Joan Smith, 55 years of age, is a female patient who presents to the intensive c

Question

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 headache and blurring vision. The patient's blood pressure is 220/130 mm Hg upon presentation .

a. According to the definition set by the Seventh report of the joint National Committee of 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. The physician orders nicardipine hydrochloride 25mg/250ml, NS for peripheral IV starting at 2.5mg/hr, and titrate by 2.5mg/hr every 15 minutes to reach the goal for the first hour, which is to achieve 25% reduction of the initial MAP. · Call the physician if the dosing range of 15mh/hr has been reached and the MAP is still not at target goal for the first hour treatment or up to four dose increases. · Lower the BP within 6hours to 160/100mmhg · Adjust the IV rate so that the IV fluids plus the nicardipine drip are equal to100ml/hr. in total. Cal the physician if the IV fluids must go above 100ml/hr to provide the nicardipine.

c. Explain what rate to set initially for both the nicardipine drip and the NS maintenance fluids

d. Explain the process of titrating the nicardipine drip for the first hour to achieve the final MAP goal of 25% reduction of the original MAP

Explanation / Answer

Ans.a) Hypertensive emergencies are defined as severe elevations in blood pressure. As it is mentioned, patient's blood pressure is 220/130 mm Hg may suffering from impending or progressive end-organ damage

b.) The treatment should include

c.) Initial rate for both the nicardipine drip and the NS maintenance fluids in this situation is   5 mg/hour as a continuous IV infusion.

d.) To achieve the final MAP goal of 25% reduction of the original MAP is the initial infusion rate of 5mg/hr IV should increased by 2.5 mg/hr every 5 minutes to a maximum of 15 mg/hr to keep the SBP less than 220 mm Hg and DBP less than 110 mm Hg. In general first try to reduce the SBP 10-15%.

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