Hypertensive emergency is defined as a severely elevated diastolic blood pressure (>120mmHg) in the presence of target-organ damage. Please read the attached article for an overview of target-organ damage.
- Sharma, S., MD., Anderson, C. PharmD., Sharma, P., MD., Frey, D., MD. (2021). Management of hypertensive urgency in an urgent care setting (Links to an external site.). The Journal of Urgent Care Medicine. https://www.jucm.com/management-of-hypertensive-urgency-in-an-urgent-care-setting/
- Chapter 19: I have attached chapter !9 from the text book and included the APA reference at the end of the attachment.
Instructions:
- Read the SOAP notes constructed by your course colleagues.
- Review the ‘P’s posted by your peers from your advanced practice nursing role perspective – educator, leader or practitioner. From your advanced practice mindset ( family nurse practitioner) reflect on a discussion you would like to have with two of your course colleagues about their ‘P’.
- Post a response individually to each of them that expresses your advanced practice nursing role perspective of their ‘P’.
- Use scholarly resources relevant to your advanced practice nursing role to support the key elements of the peer discussions you construct. [For example – if you are a nurse practitioner did your peer develop a ‘P’ that aligns with Evidence-Based Practice (EPB)/Clinical Practice Guidelines (CPG) and/or the basic sciences, etc.?
- Response posts must demonstrate topic knowledge and scholarly engagement with peers. This is not the only criteria utilized for evaluation; substantive content is imperative. All questions in the topic must be addressed. Please proofread your response carefully for grammar and spelling. All responses need to be supported by a minimum of one scholarly resource. Journals and websites must be cited appropriately. Citation and reference must adhere to APA format. Minimum 150 words.
Colleague #1 ( Nh.He.)
S: 57-year-old black and Asian male with pasted medical history of neck pain and spinal stenosis at the C5-C6 level arrived in office for screening to participate in a study. He reports of elevated BP for the last decade without seeking treatment. He does not have a regular healthcare professional that he sees on a routine basis.
O: BP 217/109 mmHg.
A: Hypertensive urgency with knowledge deficit regarding disease and condition.
P: Blood pressure should be repeated in all extremity to ensure accuracy. Immediately transfer the patient to an emergency room for him to receive medical attention and treatment. In the event of a hypertensive emergency, the patient’s blood pressure must be immediately reduced to prevent acute, progressive damage to the target organs. Hypertensive urgency patients do not have signs and symptoms of organ failure but tend to occur in patients that are noncompliant with medication or inadequate treatment (Arcangelo et al., 2017). A complete blood cell count, cardiac indicators, blood urea nitrogen, creatinine, urinalysis, and a urine toxicology screen must all be performed if a hypertensive emergency is suspected. CT scans of the chest, abdomen (to rule out aortic dissection), and brain (to rule out hemorrhagic stroke) are among the other diagnostic procedures to consider; a chest X-ray; transthoracic echocardiography or transesophageal echocardiogram; and EKG (Alley, 2021).
Patients with hypertensive emergencies should be treated right away with pharmacological and nonpharmacological interventions to reduce their blood pressure, most used are intravenous medications. Sodium nitroprusside is commonly prescribed medication to rapidly bring down blood pressure as it is short-acting and can be titrated minutes to minutes as per the response. However, medication treatment can help control blood pressure, depending on the patient. After the BP is lowered, the patient’s drug regimen should be assessed. As the patient is of black background, it is found that Chlorthalidone 12.5 mg and amlodipine 5 mg were superior in treating hypertension for that population. Monotherapy of diuretics is found to be more beneficial and the population tend to be more responsive. Chlorthalidone can be prescribed first and if it does not help the patient’s condition, amlodipine can be added to his regimen (Arcangelo et al., 2017). Patients with hypertensive urgency are advised of lifestyle changes and diet, such as decreasing sodium intake and increasing exercises.
The patient should be educated on the importance of following up with a healthcare provider to establish a pharmacological regiment to help blood pressure control and the side effects of the medication such as dizziness and light headedness (Arcangelo et al., 2017). Patient should be consulted to a primary care provider, if not already have one, to assist in hypertension management as well as a referral to a cardiologist if hypertension persists.
References:
Alley, W. D. (2021). Hypertensive urgency. Stat Pearls. https://www.ncbi.nlm.nih.gov/books/NBK513351/ (Links to an external site.)
