NCLEX Review Guide: Hypertensive Disorders of Pregnancy

Types of Hypertensive Disorders

• Gestational Hypertension: BP ≥140/90 mmHg after 20 weeks gestation without proteinuria or other features of preeclampsia
• Preeclampsia: Hypertension after 20 weeks with proteinuria (≥300mg/24hr) OR severe features (thrombocytopenia, elevated liver enzymes, renal dysfunction, pulmonary edema, cerebral symptoms)
• Chronic Hypertension: BP ≥140/90 mmHg before pregnancy or before 20 weeks gestation
• Preeclampsia Superimposed on Chronic HTN: Worsening hypertension with new-onset proteinuria or severe features in women with chronic hypertension

Signs and Symptoms

• Severe headache that doesn't respond to acetaminophen - indicates cerebral edema
• Visual disturbances (blurred vision, scotomata, photophobia) - retinal arterial spasm
• Epigastric pain - indicates liver capsule distention from edema
• Sudden weight gain >2 lbs/week or >6 lbs/month due to fluid retention
• Hyperreflexia with possible clonus - indicates CNS irritability
• Decreased urine output <30 mL/hr - indicates renal involvement

Priority Nursing Actions

1. Assess BP every 15 minutes during acute episodes, then every 4 hours when stable
2. Monitor for signs of impending eclampsia: severe headache, visual changes, epigastric pain
3. Maintain seizure precautions: padded side rails, suction at bedside, oxygen available
4. Strict I&O monitoring - output should be ≥30 mL/hr
5. Daily weights and assess for edema progression
6. Test urine for protein every 4 hours or per protocol