CRISIS

CRISIS

A.    HYPERTENSIVE CRISIS

1.      Severe dan Abrupt Elevation è BP

-          Diastolic BP 120 – 130 mmHg

-          Acut target organ damage

-          Occurs in patient – history of  HT

2.      Hypertensive Crisis è Classified :

-          Hypertensive Emwergency

Develops è Hours – Days – BP meningkat severe

Acut terget organ damage :

·         Hypertensive encephalophaty

·         Intra cranial hemorrhage

·         Acut left. Fentr. Failure dan pulmonary oedema

·         Myocardial infartion

·         Renal failure

-          Hypertensive Urgency

·         Clinical

3.      Clinical Manifestation

-          Hypertensive Encephalopati

·         Cerebral oedema

·         Spam of cerebral vessel

 

Sudden rise in arterial pressure

Headache, nausea, vomictingseizures, confusion, stupor, coma, blurred vission dan transient bliness

-          Renal in sufficiency

-          Cardiac decompensation – pulmonary     edema

Angina – infarction                                  

                                                                  dyspnea

-          Neurologic dysfution

4.      Hypertensive Crisis – often seen  ( With CVA

5.      Nursing dan Colaboratif Manajemen

-          Asses è indicator HP Crisis

·         BP meningkat dan Sign of progressive target organ damage or organ damage

-          HP Emergency è Hospitalisasi

·         Intensive care monitoring

·         IV è hypertensive drugs

-          Sodium nitroprusside

-          Nitroglycerine

·         Evaluate therapy è MAP

( mean arterial pressure )

MAP = DBP + Pulse pressure

Pulse pressure = Sistolic BP – Diastolic BP

Goal : Initial treatment

·         Decrease – MAP è 10 – 20 %

LN  1 – 2 Hours menurun

·         Gradual reduction – dext 24 hours

·         Monitor vital sign è BP

2 – 3 minute è during treatment ( intra arterial line )

·         Excessive reduction – BP è Stroke

      è M I

      è Visual changes

·         Hourly urinary out put è Renal dan Perfusion

·         Patient receinving – anti hypertensive – IV

è Restricted to bed – getting up è cerebral ischemia

-          Frequent neurologic cheks

·         Level of conciousness

·         Pupillary size dan reaction

·         Movement of extremitas dan reaction

·         Detect anychanges patient conditions

6.      Myocardial Infartion

-          Ishemia

·         Ischemia è Angina

   è Cellullar anjury - reversible

-          Myocardial Infaction

·         Cellullar injury – Irreversible

·         Cellullar Necrosis

-          Mortality rate

·         30 – 50 %

·         In the first 3 – 4 days

B.     PATHOPHYSIOLOGY

-          Oxygen in sufficiency

O2 supply menurun

O2 demand meningkat

-          Ischemia è 20 – 30 mnt

 

-          Necrosis ( Infartion )

C.     CLINICAL MANIFESTATION

1.      Pain

-          Severe not relieve with rest

-          Heaviness, tightness

-          Subternal è Radiating è meck, JAW & ARM, Back

-          retrosternal

2.      Nausea dan Vomitng

3.      Symphatetic nervour system – stimulation

-          Diaphoresis

-          Vasocontrictions bloob vessel

-          Cold sweat

4.      Fever

-          The forst 24 hours – 38 – 39 C

5.      Cardiovascular Manifestation

-          BP meningkat & HR meningkat mitially

-          BP meningkat  later è CO menurun

-          Crackles è lung

-          JVP meningkat

D.    DIAGNOSTIK

1.      Clinical presentation

2.      ECG

3.      Serum cardiac markers

E.     COMPLICATIONS

1.      Arrhytmias è 80 % MI

2.      Life threatening : total AV Block

3.      VT, VF è mostly – the first 4 hours

4.      Cardiogenic shock

5.      Papillary muscle dysfunction

6.      Ventricular aneurysma

7.      Pericarditis è 2 – 3 days after acut MI

8.      Pulmonary embolic

F.      COLABORATIVE

1.      Patien MI è Cardiac care unit è monitor ECG

2.      IV lines è Dsw è EMG drugs

3.      Mo è IV è Relief of pain

4.      Oxygen 2 – 4 l / mnt

5.      Lidocaine – IV ( Prophylactic ) è 75 – 100 mg bolus – IV drip

( 500 ml Dsw + 2 % lidocaine )

6.      Vital sign è 1 – 2 hr – firs 8 hr

7.      Activity è Absolute bed rest, bed rest + ( Bed side commode) passive ROM

8.      Intake & out put – hourly

9.      Thrombolytic care