Nursing Care Plan for Hypertension
Undoubtedly, a nursing care plan for hypertension is auseful instrument for monitoring and treatment of pregnancy-induced hypertension. Pregnancy-induced hypertension (PIH) is a complex disorder that usually occurs in pregnant women after the 20th week and threatens the patient`s life. Typically, such a disorder occurs in nulliparous women and can have two forms: the convulsive and nonconvulsive one. The nonconvulsive form of hypertension is called preeclampsia and is marked by the hypertension onset after 20 weeks of gestation. This form can be both mild and severe and it can be developed in up to 7% of the pregnancies.
In low socioeconomic groups, the incidence of preeclampsia is higher. Eclampsia, which is considered as a convulsive form, usually occurs in the period between 24 weeks' gestation and the end of the first postnatal week. The pregnant women, whohave a history of vascular disease, who are pregnant for the first time or have several fetuses are in the risk zone. In approximately 5% of pregnant women, preeclampsia transforms into eclampsia. About 15% of thesewomen die from this disorder and its complications. Such ahigh percentage of fetal mortality is the result of the increased incidence of premature parturition and its complications are the most frequent reason for maternal death in developed countries. Therefore, the importance of the effective nursing care plan for hypertension is pretty obvious.
Main Causes of Preeclampsia
Unfortunately, the real cause ofpreeclampsia is unknown. The researchers oftenconsider this disorder as the Disease of Theories since many different causes were suggested, yet none of them were supported by the reasonable proofs. According to the common experts` opinion, decreased level of prostaglandins, as well as a low resistance to angiotensin II usually lead to a severe arterial vasospasm that, consequently, result in endothelial damage. The kidney, brain, blood, and liver are susceptible to different dysfunctions most of all. In this regard, several risk factors that may predispose a woman to preeclampsia development have been identified: familial history; malnutrition; patient history of diabetes mellitus, multiple gestation, chronic hypertension, and trophoblastic disease.
Generalized arteriolar vasoconstriction produces the limited blood flow to the maternal organs and placenta. This can lead to the placental infarcts, intrauterine growth retardation, as well as abruption placentae. In their turn, elevated liver enzyme levels, hemolysis, and low platelet count are the key characteristics of severe eclampsia. Besides, this disorder is closely connected with the unique form of coagulopathy. As for the other potential complications, one should mention about coma, the stillbirth of the neonate, renal failure, hepatic damage in the mother, and premature labor.
Assessment of the Pregnancy Nursing Care Plan
The patient suffering from mild preeclampsia usually tells about the sudden weight gain. After a careful analysis of blood pressure readings, the patient`s history shows hypertension 140 mm Hg systolic, as well as an increase of 30 mm Hg systolic pressure in patients. Under the worsening of preeclampsia, the patient can suffer from oliguria (little output of urine), epigastric pain or heartburn, blurred vision, emotional tension, and irritability. Besides, the patient may complain about a severe headache. The ophthalmologic examination may reveal retinal edema, vascular spasm, detachment, papilledema, hemorrhage, and even arteriovenous nicking. In some cases, preeclampsia may transform into eclampsia extremely quickly. The patient may appear to stop breathing, then suddenly take a deep breath and continue breathing. Suddenly, the patient may suddenly fall into a coma that can last from several minutes up to several hours. After the awakening, the patient may experience significant issues with memory. Severe eclampsia mayinvolve up to twenty seizures whereas the mild form of the disorder involves only more than one seizure.
Physical examination shows that patients with eclampsia suffer from the more severe symptoms compared to the patients with eclampsia. In particular, systolic blood pressure can raise up to 200 mm Hg.
Hypertension Nursing Care Plan
- Disturbed sensory perception;
- Excessive fluid volume;
- Ineffective coping;
- Impaired elimination of urine;
- Risk of injuries;
Essential Outcomes of the Nursing Care Plan for Hypertension
- The patient will be able to identify the strategies that would help reduce anxiety;
- The patient will be able to live the active life without the feeling of excessive fatigue;
- The patient will demonstrate the satisfactory skills of orientation in the surrounding environment;
- The patient will be able to talk about the fears and hesitations;
- The fluid volume of the patient is within the normal parameters;
- The patient will succeed in demonstrating active coping behavior;
- The patient will demonstrate optimal functioning in the scope of the confines of the visual impairment.
- The patient will show the signs of adequate peripheral and cerebral perfusion;
- The patient will be able to avoid multiple complications;
- The urine output of the patient will remain within the norm;