2. LEARNING OBJECTIVES
• DEFINE HYPERTENSIVE CRISIS
• CLASSIFY hypertensive crisis
• State the causes and risk factors
• Describe the pathophysiology
• State the clinical features
• Describe the medical and nursing management
3. Hypertensive crisis
• Is a sudden ,severe increase in blood pressure. The reading is
180/120mmhg or above.
• And it is considered a medical emergency
• It may or may not be associated with organ dysfunction
• Can damage blood vessels and organs including the heart,brain and
kidneys.
4. classification
• Urgency :- ` is 180/120mmhg or greater with no organ damage
• Emergency:- BP is 180/120 or greater but there is life threatening
damage to the target organs
• Conditions associated with hypertensive emergency include: acute
myocardial infarction, dissecting aortic aneurysm, and intracranial
haemorrhage.
CAUSES
Forgetting to take medications
Suddenly stopping certain heart medications e.g. beta blockers
Medication interactions
5. Risk factors
• Low socio economic status
• Poor access to health care
• Non adherence to prescribed anti hypertensive
• Substance or alcohol abuse
• Oral contraceptive use
• Cigarette smoking
6. pathophysiology
• Initial event is an abrupt rise in BP from an unknown stimulus followed by
compensatory mechanisms from the vascular endothelial. The endothelial
releases nitric oxide ( a vasodilator). Arterioles sense the rise in BP and
arterioles smooth muscles contracts reduce the rise in BP. Vicious cycle
with prolonged arterial smooth muscle contraction leading to endothelial
dysfunction and the inability to release more nitric oxide resulting in
further increase in BP.
• Shearing forces of the vascular walls result in further endothelial damage
and dysfunction, this will result in the release of inflammatory markers (
cytokines, endothelin 1 ) and promotes platelet aggregation ,coagulation
and endothelial permeability
• Vasoconstriction and thrombosis occurs
• Hypo perfusion and end organ ischaemia occurs.
7. Signs and symptoms
• Anxiety, nausea and vomiting
• Blurred vison
• Seizures , and unresponsiveness
• Chest pain
• Confusion
• SOB
8. Management
Severe HPT
Diastolic more thn 120mmHg
Beta blocker with alpha activity
Labetalol i.v 20mg stat over 20 minutes then 10-80mg i.v.i every 10
minutes until desired BP Level is achieved. Total dose should not
exceed 300mg
Calcium channel blockers
Nicardipine iv rate 3-5 mg /hr . Reassess after 10 – 30 minutes and
switch to oral rote once an emergency is stabilised. Max infusion rate
1.6mg /kg/min not exceeding 15mg /hr
Direct acting vasodilators
Dihydralazine iv/im 6,25mg -25 mg PRN until desired rate of BP IS
ACHIVED
9. • Extremely close hemodynamic monitoring of the patient’s blood
pressure and cardiovascular status is required during treatment of
hypertensive emergencies and urgencies.
• The exact frequency of monitoring is a matter of clinical judgment
and varies with the patient’s condition.
• The nurse may think that taking vital signs every 5 minutes is
appropriate if the blood pressure is changing rapidly or may check
vital signs at 15 or 30 minutes intervals if the situation is more stable.
A precipitous drop in blood pressure can occur, which would require
immediate action to restore blood pressure to an acceptable level.
• Then switch to the usual oral drugs if acceptable levels of BP have
been achieved
10. • Risk for injury to other organs related to high blood pressure
• Activity intolerance related to reduced perfusion
• Knowledge deficit related to condition , management and preventive
measures
• Non compliance related to the side effects of medications
• Anxiety
11. REFERENCES
• EDLIZ ( 2020) 8th Edition Essential Drug List and Standard Treatment
Guidelines For Zimbabwe
• Heitkemper D.L (2006) Medical Surgical Nursing Assessment of Clinical
Problems 7th Edition . Mosby . London
• Nettina S.M ( 2006) the Lippincott Manual For Nursing Practise . Philadelphia .
New York
• Phipps . M et al .medical surgical Nursing Health and illness Perspectives 10th
Edition . Mosby .London
• Janice L Hinkle and Kerry H Cheever (2008) . Brunner and Suddath’s Textbook
of Medical Surgical Nursing 13th Edition. Philadelphia . Lippincott. Williams
and Wilkins
• Waugh A and Grant A . Ross and Wilson . Anatomy and Physiology in Health
and Illness ( 13th Edition ) . Elsevier , Churchill Livingstone . Edinburg
