A hypertensive crisis is characterized by an abrupt and severe elevation in blood pressure. The blood pressure reading can be as high as 180/120 millimeters of mercury (mm Hg). A hypertensive crisis is a life-threatening condition that may result in cardiac arrest, stroke, or other potentially fatal health complications.
Severe hypertension can harm blood vessels and organs like the heart, brain, kidneys, and eyes. The heart may be unable to pump blood effectively during a hypertensive crisis.
Types of Hypertensive Crisis
- Urgent Hypertensive Crisis. In an urgent hypertensive crisis, the patient’s blood pressure can reach 180/120 mm Hg and above. However, there is no evidence of organ damage.
- Emergency Hypertensive Crisis. During an emergency hypertensive crisis, the patient’s blood pressure is higher than 180/120 mmHg, and life-threatening organ damage is present.
Signs and Symptoms of Hypertensive Crisis
Some patients who are in a hypertensive crisis may have symptoms, while others may not exhibit any at all. Those patients who can check their blood pressure on their own may find a 180 mm Hg/120 mm Hg or higher reading. If there are no other symptoms, the American Heart Association (AHA) recommends waiting 5 minutes before taking another blood pressure monitor. If the reading remains high, the patient should consult his primary care provider right away.
Here are the symptoms of a hypertensive crisis:
- migraine or severe headache
- lightheadedness
- confusion
- extreme anxiety
- nausea or vomiting
- chest discomfort
- alterations in vision
- breathing difficulty
- nosebleed
- seizures or fits
Causes of Hypertensive Crisis
- Noncompliance with antihypertensive medications. This is the most common cause of hypertensive crisis.
- Several medications. Some medications may interact with antihypertensive maintenance drugs, leading to a hypertensive crisis.
- Renal disorders/kidney damage. When the kidneys are damaged, they can cause the blood pressure to rise even more by releasing specific hormones or causing water and salt retention.
- Endocrine system disorders. Problems with the pituitary gland can create health issues with the adrenal and thyroid glands. A hypertensive crisis can occur if the pituitary gland transmits too many signals to the adrenal glands or thyroid gland.
- Preeclampsia/Eclampsia. Persistent reductions in uteroplacental perfusion may cause a hypertensive crisis in pregnancy.
- Recreational drugs. Illicit drugs can lead to a hypertensive crisis by constricting the blood vessels that deliver blood to the heart. These substances raise the heart rate and cause cardiac muscle damage.
- Head Trauma. Head trauma caused by injury induces the brain stem to believe the body is in distress, exacerbating blood pressure elevation.
- Brain Tumor. Significant fluctuations in blood pressure may arise in the final stages of the disorder.
Risk Factors to Hypertensive Crisis
The following risk factors are frequently linked to hypertensive crisis:
- Ignoring or failing to take prescribed medications for high blood pressure
- History of potentially fatal cardiovascular diseases, such as a heart attack or stroke
- Organ failures, such as heart failure or kidney failure
- Overweight or obesity
- Unhealthy, high-salt diet
- Sedentary lifestyle
- Smoking
- Cardiovascular disease history
- Medical illnesses like diabetes or renal disease
Complications of Hypertensive Crisis
Without prompt treatment and a lifestyle modification, a hypertensive crisis can lead to a variety of complications, including:
- Brain Hemorrhage. A hypertensive crisis can rupture these narrow arteries, allowing blood to enter brain tissue.
- Stroke. A hypertensive crisis can cause the blood vessels that supply the brain with blood and oxygen to erupt or become obstructed.
- Hypertensive encephalopathy/Brain inflammation. It results from an unexpected, prolonged elevation of blood pressure from any root cause which outweighs the maximum cerebral blood flow autoregulation limit.
- Pulmonary edema. The hypertensive crisis can cause pulmonary edema due to constricted kidney arteries (renal artery stenosis) or fluid accumulation that results from renal disorder.
- Heart failure or Heart attack. The hypertensive crisis can harm the arteries by making them less elastic, reducing the oxygen and blood that travel to the heart and consequently leading to a heart attack.
Diagnosis of Hypertensive Crisis
A healthcare provider will take several blood pressure readings and inquire about the patient’s symptoms and medical history. They will also inquire about any prescription drugs or supplements the patient takes and determine whether they have used illegal substances.
If the healthcare provider suspects a hypertensive crisis is causing organ damage, they will arrange additional tests. These could include:
- Blood Tests. Blood tests are frequently performed to determine sodium, potassium, creatinine, blood sugar, and total levels of triglycerides and cholesterol. These parameters are necessary for the diagnosis of a hypertensive crisis.
- Urine Test. A urine sample may contain indicators implying health problems contributing to a hypertensive crisis.
- Eye Examination. Doctors of optometry can sometimes detect undiagnosed high blood pressure before patients’ primary care physicians by performing regular, thorough eye examinations.
