There are two hypertensive crises that require nursing interven-tion: hypertensive emergency and hypertensive urgency. Hyper-tensive emergencies and urgencies may occur in patients whose hypertension has been poorly controlled or in those who have abruptly discontinued their medications. Once the hypertensive crisis has been managed, a complete evaluation is performed to review the patient’s ongoing treatment plan and strategies to min-imize the occurrence of subsequent hypertensive crises.
Hypertensive emergency is a situation in which blood pres-sure must be lowered immediately (not necessarily to less than 140/90 mm Hg) to halt or prevent damage to the target organs. Conditions associated with hypertensive emergency include acute myocardial infarction, dissecting aortic aneurysm, and in-tracranial hemorrhage. Hypertensive emergencies are acute, life-threatening blood pressure elevations that require prompt treatment in an intensive care setting because of the serious target organ damage that may occur. The medications of choice in hyperten-sive emergencies are those that have an immediate effect. Intra-venous vasodilators, including sodium nitroprusside (Nipride, Nitropress), nicardipine hydrochloride (Cardene), fenoldopam mesylate (Corlopam), enalaprilat (Vasotec I.V.), and nitro-glycerin (Nitro-Bid IV, Tridil), have an immediate action that is short lived (minutes to 4 hours), and they are therefore used as the initial treatment. Table 32-5 provides for more information about these medications.
Hypertensive urgency is a situation in which blood pressure mustbe lowered within a few hours. Severe perioperative hypertension is considered a hypertensive urgency. Hypertensive urgencies are managed with oral doses of fast-acting agents such as loop diuret-ics (bumetanide [Bumex], furosemide [Lasix]), beta-blockers pro-pranolol (Inderal), metoprolol (Lopressor), nadolol (Corgard),angiotensin-converting enzyme inhibitors (benazepril [Lotensin], captopril [Capoten], enalapril [Vasotec]), calcium antagonists (dil-tiazem [Cardizem], verapamil [Isoptin SR, Calan SR, Covera HS]), or alpha2-agonists, such as clonidine (Catapres) and guanfacine (Tenex) (see Table 32-5).
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.