Malignant Hypertension

Question 1

Definition of malignant hypertension

Answer 1

Severely elevated BP that progresses rapidly
SBP >200
DBP >130

Question 2

Causes of malignant hypertension

Answer 2

Noncompliance with treatment
Pheochromocytoma (tumor in adrenal gland)
Cushing’s disease
Brain tumors
Pregnancy
Medications

Question 3

Meds that could cause malignant hypertension

Answer 3

BC pills
Glucocorticoids
Mineral corticoids
Sympathomimetics

Question 4

Clinical manifestations of malignant hypertension

Answer 4

Morning headaches
Blurred vision
Dyspnea
Increased ICP

Question 5

Complications of malignant HTN

Answer 5

Renal failure
Left ventricular failure
Stroke

Question 6

Management of malignant HTN

Answer 6

Use of rapid-acting IV antihypertensive meds:
*Sodium nitroprusside (Nipride)
*Lebetalol hydrochloride (Normodyne)

Question 7

Function of sodium nitroprusside (Nipride)

Answer 7

Vasodilator (decreases SVR, preload, Afterload. Increases cardiac output)

Question 8

Action of Lebatalol hydrochloride (normodyne)

Answer 8

Block alpha and beta adrenergic receptor sites
(Decreases HR, SVR, CO, and BP)

Question 9

Nursing considerations for Lebatalol hydrochloride

Answer 9

Pt must be supine for IV admin for 3 hours
Monitor BP every 5 min during admin until BP is stable

Question 10

Nursing care to decrease risk of ICP

Answer 10

Calm, quiet environment
Limit visitors
Bedrest
Monitor neuro status every hour
Monitor BP as often as q5 min until controlled - watch for hypotension

Question 11

Nursing care related to potential decreased CO due to left ventricular dysfunction

Answer 11

Monitor VS frequently, I&O, cardiac rhythm continuously
Auscultate breath sounds, resp status, O2 sat

Potential for renal failure, so monitor BUN, Cr, & I&O