1

HYPERTENSION
INTRODUCTION
A hypertensive emergency is severe hypertension (high blood pressure ) with acute
impairment of organ system 9 especially the central nervous system , cardiovascular system
and/or renal system ) and the possibility of irreversible organ damage. In case of hypertensive
emergency, the blood pressure should be lowered aggressively over minutes to hours with a
hypertensive agent. Several classes of hypertensive agents are recommended and the choice of
hypertensive agent depends on the cause for the hypertensive crisis, the severity of elevated
blood pressure and the patients usual blood pressure before the hypertensive crisis. In most
cases, the administration of an intravenous Sodium Nitroprusside injection which has an almost
immediate anti hypertensive effect is suitable but in many cases, oral agents are given like
Captopril, Clonidine, Labetalol, Prazosin, which all have a delayed onset of action by several
minutes compared to Sodium Nitroprusside, can also be used.
DEFINITION
Generally, the terminology describing hypertensive emergencies can be confusing. Terms such
as hypertensive crisis, malignant hypertension, hypertensive urgency, accelerated hypertension
and severe hypertensions are all used to=in the literature and often overlap.
Hypertension (HTN) or high blood pressure is a chronic medical condition in which the blood
pressure in the arteries is elevated. It is classified as either primary (essential) or secondary.
Primary hypertension which refers to high blood pressure for which no medical cause can be
found. The Secondary hypertension are caused by another conditions that affect the kidneys,
arteries, heart, or endocrine system.
As a specific term hypertensive emergency is primarily used as a crisis with a diastolic pressure
of 120 mm hg and above plus end organ damage (Brain, Cardiovascular, renal) as described
above in contrast to hypertensive urgency where as yet no end organ damage has developed.
The former requires immediate lowering of blood pressure as with Sodium Nitroprusside
infusions.
SIGNS AND SYMPTOMS
Headache
High blood pressure usually 140/100 and above
Shortness of breath
Convulsion
Changes in vision
Nausea
Vomiting
Heart palpitations

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DIAGNOSTIC EXAM
Blood pressure monitoring using sphygmomanometer
Electrocardiogram (ECG)
Complete Blood Count(CBC)
Physical Examination
LDL-HDL Ratio

TREATMENT
The usual treatment is to reduce blood pressure using anti hypertensive drugs, it includes:
ACE inhibitors;
ARBs;
Diuretics;
Beta-blockers;
Calcium- blockers
Diuretics are usually recommended as the first line of therapy for most people who have high blood
pressure. If one drug doesnt work or is disagreeable, other types of diuretics are available.
NURSING INTERVENTION
The primary responsibility of the nurse is to assess the condition of the patient during the
treatment. It includes the following but are not limited to;
Vital signs monitoring specifically blood pressure,
Assessment for possible and sudden drop of blood pressure,
Monitoring of adverse reactions to drugs,
Tabulation of Input and Output when ordered and carrying out doctors order.
ANATOMY & PHYSIOLOGY
The heart's job is to pump blood around the body. The heart is located in between the two
lungs. It lies left of the middle of the chest.
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The main function of the cardiovascular system is therefore to maintain blood flow to all
parts of the body, to allow it to survive. Veins deliver used blood from the body back to
the heart. Blood in the veins is low in oxygen (as it has been taken out by the body) and
high in carbon dioxide (as the body has unloaded it back into the blood).
All the veins drain into the superior and inferior vena cava which then drain into the right atrium. The
right atrium pumps blood into the right ventricle. Then the right ventricle pumps blood to the
pulmonary trunk, through the pulmonary arteries and into the lungs. In the lungs the blood picks
up oxygen that we breathe in and gets rid of carbon dioxide, which we breathe out.
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The blood is becomes rich in oxygen which the body can use. From the lungs, blood drains into the
left atrium and is then pumped into the left ventricle. The left ventricle then pumps this oxygen-
rich blood out into the aorta which then distributes it to the rest of the body through other arteries.
The heart pumps oxygenated blood to the body and deoxygenated to the lungs. In the human heart
there is one atrium and one ventricle for its circulation, and with both a systemic and pulmonary
circulation there are four chambers in total; left atrium, left ventricle, right atrium and right
ventricle. The right atrium is the upper chamber of the right side of the heart. The blood that is
returned to the right atrium is deoxygenated (poor in oxygen) and passed in to the right ventricle
to be pumped through the pulmonary artery to the lungs for re-oxygenation and removal of
carbon dioxide. The left atrium receives newly oxygenated blood from the lugs as well as the
pulmonary vein which is passed into the strong ventricle to be pumped through the aorta to the
different organs of the body.
PATHOPHYSIOLOGY
HYPERTENSI VE EMERGENCY


