Hypertensive crisis is a condition that occurs as a result of a sharp sudden increase in blood pressure. This condition is urgent, therefore, care for hypertensive crisis should occur quickly and clearly according to the algorithm.
Specific high figures are not distinguished. Changes in both the blood pressure indicators themselves and the patient’s well-being are evaluated individually in each case.
In some cases, a crisis may be the first symptom of hypertension. Hypertensive crisis is dangerous due to the risk of severe disorders of the nervous system (strokes), cardiovascular (heart attacks, pulmonary edema).
- Call a doctor on duty or your doctor.
- Lay the patient on a surface with a raised head end, unfasten tight clothing (collar, belt), and when vomiting, turn the patient’s head to the side.
- Provide physical and mental peace – reassure the patient, ask other patients to leave the room.
- Provide fresh air or oxygen.
- Give captopril (capoten) under the tongue in a dose of 12,5-25 mg (1/2-1 tablet) or nifedipine (corinfarum, cordaflex) in a dose of 10-20 mg.
- For pain in the heart, give nitroglycerin under the tongue, with intolerance – validol.
- Monitor blood pressure, pulse, respiratory rate every 2-5 minutes.
- Provide intravenous access – puncture a vein.
- Provide ECG registration.
- Further activities should be carried out under the supervision of a physician.
- Be prepared for urgent hospitalization of the patient in the intensive care unit.
In many ways, the prognosis of the consequences of a hypertensive crisis depends on the correctness and timeliness of actions at the very beginning of its occurrence. The nurse should be able to provide assistance with a hypertensive crisis and be attentive and collected during urgent events.
If a hypertensive crisis is suspected, the nurse must correctly organize medical care for each victim.
Reference. The tactics and first aid of a medical assistant will depend on the totality and severity of symptoms of a hypertensive crisis.
The duties of a medical professional during emergency situations include the adoption of such measures:
- emergency assistance during the blockade of the Civil Code;
- constant monitoring of the patient’s condition;
- providing comfortable conditions;
- patient counseling;
- An accessible explanation of information to the patient and his family about the specifics of the condition, symptoms and methods of relief.
In addition, the nurse’s first aid for symptoms of a hypertensive crisis consists in collecting an anamnesis (examination of the patient’s complaints, the period of the onset of the disease and what could provoke it).
This will help the doctor accurately establish the diagnosis and determine the therapeutic regimen.
The nursing process in hypertensive crisis is divided into 2 types of interventions, each of which is characterized by a specific list of measures.
Independent nursing intervention in case of a hypertensive crisis is a set of actions that a nurse carries out independently to the extent of her competence:
- Call a doctor.
- Lay the patient in bed, put pillows under his head.
- Remove tight clothing.
- Provide fresh air.
- Calm down, give Corvaldin drops (25-35 drops).
- Measure blood pressure and heart rate.
- To reduce pressure, use quick-acting agents (Nifedipine, Kapoten).
- Determine the localization of pain, its intensity.
- Wrap your legs in a blanket or attach a heating pad.
- Monitor blood pressure after 15 and 30 minutes.
- Prepare the necessary medicines.
Dependent nursing intervention in hypertensive crisis – activities performed by a nurse as prescribed by a doctor and under his supervision.
Such events begin after the doctor arrives, and consists in prompt response to the requests and instructions of the doctor:
- the introduction of intravenous injection;
- the implementation of sublingual administration of a tablet;
- preparation and implementation of certain manipulations;
- preparation for additional studies as prescribed by the doctor.
Nursing staff plays an important role, since the recovery process depends on the speed of response and the implementation of all necessary, prescribed measures.
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The causes of hypertensive crisis, its main symptoms. The mechanisms by which the rise in blood pressure is caused. Symptoms of a hypertensive crisis with a predominance of neurovegetative syndrome. First aid for hypertensive crisis.
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Emergency medical care for hypertensive crisis. Help with eukinetic and hypokinetic type of crisis. Emergency treatment of a hypertensive crisis complicated by acute coronary insufficiency or acute cerebrovascular accident.
The concept of hypertensive crisis as a sudden pronounced increase in blood pressure, the conditions and causes of its occurrence, duration. Characteristic symptoms, classification of crises. Diagnosis of hypertensive crisis, methods of its treatment.
General characteristic of a hypertensive crisis: etiology, pathogenesis, kinetic picture. The main symptom complexes for distinguishing crises of the first and second orders. Typical complications of the disease, the order and methods of first aid.
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Among diseases of the heart and blood vessels, arterial hypertension is in first place in popularity. The disease often leads to very serious consequences, therefore, requires increased attention.
If the treatment is carried out at home, then the algorithm of the nurse’s actions in case of hypertensive crisis implies constant monitoring of the patient, providing the necessary assistance and directly treating the disease with drugs prescribed by the doctor.
In case of complicated hypertensive crisis urgent hospitalization is required
Symptoms vary depending on the severity of the disease:
- Complicated. Develops gradually. Symptoms begin in a few days, usually with mild ailment. At the initial stage, tinnitus, nausea, possibly dizziness, and often vomiting are noted. Further, severe headaches join, hearing deteriorates, visual acuity is lost, shortness of breath appears. Often hands and feet begin to tremble, severe weakness appears. All these phenomena are accompanied by high blood pressure;
- Uncomplicated. This type of crisis is developing much faster than the previous one. Characteristic symptoms include sudden headaches, tinnitus, and impaired vision and hearing. Blood pressure rises sharply and lasts quite a long time. Then dizziness occurs, in most cases vomiting.
Note. Some patients complained of the presence of pain in the chest area, so the disease is often confused with angina pectoris.
The algorithm of medical care in the Civil Code is a document approved by the Ministry of Health containing phased clinical recommendations for emergency care physicians and hospital doctors.
But do not underestimate the importance of first aid provided to the patient at home, at his workplace, in a public place. The outcome of the acute condition largely depends on it.
Every patient suffering from hypertension, and people from his immediate environment should know this symptomatology. If hypertension has a similar symptomatology, you should immediately call an ambulance and provide first aid.
There are two types of HA that have characteristic clinical differences. Determining the type of HA affects the sequence of actions of medical personnel and is of great importance for intensive care at the second stage of care – in a hospital. Recognize the type of pathological condition should emergency doctors who arrived on call.
This type of HA often occurs in young people with existing hypertension. It is characterized by an acute onset, which often occurs within 1-2 hours after the stress. Frequent complaints of patients with hyperkinetic hypertension (except persistent symptoms) are:
- tachycardia (heart palpitations);
- feeling of fear;
- red spots on the body;
- increased sweating;
- increased urination.
With tonometry, an isolated increase in systolic (upper) pressure indicator is most often determined. Hyperkinetic type HAs are usually transient, go away on their own after a few hours, and rarely lead to complications.
Symptoms of GC
Hypertensive crisis is a sharp rise in blood pressure. It can rise to very high values, for example, up to 240/120 mm Hg. Art. and even higher. In this case, the patient experiences a sudden deterioration in well-being. Appears:
- Noise in ears.
