EMERGENCY MANAGEMENT
HYPERTENSIVE CRISIS,
RESPIRATORY DISTRESS
OBJECTIVE
1.To reduce blood pressure to acceptable limits- as rapidly and
safely to prevent further hypertensive episodes.
2.To reduce the possiblity of complications.
3.To use minimum of drugs.
POLICY
1.Hypertensive BP parameters crisis is a severe fixed elevation
of the resting arterial pressure which may produce vascular
necrosis as diastolic pressure exceeds 140 mmHg.
2.Hypertension is assessed by the following reasons.
Blurring of visionThrobbing headacheConfusion, transient facial
defectsIrritability Seizure
3.It may be classified as:
Essential (Primary) Sustained BP elevation with no known
case.
Malignant An accelerated form of hypertension in which there are
hemorrhages and exudates in the fundi, and a diastolic pressure of
140 mmHg.
Secondary Elevation of BP is related to a specific disease
process.
Hypertensive encephalopathy Usually accompanies a sudden
increase in BP and in manifested by headache, nausea, vomiting,
apprehension, confusion, or seizures.
4.Hypertensive emergencies include:
Malignant hypertensionHypertensive encephalopathyHypertension
complicated by CHF or aortic dissectionHypertension in the face of
acute M.I.Toxemia of pregnancy.
5.Patients with hypertensive crisis, severe hypertension that
does not respond well to treatment, and hypertension complicated by
organ failure should be admitted.
MATERIALS & EQUIPMENT
1.BP apparatus2.Cardiac monitor3.ECG machine4.Emergency
medications as ordered5.I.V. fluids via infusion pump
PROCEDURERATIONALE 1. Obtain history of the patient's present
illness, including nature of onset and length and severity of
symptoms.1. To provide data baseline. Patient's often decrease or
stop their medication completely when they have been asymptomatic
for a period of time.
9. Maintain intake and output.9. To ensure prevention of fluid
overload. 10. Record all procedures and medications.10. For proper
documentation. 11. Instruct the patient and family to eliminate
foods high in sodium.
12. Control weight and maintain low- cholesterol diet12. To
reduce cardiac risk factors. 13. Encourage the patient to comply
with his medication.
RESPIRATORY DISTRESS
DEFINITION
Respiratory failure is an alteration in the function of the
respiratory system that causes the PaO2 to fall below 50mmHg
(hypoxemia) or the PaCO2 to rise above 50mmHg (hypercapnia) as
determined by arterial blood gas (ABG) analysis. It is classified
as acute, chronic or combined acute and chronic.
Acute characterized by hypoxemia or hypercapnea and acidemia (pH
less than 7.35).Chronic characterized by hypoxemia or hypercapnea
with a normal pH (7.35 7.45).
OBJECTIVE
1.To assess cardiac and respiratory status.
2.To initiate respiratory life support system if necessary.
3.Initiate measures to relieve respiratory distress.
4.To correct hypoxemia and acid-base imbalance.
5.To provide adequate oxygenation of blood.
POLICY
1.Respiratory distress is life-threatening and must be treated
as medical emergency.
2.Resuscitation equipment must be ready at bedisde and ready for
intubation.
3.A blood gas analysis must be obtained immediately.
4.Oxygen therapy must be administered via face mask to relieve
hypoxia and dyspnea.
5.I.V. fluids must be administered as ordered.
6.The patient must maintain an upright position, head and
shoulders up.
7.Emotional support and reassurance must be provided as
respiratory distress may be terrifying to the patient.
8.Assessment and observation of patient's condition:
Wheezing, rales or rhonchiSevere dyspnea, tachycardiaFrothy,
blood-tinged sputumEdema peripheral or around the eyesSigns of
heart failureAltered level of consciousnessCyanosis,
diaphoresis
MATERIALS & EQUIPMENT
1.Oxygen2.Face mask or Nasal cannula3.Blood samples for
ABG4.Airway5.I.V. fluids as ordered.6.Medications, I.V. medications
as ordered
7.Suction machine8.Ventilator, if indicated.
Assess patient's condition and report the following signs and
symptoms: 2.1 Wheezing, rales and rhonchi2.2Severe dyspnea,
tachycardia2.3Frothy, blood-tinged sputum2.4Edema, peripheral or
around the eyes2.5Signs of heart failure2.6Altered level of
consciousness2.7Cyanosis, diaphoresis
3. Provide airway:3. To reduce respiratory distress.3.1Elevate
the head3.2Suction3.3Humidification
4. Administer oxygen via face mask4. To relieve hypoxia and
dyspnea. 5. Ventilate the patient as ordered5. To normalize pH.
5.1Insert endotracheal tube5.2Attach to ventilator as
indicated5.3Suction the patient's secretions.
before all, No obstacles
