevent complications such as preeclampsia or eclampsia. Treatment may include lifestyle changes like reducing sodium intake, increasing physical activity, and stress reduction; medications to lower blood pressure; and close monitoring of the mother and baby.

In rare cases, baby delivery may be recommended if the condition worsens or other complications arise.

What are the symptoms of Gestational Hypertension?

The most common symptom of gestational hypertension is high blood pressure. Other symptoms may include

• headaches,
• nausea/vomiting,
• abdominal pain,
• vision changes
• swelling.
• Increased blood pressure
• Absence or existence of protein in the urine (to diagnose gestational hypertension or preeclampsia)
• Sudden weight gain
• swelling
• Visual changes like blurred or double vision
• Right-sided upper abdominal pain or around the stomach
• Urinating small amounts
• Changes in liver or kidney function tests

How is Gestational Hypertension Diagnosed?

Gestational hypertension is usually diagnosed with a combination of tests, including a physical exam, blood pressure readings over 140/90 mmHg, and urine tests to look for protein.

If your doctor suspects you have preeclampsia, they may order additional tests, such as liver or kidney function tests and an ultrasound to check the baby’s growth.

Sometimes, treatment may be recommended even before gestational hypertension is diagnosed if the symptoms are severe.

Treatment for Gestational Hypertension

The goal of treatment for gestational hypertension is to prevent the condition from progressing to preeclampsia or eclampsia. Treatment may include lifestyle changes such as:

• reducing sodium intake
• increasing physical activity
• stress reduction
• medications to lower blood pressure
• close monitoring of the mother and baby

In rare cases, baby delivery may be recommended if the condition worsens or other complications arise.

Complications

Complications of preeclampsia may include:

• Fetal growth restriction. Preeclampsia can cause the arteries that supply blood to the placenta to become constricted. If the fetus doesn’t receive enough blood and oxygen or is deprived of essential nutrients, it may experience slow growth, known as fetal growth restriction. The consequences of this condition can be severe for both mother and baby.
• Preterm birth. If preeclampsia becomes severe, the baby may need to be delivered early. This is typically done between 34 and 37 weeks gestation.
• Placental abruption. In rare cases, the placenta can escape the uterine wall (placental abruption). This cuts off oxygen and nutrient supply to the baby and can be life-threatening for both mother and baby.
• Eclampsia. Preeclampsia can cause seizures (eclampsia). This is an emergency that needs immediate medical attention.
• Cardiovascular disease. Women with preeclampsia may be at higher risk of developing cardiovascular and metabolic disorders later in life.
• Other organ damage. Women with preeclampsia can also experience damage to other organs, like the liver, kidneys, and brain.

Other possible complications of gestational hypertension include high blood pressure during delivery, preterm labor, postpartum hemorrhage, and stillbirth.

Nursing Care Plan: Gestational Hypertension, Preeclampsia, Eclampsia

Subjective Data

The patient reports feeling anxious and overwhelmed due to the diagnosis of gestational hypertension, preeclampsia or eclampsia.

Objective Data

Vital signs are within normal range, the patient has edema in the lower extremities, and lab values indicate increased creatinine levels.

Preeclampsia Nursing Diagnosis

The best way to tackle preeclampsia is through early diagnosis and management. To ensure an accurate diagnosis, a thorough medical history and physical exam should be conducted. If any signs of preeclampsia arise, the patient should have regular check-ups every 4 hours until delivery. Any changes in symptoms or other progressions should prompt more frequent evaluations.

• To address hypertension during pregnancy, the following measures will be taken: rest, comforting words, regular checks of vital signs and fluid intake, medication to lower blood pressure, prevention or management of seizures, and readiness for delivery.
• Monitor BP daily
• Monitor urine output
• Provide IV fluids if needed

The AACN Synergy Model for Critical Analysis and Resolution of Clinical Problems suggests that a patient with preeclampsia may benefit from six related diagnoses in their care plan. They include:

• Impaired Physical Mobility
• Risk for Injury
• Imbalanced Nutrition: Less than body requirements
• Deficient Fluid Volume
• Disturbed Energy Field
• Deficient Knowledge related to diagnosis, treatment, and prognosis.

Therefore, the nursing interventions should focus on providing information about the condition, helping manage anxiety, ensuring adequate nutrition and fluid intake, monitoring for any changes in vital signs and symptoms, providing physical comfort, and assisting the patient in preparing for delivery.

Nursing Interventions and Rationales

Monitor vital signs, particularly blood pressure.

Blood pressure may fluctuate and spike quickly; monitor for changes and elevations that could indicate worsening of the condition.

Monitor urine protein levels and other lab values as ordered

Monitoring lab values will help track the disease’s progression and determine if interventions are effective.

Provide patient education regarding healthy lifestyle, nutrition, and stress management.

Educate the patient on the importance of a healthy lifestyle for managing their gestational hypertension, preeclampsia or eclampsia.

Assist with comfort measures as needed, such as changing positions frequently.

Position changes can help reduce discomfort and pain associated with edema in the lower extremities.

Encourage rest techniques

Stress reduction is an important part of managing gestational hypertension, preeclampsia or eclampsia. Encouraging rest techniques can help the patient cope with their condition.

Provide emotional support 

Assisting the patient to understand and cope with their diagnosis is essential for their well-being. Providing emotional support can help the patient through this difficult time.

Refer patient to appropriate healthcare providers for follow-up care 

Refer the patient to other healthcare providers, such as a nutritionist, an obstetrician, or a mental health provider, for further evaluation and treatment.

Follow-up care is essential to ensure the health of both mother and baby. 

Follow prescribed medications per healthcare provider instructions

It is essential to follow all medication directions your healthcare provider prescribes to manage gestational hypertension, preeclampsia, or eclampsia. Do not take any additional medications without first consulting your healthcare provider.

FAQs:

How does Gestational Hypertension affect my baby?

Gestational hypertension can increase the risk of complications such as premature labor and delivery, low birth weight, placental abruption, and stillbirth. Therefore, monitoring both mother and baby closely throughout the pregnancy is essential.

In some cases, if gestational hypertension worsens or other complications arise, the delivery may be recommended to keep the mother and baby safe.

What should I do if I have gestational hypertension?

If you are diagnosed with gestational hypertension, following your healthcare provider’s instructions and attending all recommended monitoring appointments is essential. It is also necessary to take prescribed medications as directed and make lifestyle changes such as reducing sodium intake, increasing physical activity, and reducing stress.

Final Words

Nursing diagnosis for preeclampsia, gestational hypertension, and eclampsia can help nurses ensure appropriate patient care. Early diagnosis is key to managing these conditions, and nurses can play an essential role. Regular monitoring, patient education, lifestyle changes, and emotional support are beneficial for managing these conditions. By following the guidelines provided in this article, nurses can ensure their patients receive quality care and support.

References

• https://my.clevelandclinic.org/health/diseases/4497-gestational-hypertension
• https://www.cdc.gov/bloodpressure/pregnancy.htm
• https://www.aafp.org/pubs/afp/issues/2009/0515/p895.html