Hypertensive disorders of pregnancy (also known as pregnancy-associated hypertensive disorders, pregnancy induced hypertension) are the most common complications that occur during pregnancy and are a major cause of maternal and fetal morbidity and mortality. These disorders include gestational hypertension, preeclampsia, eclampsia, chronic hypertension, and chronic hypertension with superimposed preeclampsia. If left untreated, preeclampsia can lead to a life-threatening complication called HELLP (hemolysis, elevated liver enzymes, low platelet count) syndrome. It is estimated that preeclampsia alone complicates 2-8% of pregnancies globally. 

Hypertensive disorders in pregnancy include five categories of hypertension and are defined as such by the American College of Obstetricians and Gynecologists (ACOG): 

Gestational Hypertensive Disorders

1. Gestational hypertension. Defined as a systolic blood pressure of 140 mm Hg or more, and/or diastolic blood pressure of 90 mm Hg or more on two blood pressure readings at least four (4) hours apart after 20 weeks of gestation in a woman with previously normal blood pressure. Gestational hypertension does not persist longer than 12 weeks postpartum and usually resolves after a week postpartum.
2. Preeclampsia. Preeclampsia is a pregnancy-specific condition and is defined as a new-onset of hypertension that occurs most often after 20 weeks of gestation. Blood pressure is elevated more than 140 mm Hg systolic, more than 90 mm Hg diastolic. Hypertension is usually accompanied by new-onset proteinuria although other signs and symptoms of preeclampsia (thrombocytopenia, impaired liver function, pulmonary edema, visual disturbance) may present in some women in the absence of proteinuria.
3. Eclampsia. Eclampsia is the onset of seizure activity or coma in a woman with preeclampsia with no history of preexisting pathology that can result in seizure activity. Seizure leads to severe maternal hypoxia, injury, and aspiration pneumonia. Eclampsia has an increased maternal mortality rate especially in settings with low resources. 

Chronic Hypertensive Disorders

1. Chronic hypertension. Chronic hypertension as hypertension diagnosed or present before pregnancy or before 20 weeks of gestation. It is more prevalent with increasing late childbearing and in persons with obesity. Additionally, hypertension that is diagnosed for the first time during pregnancy and that does not resolve postpartum is also classified as chronic hypertension. 
2. Chronic hypertension with superimposed preeclampsia. Preeclampsia is considered superimposed when it complicates preexisting chronic hypertension. About half of women with chronic hypertension may develop superimposed preeclampsia. It is associated with increased maternal or fetal mortality.

Nursing Care Plans

Nursing care planning and management for pregnant clients with hypertensive disorders or preeclampsia involve early detection, thorough assessment, and prompt treatment of preeclampsia. Another priority is to ensure the mother’s safety and deliver a healthy newborn as close to a full term as possible. 

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Here are six nursing diagnoses for your nursing care plans for pregnant patients with hypertensive disorders, focusing on managing clients with preeclampsia. 

1. Decreased Cardiac Output ^UPDATED!
2. Risk for Imbalanced Fluid Volume ^UPDATED!
3. Ineffective Tissue Perfusion ^UPDATED!
4. Risk for Injury ^UPDATED!
5. Imbalanced Nutrition: Less Than Body Requirements ^UPDATED!
6. Deficient Knowledge ^UPDATED!
7. Other Possible Nursing Care Plans

Recommended Resources

Recommended nursing diagnosis and nursing care plan books and resources.

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See also

Other recommended site resources for this nursing care plan:

• Nursing Care Plans (NCP): Ultimate Guide and Database ^{MUST READ!}
  Over 150+ nursing care plans for different diseases and conditions. Includes our easy-to-follow guide on how to create nursing care plans from scratch.
• Nursing Diagnosis Guide and List: All You Need to Know to Master Diagnosing
  Our comprehensive guide on how to create and write diagnostic labels. Includes detailed nursing care plan guides for common nursing diagnostic labels.

