Hypertensive & Metabolic Disorders of Pregnancy - Concept Map
High-Risk Pregnancy Conditions: Hypertensive Disorders, Gestational Diabetes, and Hyperemesis Gravidarum
Related concepts
Hypertensive Disorders of Pregnancy
Sub concepts
- Gestational Hypertension
- Preeclampsia (Mild and Severe Features)
- Eclampsia
- Chronic Hypertension with Superimposed Preeclampsia
- Chronic Hypertension
- HELLP Syndrome
Relationship to central
Major classification of pregnancy complications affecting maternal-fetal perfusion and organ systems
Gestational Diabetes Mellitus (GDM)
Sub concepts
- Pathophysiology: Placental Hormone-Induced Insulin Resistance
- Screening and Diagnosis (50-g Glucose Challenge, 3-hour OGTT)
- Glycemic Targets in Pregnancy
- Maternal Complications
- Fetal/Neonatal Complications
- Management: Diet, Exercise, and Insulin Therapy
Relationship to central
Metabolic disorder causing maternal and fetal complications through hyperglycemia and insulin resistance
Hyperemesis Gravidarum
Sub concepts
- Severe Persistent Nausea and Vomiting
- Dehydration and Weight Loss
- Electrolyte Imbalances (Hypokalemia, Metabolic Alkalosis)
- Ketonuria and Metabolic Complications
- Management: Fluid Replacement, Antiemetics, Nutritional Support
Relationship to central
Gastrointestinal metabolic disorder causing severe dehydration, electrolyte imbalance, and nutritional deficiency
Nursing Assessment and Monitoring
Sub concepts
- Blood Pressure Monitoring
- Deep Tendon Reflex (DTR) Assessment
- Clonus Evaluation
- Urine Output Monitoring
- Weight Tracking
- Fetal Heart Rate Monitoring
- Laboratory Values (CBC, Liver Enzymes, Creatinine, Proteinuria)
Relationship to central
Critical nursing process for early detection of complications and prevention of maternal-fetal morbidity
Pharmacological Management
Sub concepts
- Magnesium Sulfate (Loading and Maintenance Doses)
- Therapeutic Levels and Toxicity Signs
- Calcium Gluconate Antidote
- Hydralazine
- Labetalol
- Nifedipine
- Methyldopa
- Insulin for GDM
- Antiemetics (Pyridoxine, Doxylamine, Metoclopramide)
Relationship to central
High-alert medications and antihypertensives essential for seizure prevention and blood pressure control
Nursing Interventions and Safety
Sub concepts
- Environmental Modification (Quiet, Dim Room)
- Seizure Precautions
- Left Lateral Positioning
- Strict Intake and Output Monitoring
- Emergency Airway Preparation
- Patient and Family Education
- Emotional Support and Coping
Relationship to central
Specific nursing actions based on NANDA diagnoses to reduce risk and prevent life-threatening complications
Pathophysiology Integration
Sub concepts
- Placental Abnormalities and Vasospasm
- Endothelial Dysfunction
- Intravascular Volume Depletion
- Fluid Shift and Hemoconcentration
- Organ-System Involvement (Renal, Hepatic, Cerebral, Visual)
- Insulin Resistance Pathophysiology
- Metabolic Alkalosis from Gastric Acid Loss
Relationship to central
Understanding the underlying mechanisms guides assessment, intervention, and patient education
Concept connections
- VasospasmReduced Placental PerfusionPathophysiologic mechanism leading to fetal growth restriction and placental abruption
- Endothelial DysfunctionIncreased Vascular PermeabilityUnderlying cause of fluid shift from intravascular to interstitial space
- Intravascular Volume DepletionCaution with IV FluidsNursing principle: woman is fluid-overloaded systemically but volume-contracted in vessels; requires careful fluid management with infusion pump
- Magnesium Sulfate Loading Dose 4-6 g IVMaintenance 1-2 g/hrSequential dosing protocol to achieve therapeutic level 4-7 mEq/L
- Loss of Deep Tendon ReflexesHold Magnesium InfusionEarliest sign of toxicity; critical nursing action to prevent respiratory depression and cardiac arrest
- Oliguria Under 30 mL/hrMagnesium AccumulationDecreased renal clearance of magnesium leads to toxicity in anuric patients
- Calcium Gluconate 1 g IVMagnesium Toxicity ReversalSpecific antidote to be kept at bedside during all magnesium infusions
- Placental HormonesInsulin ResistancehCG, progesterone, and cortisol decrease maternal insulin sensitivity, leading to hyperglycemia in GDM
- Maternal HyperglycemiaFetal HyperinsulinemiaExcessive maternal glucose crosses placenta, stimulating fetal pancreatic insulin secretion
- Fetal HyperinsulinemiaNeonatal HypoglycemiaFetal hyperinsulinemia continues after birth when maternal glucose source is removed
- Insulin During PregnancySafe Glucose Management in GDMInsulin does not cross the placenta, making it the safest glucose-lowering agent
- Glycemic TargetsPrevention of MacrosomiaMaintaining fasting <95, 1-hour <140, and 2-hour <120 mg/dL reduces birth weight >4,000 g
- Severe Persistent VomitingLoss of Gastric AcidCauses metabolic alkalosis and hypokalemia in hyperemesis gravidarum
- Starvation from VomitingKetonuriaFat and protein breakdown produces ketone bodies spilled in urine
