Hypertensive Crisis

Question 1

Hypertensive emergency BP

Answer 1

> 220/140

Question 2

Defining characteristic of hypertensive EMERGENCY

Answer 2

acute target organ damage, especially CNS (b/c of high BP)

Question 3

Hypertensive URGENCY

Answer 3

severely elevated BP, no evidence of target organ damage

Question 4

Clinical manifestations of hypertensive EMERGENCY

Answer 4

• Hypertensive encephalopathy (bleeding in the brain) (N/V, confusion, severe headache)
• Acute renal failure
• MI
• HF w/ pulmonary edema

Question 5

Nursing Management: Hypertensive Crisis

MAP lowering guidelines

Answer 5

MAP = (SBP + 2DBP)/3
Initially, do not lower more than 25% w/in first hour*
Goal over 2-6 hours = 160/100-110

Question 6

IV Meds - Hypertensive EMERGENCY

Answer 6

• Most effective = sodium nitroprusside

- Beta inhibitor = labetolol

Question 7

Sodium Nitroprusside

• SE…
• Monitor…

Answer 7

SE: hypotension
Monitor: metabolized to toxic stuff, monitor levels, continuously monitor BP, hourly urine output, LOC, A&O, HR

Question 8

Labetolol (B-Blocker)

Monitor…

Answer 8

• HR!
• BP!
• change position slowly…orthostatic hypotension

Question 9

Oral meds for hypertensive urgency

Answer 9

1. Captopril (Capoten)
2. Labetalol (Normodyne)
3. Clonidine (Catapres)

• Monitor HR & BP!
• orthostatic hypotension