Hypertension (Uncontrolled) and Hypertensive Crisis for Progressive Care Certified Nurse (PCCN)
Included In This Lesson
Outline
Hypertension (Uncontrolled) and Hypertensive Crisis
Definition/Etiology:
- Definition
- Hypertension is when blood pressure, the force of blood flowing through blood vessels, is persistently too high.
- Analogy
- How is blood pressure like a garden hose? Think of blood pressure in your vessels like water in a garden hose. Ever put your thumb over the end of a garden hose? Water = more force but there’s less of it.
- POOR PERFUSION.
- Tested PCCN Stages of HTN
- Stage 2-When patients become symptomatic – leads to organ damage
- 140/90 -taken on two separate events
- HTN CRISIS – Organs are at immediate risk/Poor Compliance
- 180/120
- Stage 2-When patients become symptomatic – leads to organ damage
- Etiology/Cause
- Primary (90%) Idiopathic
- Secondary (10%)
- Renal Disease
- Anything that causes Atherosclerosis
- Hyperlipidemia, smoking, obesity, stress etc
- Endocrine Disorders
- Cushing’s (↑ Aldosterone)
Pathophysiology:
- Blood pressure is a result of Cardiac Output X Peripheral resistance
- Increased Plasma Volume (Too much Fluid)
- Increased Stroke Volume
- Increase Systolic Blood Pressure (Raises top BP number)
- Increased vasoconstriction of Peripheral Arterioles (too much squeeze)
- Increased Systemic Vascular resistance
- Increased Diastolic pressure
- When we get to antihypertensives this is what we mostly control.
- Fluids & Squeeze!
Noticing: Assessment & Recognizing Cues:
- Stage 2 HTN (140/90)
- “Silent Killer” Asymptomatic until end organ damage SLOWLY occurs
- Brain – Stroke
- Retina – Vision Loss
- Heart – MI/Heart Failure
- Kidneys – Kidney Failure
- Kidneys take up 20% Cardiac Output
- “Silent Killer” Asymptomatic until end organ damage SLOWLY occurs
- HTN CRISIS (180/120)
- QUICK onset of symptoms
- Blurred Vision
- Severe headaches
- Dizziness
- Chest Pain/Angina
- Nosebleeds
- QUICK onset of symptoms
Interpreting: Analyzing & Planning:
- Labs
- Lipid Profile – atherosclerosis
- Bun/Creatinine – Kidney involvement
- Aldosterone – Endocrine
- UA – Protein/blood
- Diagnostics
- ECG – LVH (big QRS)
- ECHO – LV Hypertrophy
- CXR – Cardiomegaly or Pulm Edema
- CT Brain – HTN Crisis = CVA
Responding: Patient Interventions & Taking Action:
- Bring down SLOWLY
- Organs are used to high pressure – can cause ischemia/infarct ↓ too quick
- Pharmacological Interventions – 2 or more + drs titrate meds “low and SLOW”
- HTN -SLOW ONSET
- ACEs/ARBS – Decrease Afterload
- Calcium Channel Blockers
- Diuretics – Get Fluid Out
- KCL sparing vs wasting
- Crisis- RAPID ONSET
- Arterial vasodilators (Hydralazine)
- Benzos – Valium/Ativan/Xanax
- HTN -SLOW ONSET
- Adjunct Medical Therapy
- Cardiology – Plumbing
- Nephrology = #1 secondary cause
Reflecting: Evaluating Patient Outcomes:
- ABCs/Hemodynamics stable
- Patient feeling – Drop it slow
- End organ perfusion
- Brain – less confusion/calm
- Eyes – vision return to normal
- Heart – Chest pain/ pulmonary
- Kidneys – 30ml/hr
- Patient education. Non-compliance = Return to ED
Linchpins (Key Points):
- Notice -Symptoms
- Chronic (Stage 2 HTN) or Acute (Hypertensive Crisis)
- Interpret- Labs/Diagnostics
- Hypertensive CRISIS + SX of CVA = CT HEAD STAT
- Respond – Pharmacology & Interventions
- Probably 2 meds – oral vs IV Push
- Bring BP down slowly
- Reflect
- Hemodynamics Stable?