- Nausea and vomiting.
- Hyperemia (redness) of the face.
- Tremor of the limbs.
- Dryness in the mouth.
- Heart palpitations (tachycardia).
- Visual disturbances (flickering flies or veil before the eyes).
If such symptoms occur, emergency care is needed for hypertensive crisis.
- A sharp headache, often in the neck.
- Sensation of pulsation in the temporal areas.
- Nausea, vomiting that does not bring relief.
- Feeling of fear, anxiety.
- Hyperemia of the skin, more often than the face, neck, front surface of the chest.
- Increased blood pressure, while diastolic – up to 110-120 mm RT. Art.
- Contraction chest pains, autonomic phenomena and other symptoms are possible.
A third of the world’s population suffers from hypertension. The disease requires constant monitoring of the condition. Hypertensive crisis (GC) is a dangerous complication that accompanies arterial hypertension. Excessive increase in blood pressure requires the provision of proper pre-medical and emergency medical care.
Blood pressure (BP) during an attack reaches 200/110 mm Hg. With these indicators, blood pressure is a high risk of heart attack, stroke, and damage to target organs.
The duration of a hypertensive crisis is different – from an hour to several days. Patients with hypertension and their relatives should be aware of the symptoms of this pathological condition.
Timely rendered first aid helps prevent dangerous complications and reduces the risk of death.
HA occurs suddenly. The reasons that provoke him are various. Among them, severe emotional upheavals, a genetic predisposition, a sedentary lifestyle, hormonal failure, etc. The pathological condition is characterized by the following symptoms:
- severe and sharp headache;
- panic, fear;
- chest pain.
The medical literature describes several classifications of crises. Some of them are still used in medical practice.
In the 50s of the XX century, a famous scientist, cardiologist A. Myasnikov identified two types of seizures.
A type I crisis is characterized by a relatively low blood pressure, a sudden onset, a duration of several minutes to 2-3 hours, and bright vegetative manifestations:
- the face is covered with red spots;
- anxiety appears, excessive excitability;
- rapid heartbeat;
- throbbing headache;
- there is a tremor of the body, chills;
- temporary vision problems occur;
- excessive urination and excessive sweating are observed.
Gradual development, prolonged course (from several hours to 4-5 days), very high blood pressure, cerebral manifestations (from the side of the brain) are characteristic for type II crisis:
- angina attacks (pain in the heart);
- shortness of breath appears;
- headache is localized in the occipital region;
- heaviness is felt in the head, rings in the ears;
- nausea, vomiting;
- lethargy, drowsiness;
- impaired vision (“flies”, darkening);
- the face acquires a bluish-red tint;
- the skin becomes cold;
- speech is difficult, confused consciousness.
Popular classification of the doctor Kushakovsky M.S. (1977). He identified three clinical forms based on the causes of the attack and the main symptoms:
- Neurovegetative. The cause of the pathological condition is a sudden overexcitation, which resulted in an adrenaline rush. Such patients are characterized by anxiety, redness of the face and neck, trembling hands, dry mouth. These symptoms are associated with severe headache, tinnitus, dizziness, tachycardia (increased heart rate). Vision worsens, a veil appears before the eyes. The duration of the attack is from 1 to 5 hours. After normalizing blood pressure, frequent excessive urination is observed. Urine is transparent, light. This form of crisis does not present a danger to life.
- Water-salt (edematous). It is characteristic of overweight women and is caused by a malfunction of the renin-angiotensin-aldosterone system. She is responsible for the water-salt balance, blood circulation in the kidneys, pressure, volume of blood circulating in the body. Patients are inhibited, do not navigate in space and in time. They have pale skin, swelling on the face and fingers. The attack is preceded by interruptions in the work of the heart, muscle weakness, a decrease in the amount of urine excreted. HA of this form lasts from several hours to a day. It has a favorable outcome if emergency care is provided on time.
- Convulsive (arterial encephalopathy). The most dangerous form of HA. It leads to serious complications – cerebral edema, paresis (paralysis), hemorrhage (intracerebral, subarachnoid). Patients experience cramps, followed by loss of consciousness. The pathological condition lasts about three days. A patient may die if emergency care is not provided for a hypertensive crisis of this form. After an attack, patients have amnesia (memory loss).
Hypertensive patients and their relatives should know how to act in case of worsening condition and suspected attack. Emergency care includes activities before the arrival of the ambulance team and medical.
The first is carried out by the patient’s relatives or he does it on his own. The medical team continues to carry out manipulations to alleviate the condition of the patient and makes a decision on hospitalization, depending on the type of HA.
Properly rendered first aid for hypertensive crisis reduces the risk of complications. With a sharp increase in blood pressure, it is necessary to determine the presence of an attack.
To do this, you need to analyze the condition of the patient. A sudden jump in pressure, a sharp headache, special reactions from the internal organs, characteristic external manifestations indicate a pathological condition.
The emergency response algorithm is as follows:
- Call an ambulance.
- Calm down. To do this, take a sedative drug – Valerian, Barboval. Excessive anxiety contributes to increased pressure.
- Open the window to provide plenty of fresh air. Clothing should not constrain respiratory movements. Deep breaths and exhalations prevent a panic attack.
- The patient should take a half-sitting position (the patient should be on his side in an unconscious state). You can’t lie down – this increases the symptoms of the attack. It is important to ensure the outflow of blood to the legs. Put a heating pad under your feet and rub your hands (during an attack, your limbs freeze). Warming foot baths in the absence of varicose veins are allowed. Put a cold compress on your forehead.
- Take an extraordinary dose of a blood pressure lowering drug. Preference should be given to drugs from the group of ACE inhibitors (Captopril and its analogues). Drugs from the group of calcium channel blockers cannot be used, because nor dramatically reduce the pressure, which leads to serious consequences. For the first hour, doctors recommend lowering the pressure by 20% from the initial indicators of the tonometer.
- If you experience pain behind the sternum, drink ½ tablet of Nitroglycerin. The second half can be used if the symptoms have not stopped. The maximum allowable amount of the drug is 3 tablets.
- Eliminate all noise sources.
- Do not give water or other drinks, so as not to provoke vomiting. This protective reflex causes an increase in pressure.
- Prior to the arrival of the emergency team, monitor blood pressure and heart rate every 15-20 minutes. For the doctor, the rapid dynamics of the patient’s condition is very important. Stable high blood pressure, heart pain – these are symptoms of a heart attack.
In cases where the patient is alone at home, he must take the medicine recommended by the doctor in case of an attack, open the door and call an emergency.
This is necessary so that when the condition worsens, loss of consciousness, doctors are able to freely enter the house and provide assistance. Do not be shy if the attack occurred in a public place.
It is necessary to take a reclining position, ask passers-by to call an ambulance or do it yourself. Before the doctor arrives, breathe deeply evenly, if possible, unfasten compressive clothing, take medication.
A simple and convenient clinical classification of HA has gained worldwide recognition. It is widely used by practitioners to quickly determine the type of crisis and treatment tactics. The following classification is recognized by the World Health Organization:
- complicated GC (life-threatening, emergency);
- uncomplicated HC (non-threatening, emergency).
