Nursing Care Plan Problem / Needs / Cues Physiologic Deficit Decreased cardiac output Objective cues: 17 year old

d elevated blood pressure from 130/80 mmHg to 150/90 mmHg presence of non-pitting edema of the face and upper extremeties 24-Hour Urine Collection was done and proteinuria was noted with a presence of 510 mg protein Oliguria of 350 mL in 24 hours Subjective cues: Sukad nabuntis k okay nitaas gyud akong BP, usually muabot og 150/100. Naa poy Nursing Diagnosis Decreased cardiac output: elevated blood pressure of 150/90 mmHg related to vasospasm Scientific Basis Accommodation to normal pregnancy includes a decrease in both systolic and diastolic BP as a result of a decrease in systemic vascular resistance primarily secondary to vasodilation. Relaxin, which is released from the ovaries under the influence of human chorionic gonadotrophin, upregulates nitric oxide synthase (NOS), the enzyme that generates NO from arginine, via the endothelial endothelin B receptor. In preeclampsia, derangement of endothelial-derived vasoactive factors is thought to result Objectives of Care After 8 hours of nurse-patient interaction, the patient will be able to participate in activities that reduce blood pressure/ cardiac workload Nursing Actions Measures to reduce blood pressure: 1. Monitor BP. 1. A comparison of pressures provides a more complete picture of vascular involvement. 2. Helps reduce sympathetic stimulation; promotes relaxation. 3. Response to drug therapy is dependent on both the individual as well as the synergistic effects of the drugs. Page 38 39 Nursing Care Plans 7th Edition by doenges, Moorhouse and Murr Rationale

2. Provide calm, restful surroundings, minimize environmental noise. 3. Monitor response to medications to control blood pressure. Page 38 39 Nursing Care Plans 7th Edition by doenges, Moorhouse and Murr

mga times nga malipong ko unya musakit pud akong kuto-kuto. as verbalized by the patient.

in the predominance of substances that are vasoconstrictors (endothelin, thromboxane A2) over vasodilators (NO, prostacyclin). Hypertension, defined as repeat BP measurements 140/90 mmHg, results from abnormal vasoconstriction.

4. Instruct patient to lie in left lateral position 5. Maintain seizure precaution Page 951 Diseases by Susan L. Davidson 6. A padded tongue blade should always be ready for use at the bedside. 7. Cluster nursing activities. 8. Assess fetal heart rate 9. Administer hydralazine, as ordered. 10. Administer Magnesium Sulfate, as ordered. 7th Edition page 809 Maternity Nursing by Reeder, Martin and Koniak

4. To increase venous return, cardiac output and renal blood flow. 5. To protect the patient from injury during a convulsion Page 951 Diseases by Susan L. Davidson 6. Prevents the client from biting her tongue if a convulsion develops 7. So that the client is disturbed as little as possible 8. Many of the prescribed drugs may affect the fetus 9. Prescribed to lower the BP 10. Prescribed to prevent development of convulsion 7th Edition page 809 Maternity Nursing by Reeder, Martin and Koniak

Source: Page 543 Pathophysiology of the Clinical Manifestations of Preeclampsia By 1. Michelle Hladunewich, 2. S. Ananth Karumanchi, 3. Richard Lafayette