Pregnancy induced hypertension

Patient: Mrs. Smith, 31 years of age, 36 weeks gestation, G2 P0 A1. Admitted due to patient feeling lightheaded and epigastric pain.
Risk of development of preeclampsia r/t high blood pressure above 140/90, and preexisting high blood pressure prior to pregnancy.
1. Risk of placental growth insufficiency due to the negative effects of severe preeclampsia and smoking combined
  1. May also lead to intrauterine growth restriction. This is due to insufficient blood supply to allow placental and fetal growth and decelopment
    1. External fetal monitoring and ultrasound need to monitor current fetal heart and activity level and to be able to appropriately see fetal and placental growth and development.
2. Continually monitor patients blood pressure. If blood pressure continues to be elevated and patient is diagnosed as being preeclamptic, administer
3. Risk of developing HEELP syndrome.
4. Induction of labour when safe for patient if diagnosed with preeclampsia.
  1. Being oxytocin 6 units in 2/3 &1/3 at a rate of 2ml
Risk of increased stress r/t potential of preterm labour and/or loss of newborn
1. Spontaneous loss of previous pregnancy at 18 weeks gestation. Why did this occur? Did this cause pyschosocial effects on the patient.
  1. Engage in fetal stress test and place patient on continuious fetal heart monitoring. This will ensure that the fetus is not in distress and appears to be happy and healthy. Further ultrasound testing may be needed to look at fetal placement, fetal growth and so forth.
  2. Multidisciplinary approach with social work to add support to the family as the last pregnancy was not desirable.
Risk of a cardiovascular accident or seizure activity r/t the effects of hypertension and smoking
1. Ensure magnesium sulfate is initated 24 hours prior to delivery and continues during delivery to ensure the patient does not experience seizure activity during the labour process.
2. Patient feeling lightheaded puts heavier need on closely monitoring patient for seizure activity. Even though this may be caused by other factors such as hydration, it may also be solely from preeclampsia
3. Take on a holistic approach to nursing interventions. This means continually checking blood pressure and other needed diagnostic testing as well as continually asking the patient of their well-being. Also ensure patient teaching on seizure and stroke signs and symptoms (visual changes, nausea, urinary incontinence, headache, etc).
4. Is the patient in pain? Offer epidural for comfort
History of pregnancy: patient states that this pregnancy seemed normal, no reports of high blood pressure up to this point. Although the patient explained that she experienced moderate high blood pressure previous to pregnancy. Stress is present during this pregnancy due to the fear of misscarrying again and fetal overall health. No alcohol use. Smokes occasionally. Only medications are prenatal vitamins.
Objective Values: BP- 142/94, temp- 37.2, resp- 18, urinanalysis- ph 6.050, protien- +++, all other values were negative. Blood tests show increase in uric acid, increase in hemocrit, slight decrease in platelet count, increase in pt/PTT, increase in creatinine, increase in AST and ALT, normal total billirubin.
1. Repeat testing every 6 hours
Allergies: Penicillin = Rash.
GBS negative, HIV negative.

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Pregnancy induced hypertension

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