Uncomplicated GC with rapid development (hyperkinetic) is removed by intravenous injection of Dibazole and diuretic drugs.
Symptoms of tachycardia and other autonomic signs are relieved with the use of beta-blockers (Obzidan), calcium antagonists (Corinfar). An uncomplicated hypokinetic attack develops gradually and occurs in the late stages of hypertension.
Brain and heart symptoms appear. To alleviate the condition, use Corinfar, Kapoten, Clonidine sublingually (under the tongue).
Complicated crisis (Enceopathy) is stopped by the intravenous administration of Dibazole (jet), Eufillin (drop), Magnesium sulfate (drop).
The drugs improve cerebral circulation, have a moderate diuretic (diuretic), vasodilating, anticonvulsant effect, reduce brain edema.
For therapeutic measures, urgent hospitalization of the patient in the intensive care unit is required.
Angina pectoris, heart attack, stroke are the most serious complications of HA. Complications are treated in the intensive care unit, intensive care unit. To alleviate the acute condition, I use Nitroglycerin (under the tongue), adrenergic blockers (Anaprilin). In the absence of cerebral symptoms, a dropper of an isotonic sodium chloride solution is made.
For the provision of emergency care for HC, different groups of pharmacological preparations are used. The goal of therapy is to slowly lower blood pressure to an individual norm, to prevent complications. The following groups of drugs are used:
- Beta-blockers relieve tachycardia, widen the lumen of the arteries (Anaprilin, Metoprolol, Obzidan, Inderal).
- ACE inhibitors lower blood pressure by acting on the hormonal system (Enam, Enap).
- Clonidine (alpha-adrenergic agonist) is used in some cases, with caution, because causes a sharp decrease in blood pressure.
- Myotropic (acting on muscle cells) lower blood pressure by relaxing the walls of the arteries (Dibazole).
- Calcium channel blockers are used for arrhythmias (Cordipin, Normodipin, Nifedipine).
- Diuretics are necessary to remove excess fluid (Furosemide, Lasix).
- Vasodilators widen the lumen of the arteries (nitroprusside).
- Nitrates cause a decrease in pressure due to the action on the walls of blood vessels (Nitroglycerin)
- Sedatives are prescribed for hyperactivity, anxiety (seduxen).
Hypertensive crisis is considered an emergency, the cause of which is a sharp increase in blood pressure.
It is accompanied by a manifestation of subjective disorders, objective symptoms that are cerebral, cardinal, vegetative in nature.
The clinical picture of this condition is a lesion of the target organ, it needs emergency medical care.
Sometimes a condition such as a hypertensive crisis can be one of the first symptoms of hypertension. The occurrence of this condition causes a violation in the activity of such systems:
- CNS (central nervous system);
- respiratory system.
These disorders are manifested by the occurrence of such diseases:
- pulmonary edema;
- angina pectoris;
- heart failure;
- myocardial infarction.
Two factors influence the rise in blood pressure:
The most common causes of the development of a hypertensive crisis are:
- self-canceling the use of prescribed antihypertensive drugs, their irregular intake.
- the presence of emotional stress.
- overwork of the body.
- a change in weather accompanied by a pressure drop.
- alcohol abuse.
- increased physical activity.
- frequent overeating.
Disturbances in the functioning of the center of regulation of blood pressure inside the brain, which occur for various reasons.
Common symptoms of a hypertensive crisis are:
- the manifestation of a sharp headache in the neck;
- increase in blood pressure (diastolic). Its indicators exceed 110 – 120 mm RT. st .;
- development of shortness of breath. It is explained by the increased load on the left ventricle of the heart;
- the appearance of a sensation of increased pulsation in the temples;
- nausea, vomiting;
- redness of the epidermis is observed;
- visual impairment is noted. Sometimes a partial loss of visual fields appears;
- increased irritability;
- sometimes constricting pain behind the sternum.
In medicine, there are such types of hypertensive crisis:
Hyperkinetic view. This species manifests itself in the early stages of hypertension. The patient’s condition is characterized by the presence of such symptoms: – increased heart rate; – a rapid increase in blood pressure (systolic);
– the presence of abundant vegetative signs.
Hypokinetic view. Its development is characteristic of the late stages of the disease. The most characteristic signs that develop gradually include: – high blood pressure; – severe course of the disease;
– violation of the brain, cardiac system.
Also distinguish these types of crisis:
- system. Include hypotonic, autonomic, hypertonic;
- regional. Include angioedema, angiotrophoneurosis, migraine.
The reason for the development of the vegetative-vascular crisis is an increase in the level of adrenaline, steroids, acetylcholine, norepinephrine, in the blood. Vegetative-vascular crisis is divided into:
- symptomatic adrenaline. It is observed in patients with a dominant sympathetic function of the autonomic nervous system. This vegetative-vascular crisis is characterized by: anxiety, chills, increased heart rate, high blood pressure;
- vagoinsular. This type of vegetative-vascular crisis is observed in people with a dominant parasympathetic function of autonomic NS. The vegetative-vascular crisis is characterized by: nausea, lack of air, dizziness, sinking heart, weakness, increased intestinal motility, sweating, vomiting;
- hyperventilation. The clinic of this vegetative-vascular crisis is characterized by shortness of breath, tension of the muscles of the hand, legs, forearms, sweating;
- vegetative-vestibular. Clinic of this type of vegetative-vascular crisis are vomiting, dizziness, nausea.
First aid for hypertensive crisis should be provided before the arrival of doctors. It is forbidden to sharply lower the pressure. Such actions can cause collapse, which is accompanied by loss of consciousness. In a very serious case, ischemic changes may develop inside the brain, as well as some other organs.
It is recommended to lower blood pressure gradually. It is advisable to reduce no more than 20 – 30 mm per hour. Hg. Art.
First aid for hypertensive crisis can be provided independently. If a person has a hypertensive crisis, then the attending physician teaches him the correct algorithm of action in this disease. Therefore, a large number of patients are able to independently provide themselves with first aid at the exacerbation of this condition. They do not even seek medical help.
The algorithm of actions for the provision of first aid is as follows:
- Calming the patient. He should be absolutely calm, because any sign of panic contributes to a rapid increase in pressure. In order to calm down, it is recommended to take such drugs as corvalol, tinctures of motherwort, valerian.
- Breathing recovery. For this purpose it is necessary to take deep breaths / exhalations. If the attack occurred indoors, it must be aired.
- Arrange the patient more comfortable. It is advisable to warm the patient, to ensure peace.
- It is recommended to apply a cold compress on the head, mustard plasters on the calves. You can also use warm warmers to warm your feet, legs. Enough 15 to 20 minutes.
- If your doctor prescribed some medicine to relieve pressure, you should take drugs: nitroglycerin (1 tablet), and then call an ambulance. If the patient’s condition is still poorly worth taking another 2 tablets of the drug, the interval between doses should be 5 minutes.
