Hypertensive Crisis (Urgent and Emergency)

to be hypertensive urgency, the SBP has to be greater than ______ and/or DBP is greater than ____

180; 110;

for hypertensive URGENCY, it's important these pts follow up within a 24 hr period after taking the oral antihypertensives to make sure

there bp is going back to normal level without any complications

for example, if the pts bp is 185/102 initially, and then 30 mins later the bp is 225/126, it's an significant increase in a short amount of time, therefore

they need treatment

what is the initial goal of MAP

to get it reduced by NO MORE THAN 20-25% or 110 or 115mg of mercury.

what happens in aortic dissection

when the bp gets severely high, the aorta gets torn apart, which causes a sudden and severe tearing or ripping pain in the pts chest and back

whats the difference between hypertensive urgency and hypertensive emergency

the absence or presence of target organ damage

what should you do if a pt has hypertensive emergency

-hospitalization -give IV antihypertensive therapy like cardapine or labetalol. -make sure teh iv drug therapy is titrated to MAP-decrease to 110-115 initially -after giving the iv antihypertensive med, closely monitor the pts bp and heart rate, especially if using a beta blocker like labetalol -based on the pts response to the med, you can titrate the medication up or down according to the hospital policy. -ongoing monitoring of the pt includes urinary output which helps to assess perfusion to the kidneys, neurologic status, which helps monitor for any cerebrovascular damage and includes the LOC, pupilary assessments and muscle strengths, also monitor ekgs for any changes in heart rhythm,

what are the signs of hypertensive emergency

-hypertensive encephalopathy (headache, nausea/vomiting, seizures, confusion, coma) -renal insufficiency -cardiac decompensation (chest pain, sob, MI, HF, pulmonary edema) -aortic dissection (due to the severity of the increased bp)

hypertensive encephalopathy (headache, nausea/vomiting, seizures, confusion, and coma) have similar symptoms as ______ and can even LEAD to it, but the difference is, hypertensive encephalopathy doesn't

stroke; focus on one focal body part like a stroke does. this is why proper diagnostics are important

what is the formula for MAP

[systolic bp + 2x the diastolic bp] divided by 3.

the mean arterial pressure (MAP) is used to help guide and evaluate the

antihypertensive treatments.

hypertensive emergency does include organ damage and often requires the patient be hospitalized to control and reduce their

blood pressure

once the hypertensive URGENCY is resolved, the ____ should be evaluated, and give the patient ____on how to avoid it in the future

cause; education;

other than not following the proper hypertensive med regimen, other causes can include

drug use (like cocaine, meth, pcp or lsd)

most often occurs in clients who do not

follow their hypertension meds appropriately

Hypertensive crisis

is either hypertensive urgency OR hypertensive emergency

How fast the bp goes up is more important than the

number itself

if the patient has hypertensive URGENCY who is NOT being hospitalized, they may be prescribed

oral anti-hypertensives such as captopril, labetolol, clonidine or amlodipine

hypertensive urgency can develop over hours and days, and doesn't have any evidence of ____ ____, and it may not even require _______

organ damage; hospitalization

If you have hypertensive emergency and the blood pressure's not treated

severe problems such as encephalopathy (bleeding in or around the brain), heart failure, heart attacks, kidney disease, dissecting aortic aneurism and retinopathy can happen