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Joan Smith, 55 years of age, is a female patient who presents to the intensive care unit with the diagnosis of intracranial hemorrhage
Joan Smith, 55 years of age, is a female patient who presents to the intensive care unit with the diagnosis of intracranial hemorrhage. The patient stopped taking her antihypertensive suddenly because of the cost of the medications and she recently lost her job to outsourcing. The patient is slightly drowsy and complains of a headache and blurred vision . The patient's blood pressure is 220/130 mm Hg upon presentation. (Learning Objective 6).
a. According to the definitions set by the Seventh report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High blood pressure (JNC 7), which type of hypertensive crisis is the patient currently experiencing?
b. Describe the treatment goals for handling the hypertensive crisis and apply the goals to the case study. Determine the current mean Arterial pressure (MAP) and the goals for treatment.
Expert Solution
Answer:
a. The patient's blood pressure is 220 /130 mm of Hg. According to JNC-7 guidelines, the blood pressure >160mm Hg/> 100 mm Hg is considered as Stage 2 hypertension. It is further classified into Hypertension emergency and hypertension urgency. The patient had symptoms of drowsy, blurred vision, headache denotes that she had acute end-stage organ failure. So the patient currently experiencing hypertensive emergency stage.
b. Goals of treatment for the hypertensive emergency crisis are
- Prevent the risk of organ damage.
- Reduce the blood pressure level
- Stop Intracranial bleeding
- Continuous monitoring of mean arterial pressure.
- Alleviate the symptoms
- Administration of IV antihypertensive drugs.
Mean Arterial Pressure = DBP +[1/3(SBP - DBP)]
= 130 + [1/3(220 - 130)]
= 130 + 30
MAP = 160
The goals of treatment are
- Reduce MAP in the next 24 - 48 hours.
- Administer parenteral agents to minimize BP.
- Administer vasopressors to mainatin adequate tissue perfusion.
- Continuous monitoring of blood pressure.
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