- If a person suffers from hypertension, he should have such drugs at hand: captopril, nifedipine, cordaflex, corinfar. If there are signs of a hypertensive crisis, it is recommended to take captopril with a dosage of 25 mg (1/2 tablet), nifedipine 10 mg. If there is no effect within half an hour, it is allowed to take another same dose. If within 30 minutes the result from taking the tablets did not come, you need to call a doctor.
- It is necessary to monitor blood pressure. It must be measured at least once every 20 minutes. The help of a doctor and nurses will be needed to eliminate all the symptoms of the disease, for example, pain behind the sternum.
Often a hypertensive crisis develops in patients suffering from diseases that are accompanied by an increase in blood pressure (BP). But they can also be met without its prior steady increase.
The following diseases or conditions can contribute to the development of HA:
- hypertonic disease;
- menopause in women;
- atherosclerotic aortic lesion;
- kidney disease (pyelonephritis, glomerulonephritis, nephroptosis);
- systemic diseases, for example, lupus erythematosus, etc .;
- nephropathy during pregnancy;
- Itenko-Cushing’s disease.
Under such conditions, any strong emotions or experiences, physical strain or meteorological factors, alcohol consumption or excessive consumption of salty foods can trigger a crisis.
Despite such a variety of reasons, common in this situation is the presence of dysregulation of vascular tone and arterial hypertension.
It is so widespread and so famous that it seems that there is no person after 40 years who would not have experienced the manifestations of this sudden condition. Hypertensive crisis (GC), as a rule, does not warn about its arrival. He can catch a person in a variety of places – at work, in public transport, at sea or in a restaurant.
Of course, this is very often facilitated by an extreme situation for the body, which the autonomic nervous system (ANS) cannot cope with, due to its characteristics inherent in this individual. It is her behavior that explains the occurrence of a vascular crisis against a background of psycho-emotional stress. Inconsistent interaction of the sympathetic and parasympathetic divisions of the ANS, the predominance of one department over another forms a hypertensive crisis of a certain type. Based on these indicators, the classification of HA is based.
Treatment of a hypertensive crisis is based on his belonging to one or another type and is designed to purposefully affect the cause of the crisis. Obviously, violations of the adaptive capacity for stressful situations of central humoral and local (adrenal and kidney) mechanisms, where an inadequate vascular reaction also plays an important role, contribute to its occurrence.
Thus, the prerequisites and causes of hypertensive crisis may be:
- Unstable nervous system, neurosis and neurosis-like conditions;
- Traumatic stress, stress;
- Genetic predisposition;
- Diseases of the endocrine system (obesity, diabetes mellitus);
- Hormonal background (premenstrual syndrome and premenopausal condition);
- The accumulation of salt and fluid in the body due to the abuse of certain foods (herring, smoked meats, marinades);
- Acceptance of alcoholic beverages even in small doses and smoking;
- Any overstrain (physical, psycho-emotional, strain of hearing and sight, vibration);
- Geomagnetic disturbances and a change in weather conditions, especially sharp, not allowing the vessels to at least somehow adapt in advance;
- Concomitant chronic diseases in the acute stage;
- Impaired renal excretory function;
- Unauthorized withdrawal without adequate replacement or irregular intake of antihypertensive drugs;
- Cervical osteochondrosis, especially in the presence of vertebro-basilar insufficiency.
Any of these factors can independently cause a hypertensive crisis, but, depending on which part of the autonomic nervous system will take the initiative, there are types of diseases that form the basis of the classification of HA and are associated with hemodynamic disorders.
Hyperkinetic (type I) develops with an increase in the tone of the sympathetic part of the autonomic nervous system and is called neurovegetative or sympatho-adrenal. This type is more characteristic of young people, especially males, can occur in minutes and is accompanied by:
- A significant increase in blood pressure;
- General excitement;
- Increased sweating;
- Heart palpitations;
- Pulsating headaches;
- Pain in the region of the heart, while it seems that the heart stops for a while (extrasystole);
- Trembling limbs;
- Facial redness and dry mouth. After stopping the attack, frequent urination with a large amount of urine is observed.
Before considering the list of actions of a nurse in case of hypertensive crisis, you first need to define this phenomenon and find out the causes, symptoms of its occurrence.
Hypertensive crisis (GC) is a process accompanied by a sudden and sharp increase in blood pressure to pathologically high rates.
The condition is dangerous because various serious complications (heart attack, stroke, pulmonary and cerebral edema, aneurysm development) can develop.
Reference. For this reason, timely help and nursing intervention in case of hypertensive crisis are extremely necessary.
The phenomenon can occur with any degree of hypertension. In addition, there are known cases of the development of HA in absolutely adult people.
A variety of causes can cause an attack: from stress, emotional overload, leading to nervous exhaustion, weather conditions, the presence of bad habits, to systemic diseases, trauma and hormonal imbalance.
In hypertensive patients, the development of the phenomenon can cause failure or non-compliance with the regimen of taking the antihypertensive drug prescribed by a specialist.
The symptomatology of the condition is diverse. Against the background of a sharp increase in blood pressure, the following symptoms are most often observed:
- intense headache;
- nausea and vomiting;
- impaired vision;
- chest pains;
- increased sweating;
- redness of the skin;
- nervousness panic.
It should be borne in mind that certain symptoms may be present / absent – it depends on the situation and the type of attack.
Next, we consider in detail the organization of actions for hypertensive crisis (protocol).
This form of HA is most often triggered by a sudden emotional overexcitation in which there is a sharp release of adrenaline. Patients have a pronounced anxiety, agitation. There is hyperemia (redness) of the face and neck, tremor (trembling) of the hands, dry mouth. Cerebral symptoms join, such as severe headache, tinnitus, dizziness.
There may be visual impairment and flies in front of the eyes or veil. Strong tachycardia is detected. After removing the attack, the patient has increased urination with the separation of a large amount of clear light urine. The duration of this form of HA can be from one hour to five. As a rule, such a form of HA is not life threatening.
This form of HA is most often found in women who are overweight. The cause of the attack is a violation of the renin-angiotensin-aldosterone system, which is responsible for renal blood flow, the volume of circulated blood and water-salt balance. Patients with an edematous form of HA are apathetic, inhibited, poorly orientated in space and time, the skin is pale, swelling of the face and fingers is observed.
This is the most dangerous form of HA, it is also called acute arterial encephalopathy. It is dangerous for its complications: cerebral edema, the development of intracerebral or subarachnoid hemorrhage, paresis. Such patients have tonic or clonic convulsions, followed by loss of consciousness. This condition can last up to three days.
The standard of emergency medical care for hypertensive crisis is a list of urgent and sequential measures that are used in typical clinical cases.
There are standards of care for every clinical situation.
- Self-help – actions that a patient can take according to the scheme prescribed by a specialist.
- Specialists of non-therapeutic institutions (dispensaries, consultations).
- In institutions of a therapeutic profile, multidisciplinary clinics.
- Specialists of linear ambulance crews.
- Doctors of special teams “ambulances.”
The algorithm of the nurse’s actions during emergency care for hypertensive crisis is a clinical approach and focus on the patient’s well-being.
