Question

Case Study, Chapter 31, Assessment and Management of Patients With Hypertension 1. Joan Smith, 55 years of age, is a female patient who presents to the intensive care unit with the diagnosis of intracranial hemorrhage. The patient stopped taking her antihypertensives suddenly because of the cost of the medications and she recently lost her job to outsourcing. The patient is slightly drowsy and complains of a headache and blurred vision. The patient's blood pressure is 220/130 mm Hg upon presentation. (Learning Objective 6) According to the definitions set by the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure (JNC 7), which type of hypertensive crisis is the patient currently experiencing a. b. Describe the treatment goals for handling the hypertensive crisis and apply the goals to the case study. Determine the current mean arterial pressure (MAP) and the goals for treatment. The physician orders nicardipine hydrochloride (Cardene) 25 mg/250 mL, NS for peripheral IV starting at 2.5 mg/hr, and titrate by 2.5 mg/hr every 15 minutes to reach the goal for the first hour, which is to achieve 25% reduction of the initial MAP Call the physician if the dosing range of 15 mg/hr has been reached and the MAP is stll not at target goal for the first hour of treatment, or up to four dose increases Lower the BP within 6 hours to 160/100 mm Hg Adjust the IV rate so that the IV fluids plus the nicardipine IV drip are equal to 100 mL/hr, in total. Call the physician if the IV fluids must go above 100 mL/hr to provide the nicardipine c. Explain what rate to set initially for both the nicardipine drip and the NS maintenance fluids

Answer 1

Hypertension :

It is a long term medical condition , in which the blood pressure is elevated.

It can lead to severe complications such as heart attack and stroke .

a) In this case study , stage 4 Hypertension as the blood pressure is greater than 180 /110.

This is primary hypertension , and it is a malignant type as it shows the signs and symptoms like blurred vision and headache.

b)The drugs that are used in hypertensive crisis is Sodium nitroprusside and nitroglycerine, intravenous labetalol.

The main goal of using these medications is to reduce the mean arterial pressure no more than 25 percent within 1 hour and then stabilize the blood pressure.