Arcangelo, V. P., Peterson, A. M., Wilbur, V. F., & Reinhold, J. A. (2017). In Pharmacotherapeutics for advanced practice: A practical approach (pp. 257–270). essay, Lippincott Williams & Wilkins/Wolters Kluwer.
Colleague # 2 (Jd.Li.)
Subjective: 57-year-old mixed-race male comes to the office to be screened for a study to participate in home cervical traction. On arrival, the patient’s blood pressure is elevated. The patient states his blood pressure has been high for the last decade. He reports not seeing a healthcare professional about this issue. He says he does not have a healthcare provider that he sees on a routine basis.
Objective: BP 217/109, The patient does not meet inclusion criteria for cervical traction research study after assessment.
Assessment: The patient currently has high blood pressure and is experiencing hypertensive urgency with a systolic BP of over 180.
Plan: The goal in hypertensive urgency is to safely control the patient’s blood pressure in hours or days in the outpatient setting. This can be accomplished with oral antihypertensives. Nifedipine has been used to treat hypertensive urgency throughout the past but has never been approved by the FDA for short-term use of reducing blood pressure.
Therapeutics: Appropriate treatment for this patient would be to start him on Clonidine 0.2 mg and additional doses of 0.1 mg to be given until systolic BP is less than 115 or a maximum of 0.7mg has been reached (Sharma et al., 2021). The patent is to have a close follow-up with a provider within a week to ensure blood pressure control and adherence. The follow-up will also allow any titration of medication or a change of medication if need be
Educational: In the meantime, the patient is advised to make lifestyle changes to assist in lowering his blood pressure. This includes reducing salt intake, avoiding alcohol, exercising regularly, quitting smoking, and reducing overall weight (Alley, 2021).
Collaboration: An interdisciplinary team best cares for patients in hypertensive urgency. This includes seeing different providers and assessing end-organ damage. These providers consist of a cardiologist, nephrologist, and ophthalmologist. The overall goal is to educate the patient on lifestyle factors contributing to hypertension and promote medication compliance. This patient, who is asymptomatic of any organ damage symptoms, should be placed on oral antihypertensives as listed above and gradually reduce the patient’s blood pressure over the next 24-48 hours (Alley, 2021).
Reference
Alley, W. D. (2021). Hypertensive urgency. StatPearls. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK513351/
Sharma, S., Anderson, C., Sharma, P., Frey, D.. (2021). Management of hypertensive urgency in an urgent care setting. The Journal of Urgent Care Medicine. https://www.jucm.com/management-of-hypertensive-urgency-in-an-urgent-care-setting/
Background information of the original question prompt:
Scenario
You have a 57-year-old mixed-race male (black and Asian) who comes into your office for a screening to participate in a study to evaluate the effectiveness of a home cervical traction device on neck pain and intervertebral disc space. He has a history of neck pain and was diagnosed six years ago with spinal stenosis at the C5-C6 level.
During the screening, the gentleman is found to have a BP of 217/109. When you question him about this BP measurement he reports to you that he knows that his blood pressure has been in that range for about the last decade. He reports he has not seen a health care professional about his elevated blood pressure and does not have a health care professional that he sees on a routine basis. He is a healthcare professional at the provider level.
Based on the blood pressure measurement he does not meet the inclusion criterion for the cervical traction device research study.
Please develop a discussion that responds to each of the following prompts. Where appropriate your discussion needs to be supported by scholarly resources. Be sure to include in-text citations in the context of the discussion and provide a full reference citation at the end of the discussion.
Discussion Prompt
- Utilize the information provided in the scenario to create your discussion post.
- Construct your response as an abbreviated SOAP note (Subjective Objective Assessment Plan).
- Structure your ‘P’ in the following format: [NOTE: if any of the 3 categories is not applicable to your plan please use the ‘heading’ and after the ‘:’ input N/A]
Therapeutics: pharmacologic interventions, if any – new or revisions to existing; include considerations for OTC agents (pharmacologic and non-pharmacologic/alternative); [optional – any other therapies in lieu of pharmacologic intervention]
Educational: health information clients need in order to address their presenting problem(s); health information in support of any of the ‘therapeutics’ identified above; information about follow-up care where appropriate; provision of anticipatory guidance and counseling during the context of the office visit
Consultation/Collaboration: if appropriate – collaborative ‘Advanced Care Planning’ with the patient/patient’s care giver; if appropriate -placing the patient in a Transitional Care Model for appropriate pharmacologic and non-pharmacologic care; if appropriate – consult with or referral to another provider while the patient is still in the office; Identification of any future referral you would consider making
