Question

1. YOU ARE THE NURSE CARING FOR THE FOLLOWING CLIENTS. DESCRIBE YOUR ACTIONS RELATED TO ASSESSMENT OF VITAL SIGNS.
2. A 58-year old client has been admitted with new onset of acute hypertension. His blood pressure was 178/106 on admission and he is now complaining of a “severe headache” and dizziness 3 hours later. what do you do next?

Answer 1

DESCRIBE YOUR ACTIONS RELATED TO ASSESSMENT OF VITAL SIGNS?

. If you experience any of the signs and symptoms of hypertension, such as frequent headaches, recurrent dizziness, nosebleeds, shortness of breath, nausea or vomiting, do not wait—speak to your doctor immediately. Hypertension requires normal visits with your medical doctor to screen your progress.

. If hypertensive emergency is suspected, lab testing should include a complete blood cell count, cardiac markers, blood urea nitrogen, creatinine, urinalysis, and a urine toxicology screen.

. Other diagnostic procedures to be considered include computed tomography scans of the chest, abdomen (to rule out aortic dissection), and brain (to rule out hemorrhagic stroke); a chest X-ray; transthoracic echocardiogram or transesophageal echocardiogram; and electrocardiogram.

. Vasodilators such as nitroprusside and nitroglycerin are also used to treat a hypertensive emergency. The goal of therapy for a hypertensive emergency is to lower the mean arterial pressure by no more than 25% within minutes to 1 hour and then stabilize BP at 160/100-110 mm Hg within the next 2 to 6 hours.

Prevent Hypertensive crises may arise as the result of one or more of the following:

• acute glomerulonephritis
• autonomic dysreflexia in the presence of spinal cord injury
• chronic parenchymal renal disease
• combining a monoamine oxidase inhibitor and tyramine-containing foods (such as soy sauce, sauerkraut, aged cheese, pepperoni, salami, liverwurst), tricyclic antidepressants, or other sympathomimetics
• eclampsia, preeclampsia
• head injury
• illicit use of sympathomimetic drugs such as cocaine, amphetamines, PCP, and LSD
• pheochromocytoma
• renin-secreting or aldosterone-secreting tumor
• renovascular hypertension
• scleroderma and other collagen vascular diseases
• too-rapid withdrawal from antihypertensive medications
• vasculitis.