Hypertensive Emergency is severe hypertension (high blood pressure) with acute impairment of an organ system (especially the central nervous system, cardiovascular system and/or the renal system) and the possibility of irreversible organ-damage. In case of a hypertensive emergency, the blood pressure should be lowered aggressively over minutes to hours with an antihypertensive agent.

Several classes of antihypertensive agents are recommended and the choice for the antihypertensive agent depends on the cause for the hypertensive crisis, the severity of elevated blood pressure and the patient’s usual blood pressure before the hypertensive crisis. In most cases, the administration of an intravenous sodium nitroprusside injection which has an almost immediate antihypertensive effect is suitable but in many cases not readily available. In less urgent cases, oral agents like captopril, clonidine, labetalol, prazosin, which all have a delayed onset of action by several minutes compared to sodium nitroprusside, can also be used.

Nursing Care Plans

Decreased Cardiac Output

NDx: Decreased cardiac output r/t altered stroke volume secondary to hypertensive emergency

Hypertension is defined as a condition wherein there is an increase in BP beyond the normal range. Hypertensive emergency is used for BPs above 160/100mmHg. With hypertension, the blood vessels constrict. When blood vessels are constricted, there is a decrease in blood volume, decrease in cardiac output and increase in BP as blood passes through the narrowed lumen of the vessels.

Assessment Objectives Nursing Interventions Rationale Expected Outcome
  1. dysrrhythmias
  2. prolonged capillary refill
  3. cold clammy skin
  4. dyspnea
  5. variations in BP
  6. restlessness
  7. BP of 190/150


Short Term:

After 6 hours of NI, the pt will manifest hemodynamic stability (BP, CO, UO, PR) pt shall also verbalize understanding of the disease process & risk factors

Long Term:

After 4 days of NI, the pt will participate in activities that decrease blood pressure

  1. Establish Rapport
  2. Monitor Vital Signs
  3. History Taking
  4. Assess patient’s condition
  5. Review lab data
  6. Review ECG strip
  7. Monitor BP, PR frequently
  8. Provide information on test procedures
  9. Explain dietary restrictions
  10. Encourage rest & reposition client q2
  11. Encourage relaxation techniques
  12. Provide PM care
  13. Encourage to increase activity level as tolerated
  14. Teach home BP reading & monitoring
  15. Administer anti hypertensives
  1. To gain pt’s trust
  2. To obtain baseline data
  3. To determine contributing factors
  4. To determine present condition
  5. For comparison with normal values
  6. To determine alterations in electrical activity of the heart
  7. To note response to activity
  8. To gain pt’s participation & decrease anxiety level
  9. To inform patient of contributing factors
  10. To decrease stress and promote venous return
  11. To alleviate anxiety & stress
  12. To promote hygiene & comfort
  13. To maintain functional ability
  14. To detect change in VS & seek timely intervention
  15. To decrease BP within normal ranges
The pt shall have manifested hemodynamic stability (BP, CO, UO, PR) pt shall have also verbalized understanding of the disease process & risk factors.The pt shall have participated in activities that decrease blood pressure

Other Possible Nursing Care Plans

  • Risk for Noncompliance
  • Acute Pain
  • Altered [Cardiopulmonary] Tissue Perfusion


  1. i suggest you add a nursing diagnosis of altered cardiopulmonary tissue perfusion related to interruption of arterial flow to myocardial tissue resulting in reduced blood supply, cardiac output and hemodynamic changes Nursing Care Plan