Pregnancy Induced Hypertension - ,. are nolonger...

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Pregnancy-Induced Hypertension The exact etiology of this disorder is unknown, with several theories being advanced. Data have suggested that  PIH may be the result of increased peripheral vascular resistance secondary to generalized vasospasm when the vessels  are no longer refractory to the effects of pressor agents. New research proposes that elevated cardiac output and  associated hyperdynamic vasodilation during the first trimester result in damage to the endothelium with compensatory  vascular vasodilation. Regardless of the mechanisms, PIH is a chronic disease process, with a decrease in placental  perfusion occurring before the late sign of hypertension is detected. (This plan of care is to be used in conjunction with the Trimesters and the High-Risk Pregnancy CPs.) CLIENT ASSESSMENT DATA BASE Circulation Persistent increase in BP over pregravid or first-trimester baseline readings after 20 wk of pregnancy (systolic  elevation > 30 mm Hg, diastolic elevation > 15 mm Hg or a BP  > 140/90 mm Hg on two consecutive readings assessed at least 6 hr apart). History of chronic hypertension. Jugular venous distension. Gallop rhythm may be present. Pulse may be decreased. May have spontaneous bruising, prolonged bleeding, or epistaxis (thrombocytopenia). Elimination Oliguria/anuria may be present. Hematuria may be noted. Food/Fluid Nausea/vomiting. Weight gain of 2+ lb in 1 wk, 4 lb or more per month (depending on length of gestation). Malnourished (overweight or underweight by 20% or greater); poor protein/caloric intake. Edema may be present, ranging from mild to severe/generalized; and may involve facies, extremities, and organ  systems (i.e., liver, brain). Glycosuria (diabetes mellitus). Neurosensory Dizziness, frontal headaches. Decreased responsiveness/somnolence. Diplopia, blurred vision, or even loss of visual fields; scotomata (spots before eyes). Hyperreflexia; clonus. Convulsions—tonic, then tonic-clonic phases, followed by a period of loss of consciousness. Funduscopic examination may reveal edema or vascular spasm. Pain/Discomfort Epigastric pain (right upper quadrant [RUQ] region) Respiration Respirations may be less than 14/min. Bibasilar crackles may be present. Dyspnea.
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Safety Rh incompatibility may be present. Sexuality Primigravida, multiple gestation, hydramnios, gestational trophoblastic disease (e.g.,: hydatidiform mole), hydrops  fetalis (Rh antigen-antibody) Fetal movement may be diminished Signs of abruptio placentae may be present (e.g., uterine tetany, tenderness) Teaching/Learning Adolescent (under age 15 yr) and older primigravida (age 35 yr or older) are at greatest risk Family history of pregnancy-induced hypertension (PIH)
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