However, the use of certain tactics by a nurse in case of a hypertensive crisis facilitates the provision of emergency measures and improves their quality, especially if there is not enough time, information and work experience in such conditions.
Algorithm of action of a nurse in hypertensive crisis
The algorithm of the nurse’s actions during a hypertensive crisis is as follows:
- call your doctor;
- help the patient to take a comfortable reclining position;
- open a window for fresh air or use an oxygen mask
- loosen the collar area;
- measure pressure;
- help take a drug prescribed to normalize blood pressure;
- with severe pain in the chest, give Nitroglycerin;
- apply a cold compress to your forehead;
- warm your feet with a blanket or heating pad;
- provide moral support;
- prepare a report on the patient’s condition by the arrival of the doctor.
The actions of the health care provider vary depending on the type of hypertensive crisis. Uncomplicated occurs suddenly, usually after severe stress, then you need to measure blood pressure and pulse difference as quickly as possible, then stop the attack using suitable antihypertensive and diuretic drugs.
A complicated hypertensive crisis manifests itself against the background of other diseases of the cardiovascular system with exacerbations, here the nurse’s tactics is to regularly monitor the tonometer, and if they increase significantly, it is necessary to provide the patient with the necessary medicine by calling the doctor on call.
Nursing care includes help in everything: take medicine, give a comfortable reclining position, provide access to fresh air.
Human participation is also important, you need to reassure and encourage the patient in order to set him up for recovery.
The main duty of a nurse is to constantly monitor the patient’s condition. All medical measures are carried out in conjunction with constant monitoring of blood pressure and pulse, fixing changes in the patient’s condition is necessary so that the doctor selects the appropriate drug and develops a further treatment plan.
First aid should be carried out urgently, but it is worth remembering that during an attack it is strictly forbidden to bring down high blood pressure with a double dose of drugs. Reduction should occur gradually to avoid blockage of blood vessels.
It is not the responsibility of the nurse to prescribe a regimen of therapeutic treatment; this is done by the doctor based on the clinical picture of the disease and the physiological characteristics of the patient.
A patient with a hypertensive crisis cannot be left unattended; during an attack, it is required to apply all the knowledge and skills of a health worker in order to prevent a fatal outcome.
With an emergency hypertensive crisis, the algorithm looks like this:
- The first step is to call an ambulance or begin to carefully transport the patient to the nearest medical facility.
- Try to find a tonometer, measure blood pressure and count the pulse of the victim.
- It is very important to reassure the patient, create a calm, quiet environment for him, instill in him faith in a successful outcome.
- It is necessary to ask the patient whether he suffers from hypertension, what drugs he takes, whether he took his medicine today or forgot whether he drank alcohol. All this information must then be transferred in detail to doctors.
- The patient needs to be moved to a semi-sitting position with legs down – this reduces the return of venous blood from the vessels of the lower extremities, which significantly reduces the load on the heart. In the same position, you need to transport the patient to a medical facility.
- If possible, the victim should be taken out to fresh air, open windows and doors, unfasten the collar to provide fresh air and facilitate breathing.
- With a rapid heartbeat – tachycardia, when the pulse is more than 90 beats per minute, and the patient complains that “the heart is jumping out of the chest” – such a technique as massage of carotid sinuses is effective. To do this, you need to rub or massage the side surfaces of the neck in the region of pulsation of the carotid artery on both sides. The duration of the massage is 10-15 minutes.
- If the victim has his anti-hypertension medication with him, it is necessary to give him one additional dose of the drug. The most effective and fastest effect will be when the tablet is absorbed or placed under the tongue.
- The second necessary drug will be any sedative medicine – valerian, motherwort, combined sedatives, corvalol, and so on.
- The third and last drug approved for use without a doctor is nitroglycerin. This medicine is recognized by the World Health Organization, or WHO, as the best way to prevent myocardial infarction and provide first aid at the prehospital stage with attacks of arterial hypertension, angina pectoris and pain in the heart. This medicine should be in any automobile first-aid kit, as well as in first-aid kits of public institutions: gas stations, shopping centers, shops and so on. Nitroglycerin exists in the form of tablets, capsules and sprays. The standard single dose of nitroglycerin is 0,5 mg. It is her and must be taken under the tongue or cheek. It is also necessary to remember the time of taking nitroglycerin and inform its arriving health workers.
Arriving doctors will evaluate the situation, measure the pressure and pulse, take a cardiogram and begin intravenous administration of drugs that lower blood pressure. Next, the victim will be taken to the nearest cardiology or intensive care unit, where he will receive specialized care, as well as a detailed diagnosis of possible complications of a hypertensive crisis.
- Building trust with the patient;
- Assessment of the features of the human diet;
- Clarification of fears and expectations regarding upcoming therapeutic treatment;
- Regular measurements of blood pressure and heart rate;
- Determination of bad habits of the patient;
- Visual examination of the skin of the patient;
- Preparing the patient for a night’s rest.
At the initial stage, the nurse has the opportunity to analyze information about the patient and draw up a plan of daily activities to care for him. She should also become familiar with the symptoms of the disease that are disturbing the person.
First aid for hypertensive crisis: how to provide the patient
If the patient is at home alone, he must first take a hypotensive agent, and then open the door. This is done so that the team that came to the call could get into the house if the patient becomes worse, and only then help him. After the entrance door lock is open, the patient must dial the number “03” on his own and call the doctors.
Usually, a nurse knows an established algorithm by which pre-medical care can be provided for hypertensive crisis.
Such information will also be valuable to patients at risk who often have to deal with relapses of arterial hypertension.
Emergency care in this condition is an emergency event that can save a human life, stop an acute pain attack.
This is an attack of a sharp increase in blood pressure, sometimes for no apparent reason.
The tonometer indicator may not show a critical mark, but the disorders on the part of the body are obvious – the presence of heart symptoms, an upset nervous system, bouts of nausea and vomiting.
It is necessary to call an ambulance, and upon the arrival of doctors send the victim to the clinic. The main goal is to restore blood pressure to normal, to eliminate relapses.
Before studying in detail the algorithm of actions in such a clinical picture, it is necessary to understand what the critical condition is connected with, what pathogenic factors preceded its unexpected exacerbation. The main causes of the pressure surge may be the most unexpected, while covering the external and internal aspects of human life. In the first case, we are talking about:
- stressful situations;
- physical exertion;
- stop taking antihypertensive drugs;
- chronic overwork;
- change of climatic conditions;
- genetic predisposition;
- nutritional features (excess salt, coffee, fatty and spicy dishes).
If we talk about pathogenic factors, then the first medical aid provided at the right time with a hypertensive crisis may be required if:
- chronic kidney disease predominates;
- diagnosed diseases of the cardiovascular system;
- endocrine pathologies are present – problems of the thyroid gland;
- there is osteochondrosis of the cervical vertebrae;
- nervous disorders predominate.
What to do at home
To stop the crisis, action is required immediately, you can’t do without taking certain medications.
