Hypertensive Crisis

Question 1

Two types of hypertensive crisis

Answer 1

emergency & urgency

Question 2

What are the numbers?

Answer 2

SBP >180 mmHg and/or DBP >120 mmHg

Question 3

Hypertensive emergency

Answer 3

1. Target organ damage

2. Requires hospitalization

Question 4

Hypertensive urgency

Answer 4

more common

i. No evidence of target organ disease
ii. Hospitalization usually not required

Question 5

Hypertensive urgency is associated with chronic stable disorders

Answer 5

Stable angina (brief episode of pain/pressure in chest), chronic HF, prior MI or CVA

Question 6

Causes of hypertensive crisis

Answer 6

History of HTN; not adherent or under-medicated

ii. Cocaine, amphetamines, PCP, LSD leads to seizures, stroke, MI, or encephalopathy

Question 7

Hypertensive Crisis Clinical Manifestations

Answer 7

1. Hypertensive encephalopathy (neuro changes)
2. Renal insufficiency
3. Cardiac decompensation
4. Aortic dissection (tear in aorta)

Question 8

S/S of hypertensive crisis clinical manifestations

Answer 8

headache, nausea/vomitting, seizures
MI, HF, pulmonary edema, chest p! dyspnea
Chest & back p!
Reduced/abscent peripheral pulses

Question 9

Hospitalization for HTN emergency (IV drugs)

Answer 9

antihypertensive, slow titration; MAP 110 to 115 mm Hg

Question 10

Drugs

Answer 10

vasodilators – often given via IV infusion

Question 11

Nursing care for HTN crisis

Answer 11

b. Monitor cardiac and renal function
c. Neurologic checks
d. Bed rest for those on IV drugs
e. Determine cause
f. Education to avoid future crisis
g. Hypertensive urgency—outpatient
i. Ensure compliance with medication therapy
ii. Require follow-up; often in 24 hours