ETIOLOGIC FACTOR: RISK FACTORS:
Obesity
Age
Stress










Stressor initiated

Reni is released by the kidney
Angiotensin is produced
Angiotensin I is converted to
Angiotensin II
Increased BP
5


II. DRUG STUDY
DRUG
NA
ME
CLASSIF
ICAT
ION
INDICATION/A
CTION
SIDE
EFFEC
TS
NSG. RESPONSIBILITIES
Generic
nam
e:
Ketorola
c

Brand
nam
e:

Stock:




Generic
nam
e:

Rani
tidin
e

Brand
Na
me:

Stock:






Generic
Na
me:
metoclo
pra
mid
e

Brand
nam
e:
plasil

Stock:1
Non-
steroi
dal
anti-
infla
mmat
ory



Doctors
order
:





Anti ulcer
drugs



Doctors
order
:






Anti-
emeti
cs




Doctors
order
:
1 amp IV
now
then
q8
PRN

Short term
manageme
nt of
moderately
severe,
acute pain
for single
dose
treatment





Gastric irritation









Nausea and
vomiting











Hypertension










Headac
he
Dyspep
sia
GI pain
Constip
ation
Flatulen
ce





Anaphyl
axis
Headac
he
Blurred
vision









Bradyca
rdia,sup
ravetricu
lar
tachycar
dia
Neurole
ptic
maligna
nt
syndrom
e,seizur
es,
suicide
ideation.



Correct Hypovolemia before giving.
Alert: Maximum Combined duration of
parenteral and oral therapy is 5 days.
When appropriate, give by deep IM
injection. Pt may feel pain at the injection
site which can be relieve by applying cold
bags.




Assess pt for abdominal pain. Note
presence of blood in emesis, stool or
gastric aspirate.
Drug may be added to total parenteral
solutions.








Monitor bowel sounds.
Safety and effectiveness of drug havent
been established for therapy lasting longer
than 12 weeks.









To prevent nocturia, give P.O. and IM
preparations in the morning. Give 2
nd
dose
in the early afternoon.
Watch for signs of hypokalemia such as
muscle weakness and cramps.





6

0mg
/2ml





Generic
nam
e:
Furose
mid
e


Brand
nam
e:



Stock:



Generic
nam
e:
Paracet
amo
l


Brand
nam
e:



Stock:





Generic
nam
e:
Losarta
n
pota
ssiu
m


Brand




Diuretics






Doctors
order
:
1 amp IV
now
then
OD


Non
opiod
analg
esic
and
anti
pyreti
cs






Doctors
order
:
1 amp IV
stat





Anti
hyper
tensi
ves









Mild pain
and/or
fever













For
hypertensio
n













Chronic
constipatio
n

Vertigo,
headach
e,
dizzines
s.
Panceat
itis,
thrombo
cytopeni
a.






Neutrop
enia,
leucope
nia,
pancyto
penia
and
hypogly
cemia









Headache,
dizzines
s,
fatigue,
abdomin
al pain,
nausea,
back
pain or
leg pain,
cough
and
respirat
ory
infection









Alert: Many OTC and prescription
products contain acetaminophen; be aware
of this when calculating total daily dose.













Drugs can be used alone or with other
antihypertensives.

Monitor patients BP to evaluate effectiveness
of therapy and monitor patients who are
also taking diuretics for symptomatic HpN.










Give drugs at times that dont interfere with
scheduled activities or sleep.
Before giving for constipation, determine
whether patient has adequate fluid intake,
exercise and diet.
7

nam
e:
getzar








Generic
nam
e:
Bisa
cod
yl


Brand
nam
e:
Dulcolax






Diphenyl
meth
ane
deriv
ative



Dizziness,
faintnes
s,
muscle
weakne
ss with
excessiv
e use
Abdominal
cramps
Electrolyte
imbalan
ce