Unit 2: Hypertensive Crisis Flashcards
Hypertensive Crisis
acute severe elevation in BP
Hypertensive Urgency
- DBP greater than or equal to 120 mmHg
- no sign of target organ damage (TOD)
Hypertensive Emergency
- DBP greater than or equal to 120 mmHg
- evidence of target organ damage (TOD)
Target Organ Damage (TOD)
damage to the heart, eyes, or kidneys caused by hypertension
Hypertension Laboratory Diagnostic Testing
- Renal System
- Endocrine
- Metabolic
- Other: hematocrit, electrocardiogram, and chest x-ray
Renal System Tests for Hypertension and expected findings if TOD is present
- Microscopic urinalysis
- Proteinuria
- Serum BUN and/or Creatinine
> If TOD present:
- proteinuria
- elevated BUN + Creatinine
Endocrine System Function Tests and expected findings if TOD present
- Serum Sodium
- Serum Potassium
- Serum Calcium
- TSH (thyroid-stimulating hormone)
> If TOD Present:
- increased sodium
- increased potassium
- increased TSH
Metabolic Function Tests and expected findings if TOD present
- Fasting blood glucose
- Total cholesterol
- HDL and LDL cholesterol
- Triglycerides
> If TOD present
- glucose > than 100 mg/dL
- increased LDLs and Triglycerides
- decreased HDLs
What would the Hematocrit level show if TOD is present?
decreased hematocrit
What would Electrocardiogram/ Chest x-ray show if TOD present?
left ventricular hypertrophy
Medications Used for Hypertension
- Diuretics
- Calcium Channel Blockers
- Angiotensin-converting enzyme inhibitors (ACE Inhibitors)
- Angiotensin II Receptor Blockers (ARBs)
- Beta Blockers
- Combined Alpha and Beta Blockers
- Vasodilators
- Central Agonists
Diuretics
- act on the kidneys to help the body eliminate sodium and water, reducing blood volume
- often first choice, but not only choice
Calcium Channel Blockers
>Amlodipine besylate (Norvasc) >Diltiazem (Cardizem) >Nifedipine (Adalat cc, Procardia XL) -help relax/dilate the muscles of blood vessels (vasodilation) -some slow HR
Angiotensin Converting Enzyme Inhibitors (ACE Inhibitors)
- help dilate/relax blood vessels by blocking the formation of angiotensin II, which is a vasoconstrictor
- reduces BP
Angiotensin II Receptor Blocker (ARBs)
- helps relax/dilate blood vessels by blocking the action not the formation of angiotensin II, the vasoconstrictor
- used in pts intolerant of ACE inhibitors
Beta Blockers
- reduce the afterload on the heart
- dilate blood vessels
- causes heart to beat more slowly and with less force
Combined alpha and beta blockers
- reduce nerve impulses that promote vasoconstriction
- slows the HR
- reduces afterload
Vasodilators
relax the muscle tissue in the blood vessel walls
-lowers BP
Central Agonists
decrease blood vessels ability to contract and cause vasoconstriction
Nursing Assessments
- Neurological Assessment
- Blood Pressure
- Heart Rate
- Examination of optic fundi
- Auscultation for carotid, abdominal, and femoral bruits (check for blood flow through a stenosed or narrow vessel)
- Palpation of lower extremities for edema and pulses
- Serum creatinine, BUN, estimated glomerular filtration rate, and 24 hour urine for creatinine clearance
- Albumin excretion rate
- BMI and waist circumference
Nursing Actions
- Administer antihypertensive medications as ordered
- Provide pt w/ DASH diet for meals
Nurse Teachings
- Adherence to antihypertensive medication regimen and lifestyle changes
- Moderate exercise
- Limit alcohol
- Stress reduction
- Smoking Cessation
- Monitoring of BP at home
- S/S of stroke, aneurysm, and TOD
Neurological Assesement
assess s/s that could indicate TOD and cerebrovascular disease leading to complications (stroke and aneurysm)
Assessment: Blood Pressure
early detection and treatment can prevent or minimize TOD
Assessment: Heart Rate
increased peripheral vascular resistance (PVR) can lead to increased HR or increased stroke volume to compensate for the increased PVR
Assessment: Examination of Optic Fundi
HTN can lead to retinal damage and eventually retinal hemorrhage b/c of vascular changes caused by HTN
Assessment: Auscultation for carotid, abdominal, and femoral bruits
bruits are sounds created by blood flow through a stenosed or narrowed vessel
Assessment: Palpation of the lower extremities for edema and pulses
weak pulses and peripheral edema can = kidney disease and/or HF
Assessment: Serum Creatinine, BUN, estimated glomerular filtration rate, and 24 hour urine collection for creatinine clearance
-abnormal levels = renal disease
Assessment: Albumin excretion rate
microalbuminuria (low levels of urinary albumin excretion of 30 to 300 mg/d) is a marker of early cardiac, renal, and retinal structural and functional changes in essential hypertension
Assessment: Calculation of BMI and Waist Circumference
obesity and diet are major risk factors for HTN
