hypertensive crisis

hypertensive crisis

Etymology: Gk, hyper + L, tendere, to stretch; Gk, krisi, turning point

a sudden, severe increase in blood pressure to a level exceeding 200/120 mm Hg, occurring most frequently in individuals who have untreated hypertension or who have stopped taking prescribed antihypertensive medication. See also malignant hypertension.

observations Characteristic signs include severe headache, vertigo, diplopia, tinnitus, photophobia, nosebleed, twitching of muscles, tachycardia or other cardiac arrhythmia, distended neck veins, narrowed pulse pressure, nausea, and vomiting. The patient may be confused, irritable, or stuporous, and the condition may lead to convulsions, coma, myocardial infarction, renal failure, cardiac arrest, or stroke.

interventions Treatment consists of antihypertensive drugs and diuretics; anticonvulsants, sedatives, and antiemetics may be used if indicated. The patient is usually placed on a cardiac monitor in a bed with the head elevated and is maintained in a quiet environment. The diet is low in calories, and sodium and fluids may be restricted. As the patient's condition improves, progressive ambulation is permitted, but the patient is carefully observed for symptoms of orthostatic hypotension, such as pallor, diaphoresis, or faintness, which may be side effects of the antihypertensive drugs.

nursing considerations The major concerns of the nurse are to observe and report any sign of hypotension. In preparation for discharge the nurse advises the patient to recognize symptoms of any dramatic increase or decrease in blood pressure, to adhere to the prescribed diet and medication, and to avoid fatigue, heavy lifting, use of tobacco products, and stressful situations.

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crisis [kri´sis] (pl. cri´ses) (L.)

1. the turning point of a disease for better or worse; especially a sudden change, usually for the better, in the course of an acute disease.

2. a sudden paroxysmal intensification of symptoms in the course of a disease.

3. life crisis.

addisonian crisis (adrenal crisis) the symptoms accompanying an acute onset or worsening of addison's disease: anorexia, vomiting, abdominal pain, apathy, confusion, extreme weakness, and hypotension; if untreated these progress to shock and then death.

aplastic crisis a sickle cell crisis in which there is temporary bone marrow aplasia.

blast crisis a sudden, severe change in the course of chronic granulocytic leukemia, characterized by an increased number of blasts, i.e., myeloblasts or lymphoblasts.

catathymic crisis an isolated, nonrepetitive act of violence that develops as a result of intolerable tension.

celiac crisis an attack of severe watery diarrhea and vomiting producing dehydration and acidosis, sometimes occurring in infants with celiac disease.

developmental crisis maturational crisis.

hemolytic crisis an uncommon sickle cell crisis in which there is acute red blood cell destruction with jaundice.

hypertensive crisis dangerously high blood pressure of acute onset.

identity crisis a period in the psychosocial development of an individual, usually occurring during adolescence, manifested by a loss of the sense of the sameness and historical continuity of one's self, confusion over values, or an inability to accept the role the individual perceives as being expected by society.

life crisis a period of disorganization that occurs when a person meets an obstacle to an important life goal, such as the sudden death of a family member, a difficult family conflict, an incident of domestic violence (spouse or child abuse), a serious accident, loss of a limb, loss of a job, or rape or attempted rape.

maturational crisis a life crisis in which usual coping mechanisms are inadequate in dealing with a stress common to a particular stage in the life cycle or with stress caused by a transition from one stage to another. Called also developmental crisis.

myasthenic crisis the sudden development of dyspnea requiring respiratory support in myasthenia gravis; the crisis is usually transient, lasting several days, and accompanied by fever.

oculogyric crisis a symptom of an acute dystonic reaction in which the person demonstrates a fixed gaze, usually upward; also, the uncontrollable rolling upwards of the eye. It can be a result of encephalitis or a reaction to antipsychotic medications.

salt-losing crisis see salt-losing crisis.

sickle cell crisis see sickle cell crisis.

tabetic crisis a painful paroxysm occurring in tabes dorsalis.

thyroid crisis (thyrotoxic crisis) see thyroid crisis.

vaso-occlusive crisis a sickle cell crisis in which there is severe pain due to infarctions in the bones, joints, lungs, liver, spleen, kidney, eye, or central nervous system.

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hypertensive crisis

A rare clinical event characterized by a severe and/or acutely ↑ diastolic BP > 120-130 mm Hg; an HC is a medical emergency if accompanied by rapid or progressive CNS–encephalopathy, infarction or hemorrhage, cardiovascular–myocardial ischemia, infarction, aortic dissection, pulmonary edema, and renal deterioration, eclampsia or microangiopathic hemolytic anemia Etiologic factors Pre-existing chronic HTN; renovascular HTN; renal parenchymal disease; scleroderma and collagen vascular disease; drugs–sympathomimetics, tricyclic antidepressants, withdrawal from antihypertensives, recreational–eg, crack cocaine; spinal cord syndromes; pheochromocytoma Clinical Severe headache, transient blindness, vomiting, rapid deterioration of renal function Complications Acute end-organ damage–eg, myocardial ischemia/infarction, renal failure, aortic dissection, stage 3 or 4 hypertensive retinopathy Treatment Organ-targeted therapy with CCBs, Lobetalol, loop diuretics, nitroglycerin, nitroprusside Prognosis Untreated 5-yr mortality is 100%