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hypertensive emergencyA 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.

Decreased Cardiac Output

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 Nursing Diagnosis Objectives Nursing Interventions Rationale Expected Outcome
S> (none)

O>

The pt. Manifested:

> dysrrhythmias

> prolonged capillary refill

> cold clammy skin

> dyspnea

> variations in BP

> restlessness

> BP of 190/150

The pt. May manifest

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

 Establish Rapport

Monitor Vital Signs

History Taking

Assess patient’s condition

Review lab data

Review ECG strip

Monitor BP, PR frequently

Provide information on test procedures

Explain dietary restrictions

Encourage rest & reposition client q2

Encourage relaxation techniques

Provide PM care

Encourage to increase activity level as tolerated

Teach home BP reading & monitoring

Administer anti hypertensives

 To gain pt’s trust

To obtain baseline data

To determine contributing factors

To determine present condition

For comparison with normal values

To determine alterations in electrical activity of the heart

To note response to activity

To gain pt’s participation & decrease anxiety level

To inform patient of contributing factors

To decrease stress and promote venous return

To alleviate anxiety & stress

To promote hygiene & comfort

To maintain functional ability

To detect change in VS & seek timely intervention

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

Source: Wikipedia> Hypertensive Emergency

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