Question

1. 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 antihypertensives 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) 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? a. 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 e goals for treatment. The physician orders nicardipine hydrochloride (Cardene) 25 mg/250 mL, NS for peripheral IV starting at 2.5 mg/hr, and titrate by 2.5 mg/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 15 mg/hr has been reached and the MAP is still not at target goal for the first hour of treatment, or up to four dose increases. Lower the BP within 6 hours to 160/100 mm Hg. Adjust the IV rate so that the IV fluids plus the nicardipine IV drip are equal to 100 mLIhr, in total. Call the physician if the IV fluids must go above 100 mL/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 final MAP goal of 25% reduction of the original MAP.

Answer 1

A, As per JNC 7 patient is in stage 2hypertension SBP >160 or DBP >100

B, Thiazide diuretics is a starting dose for uncomplicated hypertension..This patient required 2 or more medication to achieve BP goals..

Mean arterial blood pressure (MAP)

MAP = SBP +2( DBP)/3

220+2(130)/3

220 + 260/3

480/3 = 160mmHg