Hypertensive crisis is a severe elevation in blood pressure (typically >180/120 mmHg) that can lead to acute organ damage and requires immediate medical intervention. This nursing diagnosis focuses on identifying and managing severe hypertension while preventing life-threatening complications.
Causes (Related to)
Hypertensive crisis can develop from various underlying factors:
- Uncontrolled essential hypertension
- Medication non-compliance
- Secondary hypertension conditions
- Drug-induced hypertension
Medical conditions such as:
- Renal disease
- Preeclampsia/eclampsia
- Endocrine disorders
- Neurological conditions
Contributing factors include:
- Excessive sodium intake
- Stress and anxiety
- Recreational drug use
- Certain medications
Signs and Symptoms (As evidenced by)
Hypertensive crisis presents with distinct clinical manifestations that require immediate nursing attention.
Subjective: (Patient reports)
- Severe headache
- Visual disturbances
- Chest pain
- Shortness of breath
- Anxiety and restlessness
- Nausea and vomiting
- Confusion
- Neck stiffness
Objective: (Nurse assesses)
- Blood pressure >180/120 mmHg
- Altered mental status
- Retinal changes
- Focal neurological deficits
- Pulmonary edema
- Tachycardia
- Elevated respiratory rate
- Evidence of target organ damage
Expected Outcomes
The following outcomes indicate successful management of hypertensive crisis:
- Blood pressure will decrease to safer levels within the appropriate timeframe
- The patient will remain free from complications
- The patient will demonstrate medication compliance
- The patient will identify personal triggers
- The patient will maintain organ function
- The patient will verbalize understanding of the management plan
- The patient will demonstrate lifestyle modifications
Nursing Assessment
Monitor Vital Signs
- Frequent blood pressure measurements
- Heart rate and rhythm assessment
- Respiratory rate and pattern
- Temperature monitoring
- Pulse oximetry
Assess Neurological Status
- Level of consciousness
- Pupillary response
- Speech patterns
- Motor function
- Presence of headache
Evaluate Cardiovascular Status
- Heart sounds
- Peripheral pulses
- Presence of edema
- Chest pain characteristics
- ECG changes
Monitor for Complications
- Signs of stroke
- Cardiac complications
- Kidney function
- Vision changes
- Mental status changes
Review Risk Factors
- Medication history
- Compliance patterns
- Lifestyle factors
- Family history
- Comorbid conditions
Nursing Care Plans
Nursing Care Plan 1: Risk for Decreased Cardiac Output
Nursing Diagnosis Statement:
Risk for Decreased Cardiac Output related to severe elevation in systemic vascular resistance as evidenced by blood pressure >180/120 mmHg and tachycardia.
Related Factors:
- Increased afterload
- Myocardial stress
- Increased systemic vascular resistance
- Altered contractility
Nursing Interventions and Rationales:
- Monitor cardiac rhythm and hemodynamics continuously
Rationale: Detects early signs of cardiac compromise - Administer antihypertensive medications as ordered
Rationale: Reduces blood pressure to prevent organ damage - Maintain bed rest with head elevated
Rationale: Reduces cardiac workload
Desired Outcomes:
- Blood pressure will decrease to the target range
- The patient will maintain adequate cardiac output
- The patient will remain free from complications
Nursing Care Plan 2: Acute Pain
Nursing Diagnosis Statement:
Acute Pain related to increased cerebral pressure as evidenced by severe headache and neck stiffness.
Related Factors:
- Increased intracranial pressure
- Vascular changes
- Tissue hypoxia
- Anxiety
Nursing Interventions and Rationales:
- Assess pain characteristics regularly
Rationale: Monitors progression and response to interventions - Provide a quiet, calm environment
Rationale: Reduces external stimuli and stress - Implement prescribed pain management
Rationale: Promotes comfort while maintaining BP control
Desired Outcomes:
- The patient will report decreased pain intensity
- The patient will demonstrate reduced anxiety
- The patient will maintain stable vital signs
Nursing Care Plan 3: Risk for Injury
Nursing Diagnosis Statement:
Risk for Injury related to altered cerebral perfusion as evidenced by dizziness and visual disturbances.
Related Factors:
- Altered consciousness
- Sensory changes
- Balance impairment
- Visual disturbances
Nursing Interventions and Rationales:
- Implement fall precautions
Rationale: Prevents injury from altered balance - Assist with ambulation
Rationale: Ensures patient safety during movement - Maintain bed in a low position with side rails up
Rationale: Reduces risk of falls
Desired Outcomes:
- The patient will remain free from injury
- The patient will demonstrate safe mobility
- The patient will utilize safety measures
Nursing Care Plan 4: Anxiety
Nursing Diagnosis Statement:
Anxiety related to acute illness and fear of complications as evidenced by expressed concerns and increased vital signs.
Related Factors:
- Threat to health status
- Fear of death
- Lack of knowledge
- Situational crisis
Nursing Interventions and Rationales:
- Provide clear, concise information
Rationale: Reduces fear of the unknown - Teach relaxation techniques
Rationale: Helps manage stress and anxiety - Allow expression of concerns
Rationale: Promotes emotional well-being
Desired Outcomes:
- The patient will demonstrate reduced anxiety
- The patient will use effective coping strategies
- The patient will verbalize understanding of the condition
Nursing Care Plan 5: Knowledge Deficit
Nursing Diagnosis Statement:
Knowledge Deficit related to lack of information about hypertensive crisis management as evidenced by questions about treatment and prevention.
Related Factors:
- Lack of exposure to information
- Misinterpretation of information
- Cognitive limitations
- Language barriers
Nursing Interventions and Rationales:
- Provide education about the condition
Rationale: Increases understanding and compliance - Teach medication management
Rationale: Promotes adherence to treatment - Discuss lifestyle modifications
Rationale: Prevents future episodes
Desired Outcomes:
- The patient will demonstrate an understanding of condition.
- The patient will verbalize proper medication use
- The patient will identify lifestyle modifications
References
- Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2023). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier.
- Gegenhuber A, Lenz K. Behandlung des hypertensiven Notfalls [Hypertensive emergency and urgence]. Herz. 2003 Dec;28(8):717-24. German. doi: 10.1007/s00059-003-2506-8. Erratum in: Herz. 2004 May;29(3):354. PMID: 14689106.
- Harding, M. M., Kwong, J., & Hagler, D. (2022). Lewis’s Medical-Surgical Nursing: Assessment and Management of Clinical Problems, Single Volume. Elsevier.
- Herdman, T. H., Kamitsuru, S., & Lopes, C. (2024). NANDA International Nursing Diagnoses – Definitions and Classification, 2024-2026.
- Ignatavicius, D. D., Rebar, C., & Heimgartner, N. M. (2023). Medical-Surgical Nursing: Concepts for Clinical Judgment and Collaborative Care. Elsevier.
- Khan NN, Zurayyir EJ, Alghamdi AM, Alghamdi SF, Alqahtani MA, Abdalla EM, Jurays NS, Alassiri AM, Alzahrani HA, Althabet AA. Management Strategies for Hypertensive Crisis: A Systematic Review. Cureus. 2024 Aug 12;16(8):e66694. doi: 10.7759/cureus.66694. PMID: 39262522; PMCID: PMC11389756.
- Rodriguez MA, Kumar SK, De Caro M. Hypertensive crisis. Cardiol Rev. 2010 Mar-Apr;18(2):102-7. doi: 10.1097/CRD.0b013e3181c307b7. PMID: 20160537.
- Silvestri, L. A. (2023). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier.