Other care plans related to the care of the pregnant mother and her baby:

• Abortion (Termination of Pregnancy) | 8 Care Plans
• Cervical Insufficiency (Premature Dilation of the Cervix) | 4 Care Plans
• Cesarean Birth | 11 Care Plans
• Cleft Palate and Cleft Lip | 7 Care Plans
• Gestational Diabetes Mellitus | 8 Care Plans
• Hyperbilirubinemia (Jaundice) | 4 Care Plans
• Labor Stages, Induced, Augmented, Dysfunctional, Precipitous Labor | 45 Care Plans
• Neonatal Sepsis | 8 Care Plans
• Perinatal Loss (Miscarriage, Stillbirth) | 6 Care Plans
• Placental Abruption | 4 Care Plans
• Placenta Previa | 4 Care Plans
• Postpartum Hemorrhage | 8 Care Plans
• Postpartum Thrombophlebitis | 5 Care Plans
• Prenatal Hemorrhage (Bleeding in Pregnancy) | 9 Care Plans
• Preeclampsia and Gestational Hypertension | 6 Care Plans
• Prenatal Infection | 5 Care Plans
• Preterm Labor | 7 Care Plans
• Puerperal & Postpartum Infections | 5 Care Plans
• Substance Abuse in Pregnancy | 9 Care Plans

References and Sources

References and sources for this nursing care plan for hypertensive disorders in pregnancy.

