Page 137 - Critical Care Nursing Demystified

122 CRITICAL CARE NURSING DeMYSTIFIED

Prognosis
The prognosis for HTN emergencies is good as long as the patient is treated in
a timely manner. In patients over the age of 50, death from stroke or heart
failure is increased with hypertensive emergencies.

Interpreting Test Results
• There may be no other test than an elevated blood pressure that shows HTN.
• EKG may show left-ventricular hypertrophy if the HTN is long standing.
• BUN and creatinine may be elevated if renal damage has occurred.

Hallmark Signs and Symptoms
First, an accurate measurement of the patient’s BP in both arms must be per-
formed and documented. A significant difference needs to be reported to the
responsible health care provider. In an acute hypertensive crisis the patient may
present with one or more of the following symptoms: changes in neurological
status like changes in the level of responsiveness, headache, visual disturbances,
nausea, and/or vomiting, chest pain, and shortness of breath.

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For hypertensive emergency, the patient’s BP needs to be brought down
slowly but steadily.
If the patient’s BP is brought down suddenly, the abrupt lowering can cause
inadequate cerebral blood flow.
Start at least one peripheral IV and begin an infusion of nitroprusside (Nipride)
at 0.1 μg/kg per minute to lower the mean arterial blood pressure (MAP) at
least 25% below the MAP.
The physician may also order IV labetalol (Normodyne, Trandate), nitroglyc-
erin (Nitropaste), or a calcium channel blocker like nicardipine (Cardene)
infusion; hydralazine (in eclampsia); or furosemide (Lasix).
For a hypertensive urgency, a loop diuretic and an antihypertensive medica-
tion like a beta-adrenergic blocker, calcium channel blocker, or an ACE in-
hibitor may be prescribed with a follow-up appointment with a clinic or
primary physician to occur within 24 to 48 hours.

Nursing Diagnoses for
Hypertensive Emergency Expected Outcomes
Ineffective tissue perfusion The patientʼs mean arterial pressure (MAP) will
alteration (cerebral) be lowered by 25% over 2 hours
The patientʼs neurological status will indicate
improvement or no changes