In case of arrhythmias, acute headaches, tachycardia and angina, the first thing you need to do is call an ambulance, while providing the patient with unhindered access of oxygen to the body.
Before giving any medications to the affected party, there is an urgent need to measure blood pressure using a blood pressure monitor. Other specialist recommendations are presented below:
- It is required to lay the patient on a flat surface, rid him of synthetic clothing, and ventilate the room.
- Turn off the light so as not to cut into the eyes: take a pulse rate measurement, compare with the norm.
- In case of bleeding, stop the loss of blood, in case of confusion, give a tablet of Klofelin.
Practice shows that first aid for hypertensive crisis should be comprehensive and timely. Otherwise, strokes develop, extensive lesions of the cardiovascular system, cerebral edema is not excluded. The provision of emergency care for such a crisis requires compliance with the following algorithm of pre-medical actions in the home setting:
- It is convenient to lay a person down, make him morally calm, not to be nervous.
- It is necessary to make sure that the patient breathes evenly and deeply with full breasts.
- It is advisable to put a cold compress on the victim’s head.
- Give a drink a tablet of Captopril, Corinfar, Kapoten, Nifedipine, Cordaflex to choose from;
- Give to take 20 – 30 drops of tincture of Corvalol, motherwort or valerian;
- For heart pains, pre-medical administration of nitroglycerin tablets is recommended (no more than 3 per day);
The patient with such unpleasant symptoms urgently needs urgent hospitalization. At the hospital, a nurse or other staff will be given first aid for a hypertensive crisis, which will help to stabilize general well-being in a short time. Urgent pre-medical actions of specialists are presented below:
- To stop the attack, the nurse injects Dibazole and diuretics intravenously on the recommendation of the attending physician.
- To quickly remove the attack of tachycardia, it is better to use such beta-blockers as Inderal, Obzidan, Rausedil intravenously or intramuscularly.
- When a relapse of type II is diagnosed, the nurse introduces recommends hemiton, clonidine, and catapresan.
By calling an ambulance, the patient is approximately aware of the means by which medical workers reduce pressure in order to stabilize the general condition of the patient. Use them without prior medical prescription is strictly contraindicated, dangerous to life and health. Here are the relevant pharmacological groups and their representatives:
- beta-blockers: Rausedil, Propranolol, Obzidan;
- antihypertensive drugs: Apo-Clonidine, Barklid, Chlofazolin;
- selective calcium channel blockers: Nifedipine or Corinfar;
- antipsychotics: droperidol;
- nitrates: Nitrosorbide, Sustak, Nitrong;
- diuretics: Furosemide, Lasix;
- analgesics and narcotic drugs (in complicated clinical pictures).
Studying the algorithm of first aid for hypertensive crisis, you need to pay special attention to such medications:
- Normodipine. This is a calcium channel blocker, which is widely used in the next attack of angina pectoris, removes shortness of breath. The drug is available in tablets, the recommended dose is 1 pill three times a day until the symptoms disappear.
- Enap. It is an ACE inhibitor that comes in the form of lozenges. He is not prescribed as a first aid for complications, however, the pill is still able to stop the crisis even before urgent hospitalization.
It is required to act according to the standard, otherwise an attack of hypertensive encephalopathy (coma) is not excluded. After providing first aid to the patient, it is required to be hospitalized, in the future, symptomatic treatment of the hypertensive crisis should be carried out according to indications. Among the complications, doctors distinguish heart attack and stroke, progressive angina pectoris.
To prevent hypertension in the future, you need to think about prevention in advance. Here are valuable daily recommendations:
- monitor blood pressure;
- get rid of all bad habits, eat right;
- timely treat diseases of the cardiovascular system;
- strengthen blood vessels;
- eliminate stress, overwork.
The information presented in the article is for guidance only. Materials of the article do not call for independent treatment. Only a qualified doctor can make a diagnosis and give recommendations for treatment based on the individual characteristics of a particular patient.
Emergency care for hypertensive crisis – symptoms of high blood pressure, drugs for hypertension
When diagnosed with hypertensive crisis, emergency care (standard), as a rule, is provided with the help of certain groups of medicines. The goal of treatment is to lower blood pressure to the numbers familiar to the patient. It should be borne in mind that this decrease should occur slowly, because with its rapid fall, the patient can provoke a collapse.
- Beta-blockers widen the lumen of arterial vessels and relieve tachycardia. Preparations: Anaprilin, Inderal, Metoprolol, Obzidan, Labetolol, Atenolol.
- ACE inhibitors have an effect on the renin-angiotensin-aldosterone system (used to reduce blood pressure). Preparations: Enam, Enap.
- The drug “Clonidine” is used with caution. When taking it, a sharp drop in blood pressure is possible.
- Muscle relaxants – relax the walls of arteries, due to this, blood pressure decreases. Preparations: Dibazol, etc.
- Calcium channel blockers are prescribed for arrhythmias. Preparations: “Cordipine”, “Normodipine”.
- Diuretics remove excess fluid. Preparations: Furosemide, Lasix.
- Nitrates expand the arterial lumen. Preparations: Nitroprusside, etc.
With timely medical care, the prognosis for HC is favorable. Fatal cases usually occur in severe complications, such as pulmonary edema, stroke, heart failure, myocardial infarction.
To prevent HA, you need to regularly monitor blood pressure, systematically take the prescribed antihypertensive drugs and adhere to the recommendations of a cardiologist, as well as not overload yourself with physical activity, if possible, eliminate smoking and alcohol and limit the use of salt in food.
- Hypertensive crisis and its symptoms
- Causes of pathology
- Types and consequences of hypertensive crisis
- What is crisis relief
- First aid first aid
- Stopping algorithm
- Help with the crisis of the first type
- Help with a crisis of the second type
- First aid for complicated crisis
- Medicines used when stopping
- Beta blockers
- Calcium channel blockers
- Sleeping pills and sedatives
- Rehabilitation after stopping the crisis
With this disease, it is important to regularly measure the level of pressure and apply the necessary drugs. Refusal of therapeutic measures can cause a hypertensive crisis. This phenomenon is a health hazard, and any delay can cost a life, so it is important to know how the relief of a hypertensive crisis is performed.
Hypertensive crisis – a sharp increase in blood pressure over 180/120 millimeters, due to which there is an increased load on the blood vessels and heart.
In a crisis, endocrine glands produce certain substances that act on the vessels and contribute to their rupture.
This condition occurs most often in people of mature age. However, often pathology appears in people younger than 40 years.
The pathology is characterized by rapid development: a problem can occur in a few hours. A sharp increase in blood pressure is considered a crisis in the presence of such symptoms of brain damage:
- intense headache, localized mainly in the occipital area;
- violation of coordination of movements;
- feeling of nausea, vomiting, not causing relief;
- the appearance of floating spots before the eyes, a temporary loss of vision;
- numbness of the hands, muscles of the face;
- loss or decrease in sensitivity of the tongue, lips;
- “goosebumps” appearing on the hands;
- weakness of the arms and legs;
- short-term loss of ability to talk;
Signs of a crisis on the part of the heart:
- pain sensations of a pressing nature that occur in the chest;
- the occurrence of shortness of breath in a calm state;
- heart dysfunctions;
- accelerated pulse.