- Electrocardiogram. In diagnosing hypertensive crisis, an ECG is beneficial because ECG indicators can predict sudden cardiac arrest.
- Ultrasound. Carotid artery ultrasound is commonly used to diagnose and evaluate hypertensive crisis-induced organ failure.
- Imaging Test
- Brain CT Scan. In instances of hypertensive crisis with brain complications, the doctor will order a CT scan to ascertain the severity of the impairment and take preventative measures as soon as possible.
- Brain MRI. MRI could replace the integration of echocardiography, renal ultrasound, and CT imaging as a reliable and efficient monitoring procedure for secondary causes of hypertensive crisis.
Treatment of Hypertensive Crisis
Intravenous antihypertensive medications to reduce the person’s blood pressure are generally the first-line treatment for hypertensive crisis. Healthcare providers typically seek to lower blood pressure by no more than 25% within the initial hour, as rapid drops in blood pressure can induce other complications. Once the patient’s blood pressure has stabilized, the healthcare professional will immediately switch to oral antihypertensive medications.
The medications used to lower blood pressure by a healthcare provider may differ depending on several factors, including:
- Pregnancy
- Underlying medical conditions or comorbidities
- whether or not the hypertensive crisis was caused by the use of illegal drugs
Here are some of the medications or treatments that are recommended for patients suffering from a hypertensive crisis:
- Oral antihypertensive medications.
- Beta-blockers
- Calcium Channel Blockers
- Nitrates
- Proper and Balanced Diet
- Low sodium diet. Most doctors agree that patients with high blood pressure should limit their sodium intake to less than 2300 milligrams (2.3 grams) per day.
- Blood Pressure Procedure or Renal Denervation (RDN). RDN is a blood pressure-lowering procedure that explicitly targets nerve endings near the kidneys, which may get overstimulated and lead to elevated blood pressure.
Hypertensive Crisis Nursing Diagnosis
Nursing Care Plan for Hypertensive Crisis 1
Nursing Diagnosis: Activity Intolerance related to an imbalance between oxygen supply and demand secondary to the hypertensive crisis, as evidenced by elevated blood pressure, nausea, and dizziness in response to activity.
Desired Outcomes:
- The client will follow recommended techniques for enhancing activity tolerance.
- The client will report a significant improvement in activity tolerance.
Hypertensive Crisis Nursing Interventions for Activity Intolerance:
Evaluate the client’s response to activities. Take note of any elevation on the vital signs, such as a pulse rate that is more than 20 beats per minute higher than the resting rate; a significant increase in blood pressure during and after activity (systolic pressure increase of 40 mm Hg or diastolic pressure increase of 20 mm Hg); dyspnea or chest discomfort; severe tiredness and weakness; diaphoresis; dizziness or syncope. The measures listed below help assess physiological responses to activity stress and, if present, are symptoms of overexertion.
Teach the client energy-saving techniques such as sitting while showering, brushing teeth, combing hair, and performing activities at a slower speed. Energy-saving measures help to balance oxygen supply and demand by reducing energy consumption.
Promote a gradual increase in activity, including self-care when tolerated—help as necessary. A gradual increase in activity minimizes a sudden increase in cardiac workload. Assisting only when necessary promotes independence in carrying out tasks.
Nursing Care Plan for Hypertensive Crisis 2
Nursing Diagnosis: Acute Pain related to increased cerebral vascular pressure secondary to the hypertensive crisis as evidenced by Verbal reports of pulsating pain in the suboccipital area that appears upon awakening and disappears gradually after being awake, intolerance of bright lights and loudness, dizziness, blurred vision, nausea, and vomiting.
Desired Outcomes:
- The client will report relief from pain/discomfort.
- The client will use relaxation methods and diversional activities as recommended for the individual situation.
Hypertensive Crisis Nursing Interventions for Acute Pain:
Identify the location, features, intensity (0-10 scale), occurrence, and length of pain. Take note of non-verbal signals. Assists in the diagnosis of the problem and the commencement of necessary treatment. Helpful in assessing the efficacy of therapy.
Promote and continue bed rest during the acute phase. Reduces stimulation and increases relaxation.
Offer or recommend nonpharmacological relief strategies for headaches, such as a cool compress on the forehead, back, and neck rubs, a quiet, dimly lit room, relaxation techniques (guided imagery, distraction), and diversional activities. Reducing cerebral vascular pressure and slowing or blocking the sympathetic nervous system effectively alleviate headaches and their complications.
Reduce or remove vasoconstricting activities aggravating headaches, including straining at stool, persistent coughing, and bending over. When there is an increase in cerebral vascular pressure, activities that cause vasoconstriction make the headache worse.
Assist the client in moving as needed. Vascular headaches are commonly coupled with dizziness and vision impairment. The client may also have episodes of postural hypotension, which causes weakness when walking.
