Hypertensive disorders of pregnancy (also known as pregnancy-associated hypertensive disorders, pregnancy induced hypertension) are the most common complications that occur during pregnancy and are a major cause of maternal and fetal morbidity and mortality. These disorders include gestational hypertension, preeclampsia, eclampsia, chronic hypertension, and chronic hypertension with superimposed preeclampsia. If left untreated, preeclampsia can lead to a life-threatening complication called HELLP (hemolysis, elevated liver enzymes, low platelet count) syndrome. It is estimated that preeclampsia alone complicates 2-8% of pregnancies globally. Show Hypertensive disorders in pregnancy include five categories of hypertension and are defined as such by the American College of Obstetricians and Gynecologists (ACOG): Nursing care planning and management for pregnant clients with hypertensive disorders or preeclampsia involve early detection, thorough assessment, and prompt treatment of preeclampsia. Another priority is to ensure the mother’s safety and deliver a healthy newborn as close to a full term as possible. Here are six nursing diagnoses for your nursing care plans for pregnant patients with hypertensive disorders, focusing on managing clients with preeclampsia. Decreased Cardiac OutputA decrease in circulating blood volume due to the shifting of fluid from the intravascular to the interstitial spaces occurs in a pregnant client with a hypertensive disorder due to the decrease of the circulating blood volume and the total vascular volume and an increase in the systemic vascular resistance, the heart rate decreases as well as the stroke volume. These mechanisms lead to a decrease in cardiac output seen among clients with hypertensive disorders in pregnancy. Nursing Diagnosis
Related factors may include
Possibly evidenced by
Desired Outcomes
Nursing Assessment and Rationales1. Assess blood pressure and pulse every
one (1) hour or as indicated. 2. Assess the mean arterial pressure (MAP) at 11-13 and 20-24 weeks gestation. A pressure of 90 mm Hg is considered predictive of preeclampsia. 3. Assess for crackles, wheezes, and
dyspnea; note respiratory rate/effort. Note client snoring. 4. Auscultate for the apical pulse and assess the client’s heart rate and rhythm. 5. Assess the client’s neurological status. 6. Assess the client for visual
disturbances. 7.
Assess the client for indications for an earlier delivery. 8. Monitor and measure the client’s urine output as per protocol. Maintain strict intake and output. 9. Monitor and measure the client’s 24-hour urine for proteinuria. Nursing Interventions and Rationales1. Provide frequent rest periods with bed rest. Restrict activity rather than instituting complete bed rest. 2. Instruct the client to elevate legs when sitting or lying down. 3. Monitor the client’s BP and instruct monitoring of BP at home. 4. Record and graph vital signs, especially BP and pulse. 5. Monitor for invasive hemodynamic parameters such as cardiac output, as indicated. 6. Administer low-dose aspirin as indicated. 7. Administer antihypertensive medications as ordered. Observe for side effects of antihypertensive drugs.
8. Prepare for the birth of fetus by cesarean delivery, labor when severe preeclamptic or eclamptic condition is stabilized, but vaginal delivery is not feasible. Recommended nursing diagnosis and nursing care plan books and resources. Disclosure: Included below are affiliate links from Amazon at no additional cost from you. We may earn a small commission from your purchase. For more information, check out our privacy policy. References and sources for this nursing care plan for hypertensive disorders in pregnancy. Updated and reviewed by M. Belleza, R.N. and M. Vera, BSN, R.N. Which of the following positions increases cardiac output and stroke volume of a client in labor?In the supine group fluid bolus resulted in significantly increased cardiac output and stroke volume, decreased mean arterial pressure and systemic vascular resistance, and unchanged heart rate.
What position increases cardiac output?The prone position induced an increase in heart rate (54 ± 2 to 58 ± 2 beats/min, P < 0.05), total peripheral vascular resistance (13 ± 1 to 16 ± 1 mmHg · min−1 · l−1,P < 0.05), forearm venous plasma concentration of norepinephrine (97 ± 9 to 123 ± 16 pg/ml, P< 0.05), and atrial natriuretic peptide (49 ± 4 to 79 ± 12 ...
How does positioning of the pregnant woman affect cardiac output?Easterling et al. 19 studied 16 healthy women at 35–40 weeks' gestation and showed that a change from left lateral to sitting position was associated with a significant decrease in cardiac output and stroke volume, and an increase in total peripheral resistance.
Does stroke volume increase supine?In the supine position, the stroke volume was constant at rest and during exercise. In the sitting position, the stroke volume at rest was 40 per cent smaller than in the supine. It increased considerably with mild work, but not significantly with an even heavier work load.
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