Caring for the HTA CRONICA

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SKILL
COMPETENCY
CHECKLIST
Hypertension, Chronic, in Pregnancy: Caring for the
Patient with
.
Standard Met/Initials Competency Areas
Prerequisite Skills
Knowledge that caring for the patient with chronic
hypertension in pregnancy (CHP) is important to reduce risk
of maternal and fetal complications or death
Knowledge of preferred equipment for accurate BP
measurement and proper BP assessment technique
Understanding that women expect pregnancy to be a time
of enjoyment and happiness, and that complications in
pregnancy can cause feelings of helplessness, fear, and anger
Knowledge of the potential complications of CHP
Knowledge that CHP is diagnosed in women whose BP is
≥ 140/90 mm Hg before becoming pregnant (and remains
≥ 140/90 mm Hg during pregnancy) and in women who
develop BP of ≥ 140/90 mm Hg after becoming pregnant but
prior to the 20th week of pregnancy
•Understanding that women with CHP develop compromised
blood flow to the placenta, which can cause fetal
complications or death
•Knowledge that mild CHP is associated with a good
prognosis for both the mother and fetus, and that the
prognosis is less favorable when CHP is severe
Knowledge that CHP is managed by closely monitoring
maternal BP, assessing fetal growth and for fetal distress,
and frequently assessing for the development of CHP-related
complications
•Antihypertensive medications are administered, as
appropriate
•Laboratory tests may be ordered and performed
•Emergent delivery of the fetus may be necessary
Preparation
Reviews the facility/unit protocol for management of the
pregnant patient with CHP, if one is available
Reviews the treating clinician’s orders regarding management
of CHP
Verifies completion of facility informed consent documents
Reviews the patient’s medical history/medical record for
allergies (e.g., to latex, medications, or other substances); uses
alternative materials, as appropriate
Gathers the following supplies:
•Personal protective equipment (PPE; e.g., sterile/nonsterile
gloves; uses additional PPE [e.g., gown, mask, eye
protection] if exposure to body fluids is anticipated)
•Facility-approved pain assessment tool
•Equipment for taking vital signs
•Scale for weighing the patient
•Tape measure to assess fundal height
•Urine collection kit
•I.V. supplies (e.g., catheter, flush solution)
•Lab specimen collection supplies (e.g., blood specimen
tubes, patient labels)
•Equipment for fetal monitoring (e.g., ultrasound gel, strap to
secure fetal heart monitor around the patient’s abdomen)
•Written information, if available, to reinforce verbal
education on CHP
Procedure
Performs hand hygiene and dons PPE as appropriate
Identifies the patient according to facility protocol
Introduces himself/herself to the patient and family
member(s), if present, and explains his/her clinical role in
caring for the patient with CHP; assesses for knowledge
deficits and anxiety regarding CHP and its management
•Determines whether the patient/family requires special
considerations regarding communication (e.g., due
to illiteracy, language barriers, or deafness); makes
arrangements to meet these needs, if they are present
–Follows facility protocols for using a professional certified
medical interpreter, either in person or via phone, when a
language barrier exists
•Explains the procedure that will be performed and its
purpose; answers questions and provides emotional support
as needed
Assesses the patient’s general health status, including her
vital signs and level of pain using a facility-approved pain
assessment tool
•When obtaining a BP measurement, positions the patient
appropriately with the arm at the level of the heart
•Uses the same size BP cuff and the same arm for subsequent
readings to obtain the most accurate readings
Assesses fundal height
Weighs the patient
Establishes I.V. access, as ordered
Establishes I & O assessment to monitor fluid balance
Asks the patient to describe CHP signs and symptoms,
including onset, duration, and factors that cause symptoms to
occur or worsen
Positions the patient in a left side-lying position to promote
blood flow to the placenta
Assesses for changes in level of consciousness and for signs
and symptoms of increased BP, including headache, dizziness,
tremors, epigastric discomfort, irritability, vision changes,
shortness of breath, and elevated heart rate
Assesses for uterine activity (e.g., frequency and intensity
of contractions) and for signs and symptoms of membrane
rupture or labor, as appropriate
Assesses fetal movement per facility protocol
Performs fetal nonstress testing and heart rate assessment as
ordered or per facility protocol
Coordinates scheduling of/performs ultrasound assessment, as
ordered
Immediately notifies the treating clinician of abnormalities
and changes in patient and fetal status
•Administers antihypertensive and other medications, as
ordered
•Collects/arranges for collection of body fluids (e.g.,
blood, urine) for laboratory testing (e.g., proteinuria, renal
function), as ordered, and reviews results as they become
available
•As appropriate, provides emotional support to the patient and
prepares for emergency delivery per facility protocol
Assesses patient anxiety level and suggests strategies (e.g.,
relaxation therapy, distraction, music) to decrease anxiety,
pulse rate, and rate of bleeding, as appropriate
Disposes of used procedure materials according to facility
protocols
Removes PPE, discards appropriately, and performs hand
hygiene
Post-Procedural Responsibilities
Requests referral to a social worker to identify and arrange for
community resources, including an agency for providing in-
home care
Updates the patient’s plan of care, as appropriate, and
documents providing patient care in the patient’s medical
record, including the following information:
•Date and time care was provided
•Description of the care provided, including medications
administered
•Patient assessment findings, including vital signs (especially
BP), level of pain, and new or worsening signs and
symptoms of CHP
•Patient’s tolerance of the care provided
•Any unexpected events that occurred, interventions
performed, whether or not the treating clinician was notified,
and patient outcome
•All patient/family member education provided, including
topics presented, response to education, plan for follow-up
education, barriers to communication, and techniques that
promoted successful communication
.
.
Signature Date
Evaluator's Signature Date
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