Give medications as prescribed. Minimize or regulate pain, and reduce sympathetic nervous system activity. It helps alleviate tension and discomfort brought on by stress.
Nursing Care Plan for Hypertensive Crisis 3
Nursing Diagnosis: Ineffective Coping related to inadequate relaxation; work overload secondary to hypertensive crisis as evidenced by Persistent tiredness; muscular strain; frequent headaches/neck aches.
Desired Outcomes:
- The client will recognize ineffective coping techniques and their consequences.
- The client will demonstrate effective coping skills/techniques.
Hypertensive Crisis Nursing Interventions for Ineffective Coping:
Take note of reports of sleep problems, increased tiredness, reduced focus, irritability, poor headache tolerance, and difficulty coping or problem-solve. Maladaptive coping behaviors may be signs of repressed rage and play a significant role in determining diastolic blood pressure.
Observe behaviors to determine the efficiency of coping mechanisms (ability to verbalize feelings and concerns, willingness to participate in the treatment plan). Adaptation mechanisms are required to change one’s lifestyle, manage the severity of hypertension, and incorporate recommended treatments into everyday life.
Identify specific stressors with the client and provide coping mechanisms. Recognizing stresses is the first stage toward changing one’s response to stressors.
Include the client in the treatment plan and encourage the client to participate as much as possible in the treatment program. Participation gives the patient a perception of an ongoing sense of control, enhances coping abilities, and can boost cooperation with the therapeutic regimen.
Nursing Care Plan for Hypertensive Crisis 4
Nursing Diagnosis: Deficient Knowledge related to misinterpretation of information secondary to the hypertensive crisis, as evidenced by incorrectly following directions; ineffectively carrying out procedures.
Desired Outcomes:
- The client will verbally express their understanding of the disease process and treatment regimen.
- The client will recognize pharmacological side effects and any complications that require medical treatment.
- The client will keep their blood pressure within target limits.
Hypertensive Crisis Nursing Interventions for Deficient Knowledge:
Determine readiness and learning barriers. Involve significant other (SO). Misunderstandings and denial of the diagnosis may interfere with the patient’s and SO’s openness to learning about the disease, its progression, and its outcome.
Identify and state the targeted BP limitations. Describe the effects of hypertension on the heart, blood vessels, kidneys, and brain. It offers a foundation for understanding blood pressure elevations and explains commonly used medical vocabulary.
Guide the client in determining risk factors that can be modified, such as obesity, high sodium diet, saturated fats, and cholesterol, sedentary lifestyle, smoking, alcohol intake of more than 2 oz per day regularly, and stressful lifestyle. Such risk factors have been linked to hypertension and cardiovascular and renal disorders.
Explain the benefits of quitting smoking and support the client in developing a cessation strategy. Nicotine raises catecholamine release, heart rate, blood pressure, vasoconstriction, and myocardial strain while decreasing tissue oxygenation.
Explain the significance of following treatment plans and attending follow-up appointments. Failure to collaborate is a common cause of antihypertensive treatment failures. As a result, regular evaluation for patient participation is important to treatment success.
Nursing Care Plan for Hypertensive Crisis 5
Risk for Decreased Cardiac Output
Nursing Diagnosis: Risk for Decreased Cardiac Output related to myocardial ischemia secondary to hypertensive crisis.
Desired Outcomes:
- The client will engage in activities that minimize blood pressure and heart workload.
- The client’s heart rhythm and rate will be stable and within the normal range.
- The client will participate in stress-reduction activities, including stress management, balanced activities, and rest plans.
Hypertensive Crisis Nursing Interventions for Risk for Decreased Cardiac Output:
Review the laboratory results such as cardiac markers, complete blood cell count, electrolytes, ABGs, blood urea nitrogen and creatinine, and cardiac enzymes. To identify potential contributing factors.
Check and record blood pressure. For the initial evaluation, measure both arms and thighs three times, 3-5 minutes apart, when the client is at rest, sitting, and standing. Employ the appropriate cuff size and accurate technique. Pressure comparisons provide an accurate picture of vascular involvement or the extent of the disease.
Take note of the presence and quality of central and peripheral pulses. Bounding carotid, jugular, radial, and femoral pulses can be detected and palpated. Pulses in the legs and feet may be reduced due to vasoconstriction (increased systemic vascular resistance [SVR]) and venous congestion.
Listen for heart tones and breath sounds. S4 heart sounds are common in chronically hypertensive patients due to atrial hypertrophy (increased atrial volume and pressure). S3 growth suggested cardiac hypertrophy and decreased function.
Take note of your skin’s color, wetness, temperature, and capillary refill time. Pallor, cool, moist skin, and prolonged capillary refill time may indicate peripheral vasoconstriction, cardiac decompensation, and reduced output.
Nursing References
Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier. Buy on Amazon
Gulanick, M., & Myers, J. L. (2022). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon
Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2020). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier. Buy on Amazon
Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier. Buy on Amazon
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