Saturday, August 21, 2010

Hypertensive Emergency Nursing Care Plan

A hypertensive emergency is severe hypertension (high blood pressure) with acute impairment of an organ system (especially the central nervous system, cardiovascular system and/or the renal system) and the possibility of irreversible organ-damage. In case of a hypertensive emergency, the blood pressure should be lowered aggressively over minutes to hours with an antihypertensive agent.
Several classes of antihypertensive agents are recommended and the choice for the antihypertensive agent depends on the cause for the hypertensive crisis, the severity of elevated blood pressure and the patient’s usual blood pressure before the hypertensive crisis. In most cases, the administration of an intravenous sodium nitroprusside injection which has an almost immediate antihypertensive effect is suitable but in many cases not readily available. In less urgent cases, oral agents like captopril, clonidine, labetalol, prazosin, which all have a delayed onset of action by several minutes compared to sodium nitroprusside, can also be used.

Decreased Cardiac Output

Hypertension is defined as a condition wherein there is an increase in BP beyond the normal range. Hypertensive emergency is used for BPs above 160/100mmHg. With hypertension, the blood vessels constrict. When blood vessels are constricted, there is a decrease in blood volume, decrease in cardiac output and increase in BP as blood passes through the narrowed lumen of the vessels.
Assessment Nursing Diagnosis Objectives Nursing Interventions Rationale Expected Outcome
S> (none) O>
The pt. Manifested:
> dysrrhythmias
> prolonged capillary refill
> cold clammy skin
> dyspnea
> variations in BP
> restlessness
> BP of 190/150
The pt. May manifest
Decreased cardiac output r/t altered stroke volume secondary to hypertensive emergency Short Term: After 6 hours of NI, the pt will manifest hemodynamic stability (BP, CO, UO, PR) pt shall also verbalize understanding of the disease process & risk factors
Long Term:
After 4 days of NI, the pt will participate in activities that decrease blood pressure
Establish Rapport Monitor Vital Signs
History Taking
Assess patient’s condition
Review lab data
Review ECG strip
Monitor BP, PR frequently
Provide information on test procedures
Explain dietary restrictions
Encourage rest & reposition client q2
Encourage relaxation techniques
Provide PM care
Encourage to increase activity level as tolerated
Teach home BP reading & monitoring
Administer anti hypertensives
To gain pt’s trust To obtain baseline data
To determine contributing factors
To determine present condition
For comparison with normal values
To determine alterations in electrical activity of the heart
To note response to activity
To gain pt’s participation & decrease anxiety level
To inform patient of contributing factors
To decrease stress and promote venous return
To alleviate anxiety & stress
To promote hygiene & comfort
To maintain functional ability
To detect change in VS & seek timely intervention
To decrease BP within normal ranges
The pt shall have manifested hemodynamic stability (BP, CO, UO, PR) pt shall have also verbalized understanding of the disease process & risk factors. The pt shall have participated in activities that decrease blood pressure