• Abais-Battad, J. M., Lund, H., Fehrenbach, D. J., Dasinger, J. H., Alsheikh, A. J., & Mattson, D. L. (2018, 31 December). Parental Dietary Protein Source and the Role of CMKLR1 in Determining the Severity of Dahl Salt-Sensitive Hypertension. Hypertension, 73(2).
• American College of Obstetricians and Gynecologists (ACOG) Committee on Obstetric Practice. (2020). Practice Bulletin #222: Gestational Hypertension and Preeclampsia. Obstetrics & Gynecology, 135, 237-260.
• Arulkumaran, N., & Lightstone, L. (2013). Severe pre-eclampsia and hypertensive crises. Best Practice & Research Clinical Obstetrics & Gynaecology, 27(6), 877-884.
• Benigni, A., Gregorini, G., Frusca, T., Chiabrando, C., Ballerini, S., Valcamonico, A., … & Remuzzi, G. (1989). Effect of low-dose aspirin on fetal and maternal generation of thromboxane by platelets in women at risk for pregnancy-induced hypertension. New England Journal of Medicine, 321(6), 357-362.
• Braunthal, S., & Brateanu, A. (2019, April 10). Hypertension in pregnancy: Pathophysiology and treatment. SAGE, 7.Chakraborty, A., & Can, A. S. (2021, July 2). Calcium Gluconate – StatPearls. NCBI. Retrieved December 14, 2021.
• El Allani, L., Benlamkaddem, S., Berdai, M. A., & Harandou, M. (2020, June 9). A case of massive hepatic infarction in severe preeclampsia as part of the HELLP syndrome. The Pan African Medical Journal, 36(78).
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• Fróes, N. B. M., Lopes, M. V. D. O., Pontes, C. M., Ferreira, G. L., & Aquino, P. D. S. (2020). Middle range theory for the nursing diagnosis Excess Fluid Volume in pregnant women. Revista Brasileira de Enfermagem, 73.
• Gallo, D., Poon, L. C., Fernandez, M., Wright, D., & Nicolaides, K. H. (2014, April 15). Prediction of Preeclampsia by Mean Arterial Pressure at 11–13 and 20–24 Weeks’ Gestation. Fetal Diagnosis and Therapy.
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• Khooshideh, M., Ghaffarpour, M., & Bitarafan, S. (2017, July 6). The comparison of anti-seizure and tocolytic effects of phenytoin and magnesium sulfate in the treatment of eclampsia and preeclampsia: A randomised clinical trial. Iranian Journal of Neurology, 16(3), 125-129.
• Leeners, B., Wagner, P. N.-., Kuse, S., Stiller, R., & Rath, W. (2009, July 07). Emotional Stress and the Risk to Develop Hypertensive Diseases in Pregnancy. Hypertension in Pregnancy, 26(2), 211-226.
• Leifer, G. (2018). Introduction to Maternity and Pediatric Nursing (8th ed., Vol. 1). Elsevier.
• Lu, Y., Chen, R., Cai, J., Huang, Z., & Hong Yuan. (2018, October 29). The management of hypertension in women planning for pregnancy. British Medical Bulletin, 128(1), 75-84.
• Luger, R. K., & Knight, B. P. (2021, October 9). Hypertension In Pregnancy. Statpearls. Retrieved December 8, 2021.
• Mayrink, J., Souza, R. T., Feitosa, F. E., Rocha Filho, E. A., Leite, D. F., Vettorazzi, J., … & Cecatti, J. G. (2019). Mean arterial blood pressure: potential predictive tool for preeclampsia in a cohort of healthy nulliparous pregnant women. BMC pregnancy and childbirth, 19(1), 1-8.
• O’Brien, L. M., Bullough, A. S., Owusu, J. T., Tremblay, K. A., Brincat, C. A., Chames, M. C., … & Chervin, R. D. (2012). Pregnancy-onset habitual snoring, gestational hypertension, and preeclampsia: prospective cohort study. American journal of obstetrics and gynecology, 207(6), 487-e1. 
• Pradhan, M., Kishore, S.V., & Champatiray, J. (2020, April 4). Effect of low dose aspirin on maternal outcome in women at risk for developing pregnancy-induced hypertension. International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 9(4), 1590+.
• Perry, S. E., Hockenberry, M. J., Lowdermilk, D. L., Wilson, D., Alden, K. R., & Cashion, M. C. (2017). Maternal child nursing care-E-Book. Elsevier Health Sciences.
• Rasouli, M., Pourheidari, M., & Gardesh, Z. H. (2019, February 12). Effect of Self-care Before and During Pregnancy to Prevention and Control Preeclampsia in High-risk Women. International Journal of Preventive Medicine, 10(21).
• ​​Schiff, E., Peleg, E., Goldenberg, M., Rosenthal, T., Ruppin, E., Tamarkin, M., … & Mashiach, S. (1989). The Use of Aspirin to Prevent Pregnancy-Induced Hypertension and Lower the Ratio of Thromboxane A2 to Prostcyclin in Relatively High-Risk Pregnancies. New England Journal of Medicine, 321(6), 351-356.
• Schmidt P, Skelly CL, Raines DA. Placental Abruption. [Updated 2021 Jul 5]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing.
• Sinkey, R. G., Battarbee, A. N., Bello, N. A., Ives, C. W., Oparil, S., & Tita, A. T.N. (2020, August 27). Prevention, Diagnosis, and Management of Hypertensive Disorders of Pregnancy: a Comparison of International Guidelines. Current Hypertension Reports, 22(66), 2. Topical Collection on Preeclampsia.
• Weight Gain During Pregnancy | Pregnancy | Maternal and Infant Health. (2021, May 26). CDC.
• Wisner, K. (2019). Gestational hypertension and preeclampsia. MCN: The American Journal of Maternal/Child Nursing, 44(3), 170.
• Xu, T. T., Zhou, F., Deng, C. Y., Huang, G. Q., Li, J. K., & Wang, X. D. (2015). Low‐Dose aspirin for preventing preeclampsia and its complications: a meta‐analysis. The Journal of Clinical Hypertension, 17(7), 567-573. 
• Zelalem, A., Endeshaw, M., Ayenew, M., Shiferaw, S., & Yirgu, R. (2017, July 25). Effect of Nutrition Education on Pregnancy Specific Nutrition Knowledge and Healthy Dietary Practice among Pregnant Women in Addis Ababa. Clinics in Mother and Child Health.

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Updated and reviewed by M. Belleza, R.N. and M. Vera, BSN, R.N.