44874719 case study hypertension

8/10/2019 44874719 Case Study Hypertension

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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 pressureis 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 antihypertensive 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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II. DRUG STUDY

DRUG

NA

ME

CLASSIF

ICAT

ION

INDICATION/A

CTION

SIDE

EFFEC

TS

NSG. RESPONSIBILITIES

Genericname:

Ketorolac

Brandname:

Stock:

Genericname:

Ranitidine

BrandNa

me:

Stock:

GenericName:

metoclo

pramide

Brandname:

plasil

Stock:1

Non-steroidalanti-inflammatory

Doctorsorder

:

Anti ulcerdrugs

Doctorsorder

:

Anti-emetics

Doctorsorder:

1 amp IVnowthenq8PRN

Short termmanagement ofmoderatelysevere,acute painfor singledosetreatment

Gastric irritation

Nausea and

vomiting

Hypertension

Headache

Dyspepsia

GI pain

Constipation

Flatulence

Anaphylaxis

Headache

Blurredvision

Bradycardia,supravetriculartachycardia

Neurolepticmaligna

ntsyndrome,seizures,suicideideation.

Correct Hypovolemia before giving.

Alert: Maximum Combined duration ofparenteral and oral therapy is 5 days.

When appropriate, give by deep IMinjection. Pt may feel pain at the injectionsite which can be relieve by applying coldbags.

Assess pt for abdominal pain. Notepresence of blood in emesis, stool orgastric aspirate.

Drug may be added to total parenteralsolutions.

Monitor bowel sounds.

Safety and effectiveness of drug haventbeen established for therapy lasting longerthan 12 weeks.

To prevent nocturia, give P.O. and IM

preparations in the morning. Give 2nd

dosein the early afternoon.

Watch for signs of hypokalemia such asmuscle weakness and cramps.


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0mg/2ml

Genericname:

Furosemide

Brandname:

Stock:

Genericname:

Paracetamol

Brandname:

Stock:

Generic

name:Losarta

npotassium

Brand

Diuretics

Doctorsorder:

1 amp IVnowthenOD

Nonopiodanalgesicandantipyretics

Doctorsorder:

1 amp IVstat

Antihyper

tensives

Mild painand/orfever

Forhypertension

Chronicconstipation

Vertigo,headache,dizziness.

Panceatitis,thrombocytopenia.

Neutropenia,leucopenia,pancytopeniaandhypoglycemia

Headache,dizziness,fatigue,abdominal pain,nausea,backpain orleg pain,cough

andrespiratoryinfection

Alert: Many OTC and prescriptionproducts contain acetaminophen; be awareof this when calculating total daily dose.

Drugs can be used alone or with other

antihypertensives.

Monitor patients BP to evaluate effectivenessof therapy and monitor patients who arealso taking diuretics for symptomatic HpN.

Give drugs at times that dont interfere withscheduled activities or sleep.

Before giving for constipation, determinewhether patient has adequate fluid intake,exercise and diet.


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name:

getzar

Genericname:Bisacodyl

Brand

name:

Dulcolax

Diphenylmethanederivative

Dizziness,faintness,muscleweakness withexcessive use

Abdominalcramps

Electrolyteimbalance

44874719 case study hypertension

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