NURSING MANAGEMENT OF

HYPERTENSION IN PREGNANCY

For the purpose of understanding, a brief explanation of the nursing process will
be needed.

THE NURSING PROCESS

Definition: The nursing process is a systematic client centred method of

structuring the delivery of nursing care. The nursing process entails gathering
and analysing data in order to identify client strengths and potential or actual
health problems, and developing and continually reviewing a plan of nursing
interventions to achieve mutually agreed outcomes. At every stage of the
process, the nurse works closely with the client to individualise care and build a
relationship of mutual regard and trust. This process includes:

1-ASSESSMENT

 Obtain a nursing history.

 Conduct physical assessment/Examination/observations.
 Review client records
 Review nursing literature.
 Consult support persons.
 Consult other health professionals.

2-DIAGNOSIS

 Compare data against standards.

 Generate tentative hypothesis.
 Identify gaps and inconsistencies.
 Determine client’s strength, risks, diagnosis and problems.

3-PLANNING: Develop an individualised care plan that specifies client goals /

desired outcomes, and related nursing interventions.

 Set priorities and goals

 Write goals/ desired outcomes.
 Select nursing strategies/interventions.
 Consult other health professionals.
 Write a care plan.

4-IMPLEMENTING: carrying out (or delegating) and documenting the planned

nursing intervention.

5- EVALUATING.
Nursing management of HIP is divided into 3 phases, namely;

1- Nursing management of mild hypertension in pregnancy at the ante

natal clinic (for mild hypertension) using focused ante natal care,
where the patient is treated as a doctors patient, this is to say that the
client is seen by a doctor at each visit. The nursing management of
this type of client is intended to give the client a close monitoring in
order to halt the progress of the disorder, ensure maternal and foetal
survival and the progress of the pregnancy till term or until it is
considered safe for alternative method of delivery by the doctor.
Nursing management may include:

✔ Advice on bed rest preferably lying in the left lateral position to

enhance venous return.
✔ Health education to the client and relatives on the disease
condition, diet and drug adherence.
✔ Monitor vital signs and foetal heart rate at each visit paying
special attention to the blood pressure.
✔ Urine testing for sugar, protein and acetone at each visit.
✔ Give regular and closely dated appointments.
✔ Physical examination for oedema (Pedal, abdominal and facial)
at each visit.
✔ As the need arises send patient for an ultrasound scan to
monitor foetal wellbeing.
✔ Other routine procedures.
1- The 2nd phase is the nursing management of HIP in the ward. This is
usually in cases of moderate to severe hypertension. The client is
reviewed by the doctor, who may decide to admit and manage in the
ward. Patient is managed using the nursing process and a care plan as
the medium.
Some of the activities carried out by the nurses in the ward are as
follows:
A comprehensive admission procedure as follows: Initial
assessment of the patient’s condition on admission. This serves
as a baseline data for further nursing management
✔ History taking.
✔ Physical examination, noting oedema (arms, face, ankles,
abdomen and fingers), pallor, jaundice, cyanosis.
✔ Observations: This includes vital signs with particular
attention to blood pressure and pulse rate, foetal heart
rate. Weigh client.
✔ Open an in put and out put chart.
✔ Urine testing for protein, sugar, acetone and specific
gravity.
While client is on admission:
✔ Minimise external stimuli: This is to promote rest and relaxation, minimize
visitors.
 ✔ Ensure moderate protein and carbohydrate diet.
✔ Sodium restrictions.
✔ Address emotional, physical and psychological needs.
✔ 4 hourly vital signs monitoring and daily weighing of patient.
✔ Daily assessment for placental separation, headache, visual disturbances,
epigastric pains and altered level of consciousness.

The 3rd phase involves the care of the patient with HIP in labour and due to
time factor the

Presenter will not delve into that. It involves the nursing management of HIP
using the pathograph and depending on the doctor’s judgement; delivery
may be expedited or alternative method of delivery used.

ASSESSME DIAGNOSI OBJECTIVE INTERVENTIO SCIENTIFIC EVALUATIO

NT S S N PRINCIPLES N

1-Oedema 1-Fluid After 8 1-- These Patient lost

volume hours of Implement restrictions 2 kg at the
excess nursing dietary can. help expiration
related to action, the restrictions reduce of 2 hours.
decreased client as indicated cellular Goal met.
venous weight will fluid
return as reduce by -Educate retention
evidenced at least patient on
by 2kg the need to
oedema. elevate legs
when
2- sitting.

-Serve
prescribed
diuretics

Restlessne Anxiety Patient will -Educate the -Knowledge Patient was

ss related to be able to client about
about the able to
disease sleep for the disorder
disorder sleep for 3
condition at least 2 and its
and hours
as hours Prognosis. possible during the
evidenced during the prognosis day and 8
by day and 8 -Reassure will help hours
patient’s hours patient alleviate during the
inability to during the -Nurse in a patients night.
sleep. night. quiet fear and
environment. concerns.

-Restrict -
visitors. Reassuranc
 e alleviates
worries.

-A quite
and calm
environme
nt
promotes
rest and
sleep.

Some nursing diagnosis associated with HIP

• Activity intolerance.
• Disturbed sensory perception (visual).
• Disturbed thought process.
• Ineffective coping.
• Altered sleep pattern.
• Excess fluid volume.
• Risk for injury.