HYPERTENSION > INTRODUCTIO

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 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 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

> 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 doesn’t 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 doctor’s 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.
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.
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
HYPERTENSIVE EMERGENCY
ETIOLOGIC FACTOR: RISK FACTORS:
* Obesity
* Age
* Stress

II. DRUGSTUDY
DRUG NAME CLASSIFICATION INDICATION/ACTION SIDE EFFECTS NSG. RESPONSIBILITIES Generic name:
Ketorolac

Brand name:

Stock:
Generic name:
Ranitidine

Brand Name:

Stock:
Generic Name:
metoclopramide

Brand name:
plasil

Stock:10mg/2ml

Generic name:
Furosemide
Brand name:

Stock:

Generic name:
Paracetamol
Brand name:

Stock:

Generic name:
Losartan potassium
Brand name:
getzar
Generic name: Bisacodyl
Brand name:
Dulcolax
Non- steroidal anti-inflammatory

Doctor’s order:

Anti ulcer drugs

Doctor’s order:
Anti-emetics
Doctor’s order:
1 amp IV now then q8° PRN

Diuretics
Doctor’s order:
1 amp IV now then OD
Non opiod analgesic and anti pyretics
Doctor’s order:
1 amp IV stat

Anti hypertensives

Diphenyl methane derivative Short term management of moderately severe, acute pain for single dose treatment

Gastric irritation

Nausea and vomiting

Hypertension

Mild pain and/or fever

For hypertension

Chronic constipation * Headache
* Dyspepsia
* GI pain
* Constipation
* Flatulence
* Anaphylaxis
* Headache
* Blurred vision

* Bradycardia,supravetricular tachycardia
* Neurolepticmalignantsyndrome,seizures, suicide ideation.
* Vertigo, headache, dizziness.
* Panceatitis, thrombocytopenia.
* Neutropenia, leucopenia, pancytopenia and hypoglycemia

Headache, dizziness, fatigue, abdominal pain, nausea, back pain or leg pain, cough and respiratory infection

Dizziness, faintness, muscle weakness with excessive use
Abdominal cramps
Electrolyte imbalance * 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 haven’t been established for therapy lasting longer than 12 weeks.

* To prevent nocturia, give P.O. and IM preparations in the morning. Give 2nd dose in the early afternoon.
* Watch for signs of hypokalemia such as muscle weakness and cramps.
* 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 patient’s BP to evaluate effectiveness of therapy and monitor patients who are also taking diuretics for symptomatic HpN.
Give drugs at times that don’t interfere with scheduled activities or sleep.
Before giving for constipation, determine whether patient has adequate fluid intake, exercise and diet.
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