Category: Critical Care Nursing The history and physical examination in the patient with an acute elevation in systemic arterial blood pressure will focus on signs and symptoms of acute organ dysfunction. No specific blood pressure defines an hypertensive emergency.
Category: Critical Care Nursing The standard safe level of blood pressure reduction in hypertensive emergency is a 10% to 20% reduction of MAP from the highest values on clinical presentation, or a diastolic blood pressure typically in the 100 to 110 mm Hg range.
Category: Critical Care Nursing An acute elevation in systemic arterial blood pressure involves an increase in systemic vascular resistance. This increase in vascular resistance results from an interaction of vascular mediators in the setting of preexisting hypertension.
Category: Critical Care Nursing A rapid decrease in blood pressure in hypertensive urgency can cause cerebral or myocardial ischemia by aggressive antihypertensive therapy if the blood pressure falls below a level needed to maintain adequate tissue perfusion.
Category: Critical Care Nursing The term hypertensive urgency has been historically used to describe critically elevated blood pressure (>180/110 mm Hg) without evidence for acute and progressive dysfunction of target organs.
Category: Critical Care Nursing Clinical conditions associated with hypertensive emergency include hypertensive encephalopathy, intracranial hemorrhage, acute coronary syndrome, acute pulmonary edema, aortic dissection, acute renal failure and eclampsia.
Category: Critical Care Nursing Although hypertensive emergency is often associated with a blood pressure elevation >180/110 mm Hg, the diagnosis is based upon the patient’s clinical signs and symptoms rather than a specific blood pressure measurement.
Category: Critical Care Nursing Hypertensive emergency is a severe elevation in systemic blood pressure combined with new or progressive end-organ damage most frequently in the cardiac, renal and central nervous systems.
Category: Critical Care Nursing When agitation or delirium develops, a rapid assessment should be performed to rule out life-threatening problems (hypoxia, pneumothorax, hypotension), or other acutely reversible causes (hypoglycemia, metabolic acidosis, stroke, seizure, pain).
Category: Critical Care Nursing Hypoactive delirium, which is the most prevalent form of delirium, is characterized by decreased physical and mental activity and inattention. In contrast, hyperactive delirium is characterized by combativeness and agitation.
Category: Critical Care Nursing Agitation may be caused by various factors: metabolic disorders (hyponatremia and hypernatremia), hyperthermia, hypoxia, hypotension, use of sedative drugs and/or analgesics, sepsis, alcohol withdrawal and long-term psychoactive drug use.
Category: Critical Care Nursing A new or sudden change in the neurologic condition of a critically ill patient necessitates a neurologic examination, review of the clinical course, medications, laboratory data, and appropriate imaging or neurophysiologic studies.
Category: Critical Care Nursing New-onset seizures in general medical-surgical intensive care unit patients are typically caused by narcotic withdrawal, hyponatremia, drug toxicities or previously unrecognized structural abnormalities.
Category: Fundamentals Therapeutic oral doses of barbiturates produce mild decreases in pulse and blood pressure, similar to sleep. With toxic doses, hypotension occurs from depression of the myocardium along with pooling of blood in a dilated venous system.
Category: Fundamentals Barbiturates act directly on the medulla to produce respiratory depression. In therapeutic doses, this respiratory depression mimics that of normal sleep. With toxicity, the neurogenic, chemical and hypoxic respiratory drives are suppressed.
