04.11 Gestational HTN (Hypertension)

Overview

  1. Elevated BP after 20 weeks
  2. Gestational HTN = BP greater than 140/90

Nursing Points

General

  1. It can progress and worsen to preeclampsia (see lesson on preeclampsia)
    1. Goal to monitor closely, prevent a dangerous progression to preeclampsia
    2. Might induce early when benefit of delivery outweighs risk of staying pregnant
  2. Monitoring includes:
    1. Labs (CBC, BMP, checking urine for protein, 24 hr urine for creatinine clearance)
      1. All done to ensure it is not progressing
    2. Monitor mother’s blood pressure
    3. Frequent assessments of baby (NST’s, ultrasounds)
      1. High pressures can reduce healthy blood flow to the fetus and restrict growth

Assessment

  1. Elevated BP (over 140/90) with no other signs/symptoms
  2. Assess closely for progression
  3. Hypertensive States of Pregnancy:
    1. Gestational HTN
      1. BP greater than 140/90
      2. Occurs after 20 weeks
        1. HTN prior to 20 weeks is labeled as “chronic”
    2. Preeclampsia and eclampsia
      1. See lesson on preeclampsia

Therapeutic Management

  1. Antihypertensives
  2. Possible induction

Nursing Concepts

  1. Reproduction – always remember there’s a second life at stake
  2. Perfusion – BP control

Patient Education

  1. Signs to report to provider
    1. Headache, blurred vision, and increase in swelling
  2. BP monitoring and tracking

Reference Links

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Video Transcript

In this lesson I will explain gestational hypertension and the effects it has on the patient as well as your role in providing care

So what does all of this mean? The patient has an elevated blood pressure. Ok let’s talk about this in more detail. It is not just a little elevated, we are looking at blood pressures of 140/90 or greater AND an absolute must have is the 20 weeks gestation. The patient has to be 20 weeks or more pregnant. If she is under 20 weeks gestation then it is just called chronic hypertension. A patient with gestational hypertension will have no other symptoms. If there are other symptoms like proteinuria then it is progressing. Progressing to preeclampsia. So refer to the lesson on preeclampsia for more details on this. For this patient there will be close monitoring and they might induce early if the benefit of delivery outweighs the risk of staying pregnant. So what does monitoring mean? Monitoring will include lab work like CBC, BMP, and checking urine for protein. Monitoring blood pressures and frequent assessments of the baby with non stress tests and ultrasounds are done to make sure the fetus is getting the nutrients it needs and growing properly.
Our assessment is going to be of the elevated BP which rememer is 140/90 or over with no other signs/symptoms. Signs and symptoms are a signal that we are progressing to preeclampsia. Lab work assessment is done to again check for progression. We can’t forget to also assess the fetus. We have to make sure the fetus is in a safe environment and getting the nutrients that it needs. So with this fetal assessment we will check it’s growth because hypertension will cause growth restriction and also a non stress test or even an U/S for those measurements to ensure the baby is okay.
We need to manage the blood pressures to make sure we can keep the patient and fetus safe. So antihypertensives might be prescribed to help bring the blood pressure down. First line treatment is methyldopa and labetalol. Induction might need to be part of our management if the fetus or mother is at risk.

The patient needs education on signs to report to the provider. These are signs like headache, vision changes and increased swelling. These symptoms are signs that the hypertension could be progressing. She needs to know how to do BP monitoring at home and how to keep a log and report any high readings. She also needs to be instructed on any medications to help control the pressures.

The nursing concepts are going to be reproduction because gestational hypertension is caused by the reproduction and always remember there’s a second life at stake. Perfusion is the other concept because we are concerned with the high blood pressure and the organs including the placenta not getting perfused the way that they should.
So the key points to remember and know are this is hypertension. Hypertension is 140/90 or greater. The patient must be 20 weeks or more pregnant. This is a must have criteria. If the patient is 18 weeks pregnant and has a high blood pressure then she is just classified as being a chronic hypertensive patient. There are no other symptoms with this. If patients start having additional symptoms it could be a sign that the disease is progressing . Gestational hypertension does put the patient at risk just like a regular non pregnancy cardiac patient. They are at risk for perfusion problems. And remember we need to perfuse something very important, a baby! So without adequate perfusion the fetus doesn’t get healthy blood flow like it should and the baby will grow small and be grown restricted.

Make sure you check out the resources attached to this lesson. Now, go out and be your best selves today. And, as always, happy nursing.

Read more

  • Question 1 of 8

After reviewing a newly pregnant client’s history, a nurse knows that which of the following puts the client at risk for gestational hypertension?

  • Question 2 of 8

A nurse is caring for a 30-year-old pregnant client who has been diagnosed with HELLP syndrome. Based on the nurse’s knowledge of the condition, the nurse understands that the H stands for:

  • Question 3 of 8

A nurse is providing education to a patient who is 24 weeks pregnant and had a blood pressure of 150/91. Which statement by the client indicates understanding of teaching?

  • Question 4 of 8

A postpartum client complains that she gained a lot of weight during her pregnancy and that her ankles are swollen. The nurse assesses her feet and lower legs for edema. Which actions would be part of assessing peripheral edema? Select all that apply.

  • Question 5 of 8

A pregnant client with preeclampsia is being assessed by the nurse in the labor and delivery unit of the hospital. The nurse checks the client’s lower legs and feet to assess for edema and notes 3+ pitting edema bilaterally. Which of the following describes this stage of pitting edema? Select all that apply.

  • Question 6 of 8

A nurse is educating a pregnant client with gestational hypertension on signs that indicate worsening. Which of the following should be included in the teaching? Select all that apply.

  • Question 7 of 8

A nurse is caring for a client who is 33 weeks pregnant and has a blood pressure of 143/94. The nurse knows the client is at risk for which of the following?

  • Question 8 of 8

A nurse is caring for a pregnant client at her 16-week appointment. Her blood pressure is 142/91. What diagnosis should the nurse expect?

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