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 |
