Hypertensive crisis is known to be a situation in a hypertensive patient wherein blood pressure has been raised to 250/150mmHg.
Hypertensive crisis most frequently occurs to individuals having untreated hypertension and those who stopped taking their prescribed medications. When hypertensive crisis strikes, immediate treatment is needed. Although increased blood pressure has always been a serious problem, in hypertensive crisis, such rate where blood pressure tends to rise is more important to be treated well. The sudden and severe rise in blood pressure can damage the lining of the cells of your arteries, causing fibrin and platelets accumulation, thus the blockage of blood flow into the heart. This condition is life-threatening which may lead to heart attack, stroke, kidney failure and congestive heart failure.
Hypertensive crisis is divided into 2 categories – the emergency and urgent hypertensive crisis. During emergency hypertensive crisis, blood pressure rises to an extreme level, causing organ damage. This kind of hypertensive crisis can be associated to life-threatening complications. On the other hand, urgent hypertensive crisis can also be accounted to extreme high blood pressure. However, the doctor here won’t suspect you to have organ damage.
Usually, hypertensive crisis occurs to people who have been already diagnosed with increased blood pressure, yet such blood pressure has been controlled inadequately. But there is only a small percent of people (usually less than 1% of 60M Americans with increased blood pressure) who are developing hypertensive crisis. More common, the African-Americans are the ones who are more susceptible to develop hypertensive crisis compared to other ethnicities. The common causes of this condition can be associated to withdrawal from hypertensive medications, drug use like amphetamines and cocaine, vascular diseases, head injury, presence of tumors, eclampsia, pre-eclampsia and acute glomerulonephritis.
For the causes of emergency hypertensive crisis, the following may be accountable: stroke, heart failure, heart attack, being not able to take the medications for increased blood pressure, kidney failure, interaction in between medications, rupture of aorta and pregnancy convulsion which is also known as eclampsia.
The Signs and Symptoms
A person who is suffering from hypertensive crisis may experience the following: severe headache, diplopia, vertigo, photophobia, tinnitus, muscle twitching, nosebleed, tachycardia or cardiac arrhythmia, pulse pressure that is narrowed, neck veins that are distended, vomiting, nausea, severe anxiety and breath shortness. Also, the patient may be confused, stuporous or irritable. More so, hypertensive crisis can lead to coma, convulsion, renal failure, myocardial infarction, stroke or cardiac arrest.
Hypertensive crisis always needs immediate medical assistance. For this reason, whenever you are expecting that you or other people are experiencing this kind of medical condition, it is important to go and visit your doctor. If hypertensive crisis is left untreated, it may lead to death.
While reducing your increased blood pressure has been the main focus, the goal of treatment is to halt the damage caused by the condition into the blood vessels as well as reverse the process. The treatment of hypertensive crisis may focus on intravenous or oral hypertensive medications and diuretics, sedatives, anticonvulsants, as well as anti-emetics (if indicated). Such drugs may include Nicardipine, Nitroprusside, Trimethaphan, Labetalol, Nitroglycerin or Diaz oxide.
Since hospitalization is required most of the times, the patient is being placed on bed with cardiac monitor and the head must be elevated. Also, quiet environment must be maintained. The vital signs such as the pulse, blood pressure, as well as the respiration must be monitored every five to ten minutes. The neurological signs of the patient must likewise be monitored. The fluid intake as well as the output of the patient is to be monitored too in order to assess the progress level. The probability that the patient is to develop acute hypertensive reaction may be considered as this may be a result of hypertensive drugs taken by the patient. Therefore, the patient must be monitored in a very strict manner and must not be allowed to suddenly get up from his or her bed.
For the diet, hypertensive crisis patients should observe decreased intake of sodium and calories. Also, fluid might be restricted. When the condition of the patient has already improved, progressive ambulation may be permitted. However, the patient will be observed carefully for any symptoms that may be associated to orthostatic hypertension like diaeresis, pallor or faintness. These symptoms may be the side effects following the administration of the mentioned hypertensive drugs.
Everything that includes the medical aspect must be done in assuring that the patient who have hypertensive crisis doesn’t suffer from stress because this can increase the chances of the patient to develop complications like stroke. Hence, the patient must be placed in a good and quiet environment with restricted visitors as not doing so may cause the patient to develop both mental and physical stress. If this is properly observed, it is more likely that the patient will have a speedy recovery. The physical care of the patient must be properly done by the nurses.
The Nursing Considerations
The main concern of nurses in managing hypertensive crisis is to observe as well as report signs of hypertension. As a preparation for the patient to be discharged, the nurses must advise the patient in recognizing the symptoms that are associated to the decrease or increase of his or her blood pressure. This is to adhere with the prescribed medication and diet as well as to prevent fatigue, tobacco products use, heavy lifting as well as those stressful situations.
Hypertensive crisis happens when a person experiences a severely increasing blood pressure which may lead to stroke. Hypertensive crisis can damage the blood vessels of an individual wherein it may get inflamed and leak blood or fluid. As an effect of this, the heart might not be able to effectively pump blood. This is a condition that is fatal. For this reason, whenever you are experiencing symptoms that are related to hypertensive crisis, never hesitate seeking for medical attention as this can save your life. Always remember that prevention is always better than cure for any hypertensive crisis.