- Signs of Organ damage?(Kidneys!)
Transcript
References
- AACN, and Tonja Hartjes. AACN Core Curriculum for Progressive and Critical Care Nursing. Available from: Pageburstls, (8th Edition). Elsevier Health Sciences (US), [Insert Year of Publication].
- Dennison, R. D., & Farrell, K. (2015]). Pass PCCN!. Elsevier Health Sciences (US).
- Kupchik, N. (2020). Ace The Pccn! you can do it!: Study guide. Nicole Kupchik Consulting, Inc.
NCLEX
Concepts Covered:
- Circulatory System
- Emergency Care of the Cardiac Patient
- Cardiac Disorders
- Cardiovascular
- Shock
- Shock
- Disorders of the Posterior Pituitary Gland
- Endocrine
- Disorders of Pancreas
- Disorders of the Thyroid & Parathyroid Glands
- Hematology
- Gastrointestinal
- Upper GI Disorders
- Liver & Gallbladder Disorders
- Newborn Complications
- Lower GI Disorders
- Multisystem
- Neurological
- Nervous System
- Central Nervous System Disorders – Brain
- Renal
- Respiratory
- Urinary System
- Respiratory System
- Noninfectious Respiratory Disorder
- Test Taking Strategies
- Note Taking
- Basics of NCLEX
- Prefixes
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- Medication Administration
- Gastrointestinal Disorders
- Respiratory Disorders
- Pregnancy Risks
- Labor Complications
- Hematologic Disorders
- Fundamentals of Emergency Nursing
- Factors Influencing Community Health
- Delegation
- Perioperative Nursing Roles
- EENT Disorders
- Basics of Chemistry
- Adult
- Emergency Care of the Neurological Patient
- Acute & Chronic Renal Disorders
- Emergency Care of the Respiratory Patient
- Respiratory Emergencies
- Studying
- Substance Abuse Disorders
- Disorders of the Adrenal Gland
- Behavior
- Documentation and Communication
- Preoperative Nursing
- Endocrine System
- Legal and Ethical Issues
- Communication
- Understanding Society
- Immunological Disorders
- Infectious Disease Disorders
- Oncology Disorders
- Female Reproductive Disorders
- Fetal Development
- Terminology
- Anxiety Disorders
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- Musculoskeletal Trauma
- Intraoperative Nursing
- Tissues and Glands
- Vascular Disorders
- Renal Disorders
- Eating Disorders
- Prenatal Concepts
- Microbiology
- Male Reproductive Disorders
- Sexually Transmitted Infections
- Infectious Respiratory Disorder
- Depressive Disorders
- Personality Disorders
- Psychotic Disorders
- Trauma-Stress Disorders
- Peripheral Nervous System Disorders
- Integumentary Disorders
- Neurologic and Cognitive Disorders
- Integumentary Disorders
- Newborn Care
- Basics of Mathematics
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- Labor and Delivery
- Proteins
- Emergency Care of the Trauma Patient
- Hematologic System
- Hematologic Disorders
- Developmental Considerations
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- Postpartum Care
- Basic
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- Bipolar Disorders
- Metabolism
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- Concepts of Population Health
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- Basics of Human Biology
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- Neurological Emergencies
- Prioritization
- Disorders of Thermoregulation
- Writing
- Community Health Overview
- Dosage Calculations
- Neurological Trauma
- Concepts of Mental Health
- Health & Stress
- Endocrine and Metabolic Disorders
- Childhood Growth and Development
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- Concepts of Pharmacology
- Integumentary Important Points
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- Growth & Development
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- Reading
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- Med Term Basic
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- Central Nervous System Disorders – Spinal Cord
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- Pediatric
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- State of Consciousness
- Sensory System