Symptoms of pathology associated with the work of the autonomic nervous system:
- trembling hands;
- the appearance of unreasonable anxiety, fear, irritability;
- increased sweating;
- dry mouth;
- feeling of heat in the body;
- excessive urination after lowering blood pressure readings.
Based on the characteristics of the course, severity of the disease, the manifestations of the disease can vary.
The development of a crisis can be caused by the following reasons:
- regular stresses, emotional stresses – these situations contribute to the release of adrenaline into the bloodstream, causing an increase in heart rate, which, in turn, provokes an increase in pressure;
- pathology of the endocrine system – the thyroid gland normalizes the hormonal background of the body, due to a malfunction, a strong increase in pressure occurs;
- the use of antihypertensive drugs without prescribing a doctor or ignoring his recommendations – reducing or entraining the dose, self-stopping the use of the drug;
- adding a large amount of salt to food, drinking alcohol, coffee, tea, other caffeinated foods or drinks;
- sudden changes in weather – heat, magnetic storms often cause deterioration in weather-dependent people;
- excessive exercise;
- diseases of the cardiovascular system, kidneys;
- the occurrence of a cold;
Doctors divide the hypertensive crisis into two types:
- uncomplicated – characterized by transience and the absence of consequences in most cases;
The latter is divided into several subspecies:
- Cerebral. It arises as a result of a violation of the blood flow of the cerebral cortex. It can cause a stroke, complete loss of vision and hearing, encephalopathy.
- Coronary. The consequences of this type of pathology can be cardiac asthma, pulmonary edema, and other life-threatening complications.
- Asthmatic. It can cause pulmonary edema, cardiac asthma, heart failure.
Any kind of pathology can provoke the occurrence of angina pectoris, aortic wall dissection, renal failure, edema of the brain of the head, coronary heart muscle disease, the appearance of blood clots, retinopathy, cardiogenic shock.
Stopping a hypertensive crisis is a complex of therapeutic measures carried out urgently. Using these measures, the manifestations of pathology are eliminated, the risk of dangerous complications is reduced, the functioning of the patient’s cardiovascular system is normalized.
The effectiveness of stopping hypertensive crisis depends on compliance with a certain algorithm of the procedures. It is worth knowing that within 2 hours from the onset of the attack, the upper blood pressure should be reduced by no more than a quarter of the total indicator. In the next 6 hours of time, indicators, if this has not happened yet, can be reduced to 160/100 millimeters.
When stopping, it is forbidden to sharply reduce the pressure – this can cause a deterioration in blood flow to the heart, the cerebral cortex of the head and other organs. Such actions can cause severe hypertension, which is fraught with heart attack, hemorrhage, pulmonary edema.
When identifying the first signs of a hypertensive crisis, you need:
- Call an ambulance, open the front door in advance.
- Measure blood pressure, take medicine, if necessary and possible, to lower it.
- Lie down, try to calm down and even out your breath.
- Make ear shell massage.
- If chills occur, cover yourself with a blanket, put a heating pad.
With a hypertensive crisis, it is first necessary to normalize the psychological state of the patient. With a sharp increase in blood pressure and deterioration of well-being, almost every person has a feeling of anxiety, fear, which negatively affects the effectiveness of stopping a hypertensive crisis.
The next stage in stopping the crisis is to collect an anamnesis. The doctor needs to get answers to the questions:
- How long does the patient suffer from hypertension?
- What indicators of pressure for the victim are the norm, and which are lowered and increased?
- How long has the hypertensive crisis started?
- What medications does a person use to normalize the functioning of the cardiovascular system?
- Did the person take any medications before the doctor arrived?
- Are there any concomitant diseases (arthrosis, arthritis, diabetes mellitus)?
The completeness and veracity of the data directly affects the effectiveness of relief of hypertensive crisis.
After that, the specialist selects a group of drugs to eliminate the symptoms of the disease.
What medications can be given with HA?
Before the arrival of the attending physician, the nurse must take basic measures to normalize the pressure. For this, it is worth using the previously prescribed short-acting antihypertensive drugs, not exceeding the specified dose. The pulse is stabilized with Nitroglycerin. In addition to antihypertensive drugs, the following medications are used to eliminate the symptoms of a hypertensive crisis:
Nursing care for hypertensive crisis
The nurse must identify the real and potential problems of the patient, which are determined by the individual characteristics of the pathogenesis of the disease. The nurse’s responsibilities include diagnostics for all patient complaints. With hypertension, the diagnosis of symptom detection is based on the analysis of the patient’s complaints, which may have a physiological or psychological basis. Use them to conduct adequate pre-medical diagnosis:
- Fatigue, nosebleeds, and decreased performance are the first symptoms of hypertension.
- Violation of night sleep causes dysfunction of the state of the central nervous system under the influence of hypertension,
- Dyspnea is provoked by pulmonary edema,
- Increased anxiety is associated with ignorance, ignorance about the presence of the disease, inability to provide yourself with the right help.
All problems of the patient are divided into two groups: real and potential. The first group includes sleep problems, headaches, irritability and frequent mood changes, lack of rest, poor nutrition. And to potential problems – the risk of developing a hypertensive crisis, the risk of complications (disruption of the vascular and respiratory systems), heart attacks, strokes, coma.
The nurse should know all the symptoms of a hypertensive crisis, provide first aid to the patient.
Most often used in a crisis: Lasix, Verapamil, Nitroglycerin, Labetalol, Furosemide, Clonidine. The main goal of treatment or relief of the crisis is a slow and stable decrease in blood pressure, normalization of renal blood circulation and blood circulation in the brain.
If you feel unwell, the patient will call a nurse.
Nursing help consists in measuring blood pressure. After establishing high numbers, the nurse carefully collects the patient’s complaints, an anamnesis of the development of a crisis and conducts a superficial objective examination. This independent nursing intervention in hypertensive crisis is necessary to provide the attending or on-call doctor with all the necessary information. Such actions will accelerate the process of resolving the issue and save a person’s life or relieve complications.
Before the doctor arrives, the nurse performs the following manipulations:
- raising the head end of the bed to improve breathing excursions and prevent pulmonary edema;
- providing access to fresh air, preparation of an oxygen pillow or mask;
- assistance in the prevention of aspiration pneumonia or asphyxia (in case of vomiting, put the patient’s head on one side and check the airway);
- taking an electrocardiogram with a preliminary diagnosis;
- if it is impossible to quickly see the doctor, the nurse performs distracting therapy (applies hot compresses to the distal parts of the body) to unload the central vessels and heart and reduce centralization of pressure.
The nursing process in case of hypertensive crisis after the arrival of the doctor consists in the prompt response to the requests and orders of the doctor. Nursing staff plays an important role, since the recovery process depends on the speed of all necessary medical procedures.
Providing assistance, the nurse performs intravenous injections, if the latter is impossible, the desired result is achieved by sublingual administration of the tablet preparation.
