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Nursing diagnosis Deficiency of cognitive information related to elevated blood pressure as a health deficit

Goal of care
After nursing intervention the client will have the sufficient knowledge about the problem and the ability to deal with health situation and remain in control of life

Objective of care. After nursing intervention the client will be aware of this condition and how vital is the condition to her health. The client will be able to understand and to apply what are the certain ways that can progress her health and what can lead her to greater complication. The client will be able to manage herself when symptoms of the condition occur. Nursing intervention Discuss what is it all about elevated hypertension and the threat of this condition to health. Teach the client on ways to manage her condition such as stress reduction activities. Teach the client some ways to improve her health condition by engaging to exercises Explain to the client of what food items and the quantity of food she must take to maintain her health and to progress from her condition.

Hypertension is a major risk factor for cardiovascular disease (CVD - cerebrovascular event (CVE) and ischaemic heart disease (IHD)) and, as such, is one of the most important preventable causes of premature morbidity and mortality

Patients should stop smoking (offer help nicotine replacement therapy). Weight reduction should be suggested if necessary, to maintain ideal body mass index (BMI) of 20-25 kg/m2. Offer a diet sheet and/or dietetic appointment. Dietary self-help, e.g. dieting clubs, may be appropriate. Reduce their salt, total fat, saturated fat and cholesterol intake, while increasing consumption of polyunsaturated, monosaturated fats and oily fish. Encourage fruit, vegetables, legumes and whole grains; and low-fat (or zero-fat) dairy, poultry meat, fish and shellfish products - as in the Dietary Approaches to Stop Hypertension (DASH) eating plan.4 Cut alcohol intake to no more than 21 units (male) or 14 units (female) of alcohol per week. Encourage regular dynamic exercise tailored to the age and capabilities of the patient. This may mean three vigorous training sessions per week for a young adult, or brisk walking for 30 minutes most days for the older individuals. Do not offer supplements of calcium, magnesium or potassium to reduce BP.5 Relaxation therapy can help (PCTs are not recommended to provide them routinely). As well as the targets above, strive for a happy, well-informed patient. Remember to look for and treat any underlying cause in your initial assessment

Weight reduction if overweight Reduce sodium intake to ? 100 mmol/day: 2.4 g sodium, 6 g salt Increase aerobic exercise: 3045 min/day Limit alcohol intake to ? 1 oz/day Maintain adequate intake of potassium: 90 mmol/day Eat a diet rich in fruits, vegetables, and low-fat dairy products but reduced in saturated and total fat Discontinue tobacco use (reduce CVD risk)

Management of Preeclampsia
The optimal management of a woman with preeclampsia depends on gestational age and severity of the disease. Since delivery is the only cure for preeclampsia, clinicians must try to minimize maternal risk while maximizing fetal maturity. The primary objective is the safety of the mother and then the delivery of a healthy newborn. Preeclampsia A pregnancy complicated by mild preeclampsia at or beyond 37 weeks should be delivered. While the pregnancy outcome is similar in these women as those with a normotensive pregnancy, the risk of placental abruption and progression to severe disease is slightly increased.38,39 Thus, regardless of cervical status, induction of labor should be recommended. Cesarean section may be performed based on standard obstetric criteria. Prior to 37 weeks, expectant management is appropriate. In most cases, patients should be hospitalized and monitored carefully for the development of worsening preeclampsia or

complications of preeclampsia. While randomized trials in women with gestational hypertension and mild preeclampsia demonstrate the safety of outpatient management with frequent maternal and fetal evaluations, most of the patients in these studies had mild gestational hypertension.40 Therefore, the safety of managing a woman with mild preeclampsia as an outpatient still needs to be investigated. While bedrest has been recommended in women with preeclampsia, little evidence supports its benefit. In fact, prolonged bed rest during pregnancy increases the risk of thromboembolism. Antepartum testing is generally indicated during expectant management of these patients. However, the types of tests to be used and the frequency of testing have little consensus. Most clinicians offer a nonstress test (NST) and a biophysical profile (BPP) at the time of the diagnosis and usually twice per week until delivery.28,29 If a patient is at 34 weeks' gestation or more and has ruptured membranes, abnormal fetal testing, progressive labor, or fetal growth restriction in the setting of mild preeclampsia, delivery is recommended. Severe preeclampsia When severe preeclampsia is diagnosed after 34 weeks' gestation, delivery is most appropriate. The mode of delivery should depend on severity of the disease and the likelihood of a successful induction. However, whenever possible, vaginal delivery should be attempted and cesarean section should be reserved for routine obstetric indications. In addition, women with severe preeclampsia who have nonreassuring fetal status, ruptured membranes, labor, or maternal distress should be delivered regardless of gestational age. If a woman with severe preeclampsia is at 32 weeks' gestation or more and has received a course of steroid, she should be delivered as well. Patients presenting with severe, unremitting headache, visual disturbance, and right upper quadrant tenderness in the presence of hypertension and/or proteinuria should be treated with utmost caution. Expectant management of severe preeclampsia If a patient presents with severe preeclampsia before 34 weeks' gestation, but appears stable and fetal condition is reassuring, expectant management may be considered provided they meet the strict criteria set by Sibai et al (see Laboratory values for preeclampsia and HELLP syndrome).41 This type of management should be considered only in a tertiary center. In addition, because delivery is always appropriate for the mother, some authorities consider delivery as the definitive treatment regardless of gestational age. However, delivery may not be optimal for a fetus that is extremely premature. Therefore, in a carefully chosen population, expectant management may benefit the fetus without greatly compromising maternal health. All of these patients must be evaluated on a Labor and Delivery unit for 24 hours before a decision for expectant management can be made. During this period, maternal and fetal evaluation must show that the fetus does not have severe growth restriction or fetal distress. In

addition, maternal urine output must be adequate. The woman must have essentially normal laboratory values (with the exclusive exception of mildly elevated liver function test results less than 2 times the normal value) and hypertension that can be controlled. Fetal monitoring should include daily nonstress test and ultrasonography performed to monitor for the development of oligohydramnios and decreased fetal movement. In addition, fetal growth determination at 2-week intervals must be performed to document adequate fetal growth. In addition, a 24-hour urine collection for protein may be repeated. Corticosteroids for fetal lung maturity should be administered prior to 34 weeks. Daily blood tests should be performed for LFTs, CBC, uric acid, and LDH. Patients should be instructed to report any headache, visual changes, epigastric pain, or decreased fetal movement. Women with severe preeclampsia who are managed expectantly, must be delivered under the following circumstances:

Nonreassuring fetal heart status Uncontrollable blood pressure Oligohydramnios with AFI of less than 5 cm Severe intrauterine growth restriction where estimated fetal weight is less than 5% Oliguria (<500 mL/24 h) Serum creatinine level of at least 1.5 mg/dL Pulmonary edema Shortness of breath or chest pain with pulse oximetry of <94% on room air Headache that is persistent and severe Right upper quadrant tenderness Development of HELLP syndrome