- Prolonged VomitingThiamine DeficiencyRisk of Wernicke encephalopathy requires thiamine supplementation
- Pyridoxine DoxylamineFirst-Line AntiemeticEvidence-based combination as initial treatment for hyperemesis gravidarum
- Left Lateral PositionMaximized Placental PerfusionNursing intervention to improve blood flow to uterus in preeclampsia
- Quiet Dim EnvironmentSeizure PrecautionsReducing sensory stimulation decreases risk of precipitating eclamptic seizure
- Seizure OccurrenceDelivery as Definitive TreatmentEclampsia is cured only by delivery; seizure is indication for expedited delivery
- HELLP SyndromeAvoid Liver PalpationPhysical trauma to liver can precipitate hepatic rupture in HELLP
- Chronic Hypertension Plus New ProteinuriaSuperimposed PreeclampsiaHighest-risk group for maternal and fetal complications
- Blood Pressure 160 over 110 mmHgAntihypertensive Medication IndicatedSevere hypertension requires acute treatment to prevent stroke
- ACE Inhibitors ARBsTeratogenic ContraindicationCause fetal renal damage; avoided in pregnancy
- Deep Tendon Reflex AssessmentMagnesium Sulfate Safety MonitoringBaseline and repeated DTR checks before each magnesium dose prevent toxicity
- Urine Output MonitoringMagnesium Clearance AssessmentOutput <30 mL/hr indicates reduced renal clearance; hold infusion to prevent toxicity
- Respiratory Rate AssessmentMagnesium Toxicity Early DetectionRR <12/min signals CNS depression; hold infusion immediately
- Fetal Movement DecreaseMaternal Complication IndicatorDecreased movement may signal fetal hypoxia from vasospasm or abruption
- Proteinuria Greater than 0.3 g per 24 hoursDiagnostic Criterion for PreeclampsiaEssential finding differentiating preeclampsia from gestational hypertension
- RA 9173 Philippine Nursing Practice ActIndependent Nursing Diagnosis and InterventionGuides scope of nursing practice for high-risk pregnancy monitoring and care
- NCM Level Assessment and InterventionCommunity to Critical Care ManagementPreeclampsia and GDM managed across different healthcare settings from primary to tertiary
Diagrams
Hypertensive & Metabolic Disorders of Pregnancy: Complete Concept Hierarchy
Comprehensive mind map displaying the hierarchical relationships between hypertensive disorders, gestational diabetes, hyperemesis gravidarum, and nursing management strategies. Shows how pathophysiology, classification, assessment, and interventions interconnect within the context of high-risk pregnancy.
Magnesium Sulfate Management Protocol: Dosing, Monitoring, and Toxicity Response
Step-by-step decision tree for magnesium sulfate administration in preeclampsia and eclampsia management. Emphasizes the critical monitoring parameters (deep tendon reflexes, respiratory rate, urine output) before each dose, toxicity signs in order of appearance, and the antidote protocol. This is a high-yield NLE concept tested relentlessly.
Gestational Diabetes Mellitus Screening and Diagnostic Pathway
Complete diagnostic pathway for gestational diabetes screening and management from 24-28 weeks gestation through delivery and postpartum follow-up. Shows the two-step screening process (50-g challenge followed by 3-hour OGTT if indicated), glycemic targets for pregnancy, and the progression from diet/exercise to insulin therapy as needed.
Eclamptic Seizure: Priority Response and Immediate Nursing Actions
Critical emergency response flowchart for management of an eclamptic seizure. Emphasizes the priority is airway and safety, not restraint or forcing objects into the mouth. Details the immediate post-seizure assessment and the path toward delivery, which is the only definitive treatment for eclampsia.
Preeclampsia Classification and Progression: From Gestational Hypertension to Eclampsia
State diagram showing the continuum of hypertensive disorder progression during pregnancy, from gestational hypertension through mild preeclampsia, severe preeclampsia, and eclampsia. Also illustrates HELLP syndrome and chronic hypertension with superimposed preeclampsia as distinct high-risk states. Each state includes key diagnostic criteria.
Hyperemesis Gravidarum: Assessment to Antiemetic Management
Comprehensive management pathway for hyperemesis gravidarum from initial assessment through antiemetic selection and therapeutic response. Emphasizes dehydration signs, electrolyte assessment, dietary modifications, and the evidence-based first-line antiemetic combination (pyridoxine with or without doxylamine), with escalation to second-line agents if needed.
Organ System Involvement in Preeclampsia: Distribution of Clinical Manifestations
Distribution chart showing how preeclampsia affects multiple organ systems due to generalized vasospasm and endothelial dysfunction. Helps students understand that preeclampsia is a multi-system disease requiring comprehensive monitoring of renal, hepatic, cerebral, cardiovascular, hematologic, and placental function.