After stopping the attack, the nurse measures the blood pressure while lying down. This prevents the onset of orthostatic hypotension. Also, nursing care consists in the subsequent observation of the patient and direct presence near him.
Drug therapy and nursing care for hypertensive crisis are inextricably linked and equally important for a positive outcome of the disease.
The duties of a nurse include monitoring the patient’s compliance with all the doctor’s prescriptions and maintaining the morale of the patient.
Hypertensive crisis refers to diseases with high mortality, therefore, the task of the healthcare provider is to monitor vital indicators around the clock to provide timely assistance.
The nursing staff when caring for a patient with hypertension should perform the following tasks:
- conduct daily preventive conversations about healthy eating, the positive impact of adhering to the daily routine and the harmful effects of bad habits;
- teach patients how to measure heart rate and blood pressure;
- give a lecture on how emergency care is provided for hypertensive crisis;
- provide normal sleep and a healthy diet;
- to study with the patient the schedule of taking the drugs and their quantity;
- monitor the actions of the patient (food intake, tablets).
In addition to these tasks, the nurse must fulfill her direct duties that are related to providing household necessities, creating a menu, conducting regular manipulations and classes with patients about self-care skills. Constantly monitor the condition of patients so that first aid for hypertension is provided on time.
From a conversation with the patient’s relatives, the health worker should extract as much information as possible for his further actions.
The nurse should organize the patient care process, which will take into account the patient’s complaints, attitude to treatment, the presence of bad habits.
Clarification of information is necessary from family members or from the patient himself, if he is conscious. Having carefully studied the history of the disease, a plan should be developed to provide the necessary assistance, which should consist of 4 stages:
- Visually examine and find out the necessary information for treatment.
- Set a diagnosis.
- Organize and apply medical manipulations.
- Correct the patient’s lifestyle and analyze the therapy.
The first stage
The nursing process at the initial stage is to get to know the patient and his medical history. The nurse must establish a trusting relationship with the patient, using a simple conversation to collect information about nutrition and bad habits. According to the doctor’s instructions, it is necessary to measure blood pressure and pulse, as well as regularly examine the skin.
The second stage
At the second stage of his work, the physician must determine the sequence of further activities.
The nurse analyzes the information collected at the initial stage of the information and draws up a manipulation plan.
The essence of the stage is to make a pre-medical diagnosis, based on complaints and manifestations in the patient. Symptoms may be psycho-emotional or physiological in nature.
The task of the health worker is to determine the real state of the patient and make an adequate conclusion.
The third stage
The health worker is obliged to exercise control over the process of taking medication to patients. Nursing intervention for hypertension consists in the development of treatment procedures and a plan for the implementation of treatment. The scheme of medical manipulations has two directions: tasks for a day or a week, long-term (for the entire period of therapy).
The nurse must keep records that indicate:
- dates of visits;
- problem situations with the patient;
- carried out manipulations;
- patient response to treatment.
The fourth stage
The results of the prescribed treatment are discussed by the nurse with the doctor and the patient.
The tactics of the last stage is to deeply analyze the course of treatment and discuss the results with the doctor and the patient in order to make changes in the lifestyle of the latter.
The professional approach of the medical worker to the treatment process, his regular monitoring of the patient’s condition is the key to a positive result of therapy.
- Ask a third party to call a doctor.
- To reassure the patient, release the airways from tight clothing, create conditions for free access of oxygen.
- Put the victim on the floor and raise his head. Put cold on your forehead.
- In case of gagging, turn your head to the side.
- Drip “Corvalol” 30 drops., Mix with water and give a drink.
- Place mustard plasters on the back near the neck and lower limbs or lower your legs in hot water.
- Make an electrocardiogram and measure blood pressure, NPV and heart rate every half hour.
- Put Captopril tablet under the tongue for the patient.
Clofelin tablets may be used for first aid.
- “Clonidine” 0,01% 1 ml iv or under the tongue 0,15 mg tablet;
- Propranolol 40 milligrams;
- “Furosemide” 1% or “Magnesium sulfate” 25%;
- Nitroglycerin solution;
- Diazepam 0,25%.
To confirm the patient’s disease, the algorithm of the nurse’s actions consists in the implementation of an ECG procedure, on which signs of damage to the ventricular muscle on the left side of the heart will be visible, ultrasound will show a seal of the same wall. And you should also assist in collecting material by informing about the methodology for biochemical blood tests and general urine analysis.
To increase the effectiveness of drug treatment, the nurse informs the patient about non-pharmacological methods of therapy, which include:
- getting rid of bad habits;
- reduction in the amount of fluid drunk;
- increased intake of potassium, calcium, magnesium, fiber and protein;
- optimization of work and rest.
The nurse carefully monitors the process of drug use by the patient.
The action of pharmacological medications prescribed by a doctor for hypertensive crisis is aimed at stabilizing blood pressure.
The use of diuretics contributes to the rapid elimination of decay products in a physiological way. B-blockers help slow down the heart rate and lower blood pressure.
The administration of antagonists inhibits the flow of calcium into muscle cells through channels.
Hypertensive crisis is a pathological condition during which blood pressure rises rapidly, which poses a danger to human health and life.
Therefore, correctly provided first aid affects the patient’s further recovery, and prevents dangerous complications.
Nursing care for a hypertensive crisis involves many stages, but the main one is the optimal provision of emergency care for a particular case.
To organize the nursing process in hypertensive crisis, the nurse must draw up a plan of treatment measures:
- Define the goal: reduction of blood pressure over a certain period of time, which will depend on the patient’s condition and symptoms of the disease;
- Set the terms for the implementation of short-term (lowering blood pressure, emergency therapy) and long-term tasks (rehabilitation of the patient after discharge from the hospital or stopping a hypertensive crisis at home).
To plan a medical intervention for hypertensive crisis, it is important to consider the following nuances:
- Call a doctor;
- Elimination of panic in a patient;
- Compliance with the patient’s reclining posture, with the head turned to the side (if there are attacks of nausea and vomiting);
- Measurement of heart rate, blood pressure, NPV, heart rate and body temperature;
- Preparation of tools and materials for performing medical procedures (syringes, tonometer, system for drip of solutions, tourniquet, needles).
When stopping the symptoms of a hypertensive crisis, parenteral preparations are used to stabilize blood pressure such as:
- Sodium nitroprusside (the drug can increase intracranial pressure);
- Nitroglycerin preparations (they are desirable for myocardial ischemia);
- Enalaprilat (medication prescribed for heart failure);
- Labetalol, Lasix, pentamine;
- Clonidine and dibozole, retaining limited relevance.
Classification of hypertensive crisis
For the first 2 hours after the attack, the pressure must be reduced by 25%. The tonometer readings should be no more than 160/100 mm RT. Art. Over the next 6 hours, the situation should stabilize.
If the increase in blood pressure was not accompanied by symptoms of other diseases, and other organs and systems function normally, urgent measures are not needed. It is enough to limit oneself to taking oral agents with a relatively quick effect (cartopril, clonidine, diuretics).
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