Hypertension Blog

Monitor your patient’s neurologic status frequently. Look for signs and symptoms of worsening neurologic deficits, such as mental status changes, agitation, weakness, unequal pupils, vomiting, and bradycardia. Each time, compare your findings with those of your previous assessment and immediately report any changes to the physician.

If you’re administering mannitol, closely monitor your patient’s intake and output to assess fluid balance and fluid loss. Include the mannitol as part of his intake.

Monitor his cardiovascular status by taking continuous blood pressure readings using an arterial line or an automatic sphygmomanometer. Be alert for potential cardiac decompensation, such as ectopy or heart block.

Assess the rhythm and depth of the patient’s respirations, his respiratory rate, and any changes in his breathing pattern. Cheyne-Stokes respirations-episodes of apnea that last 10 to 60 seconds followed by a gradual increase in respiratory rate and depthmay result from brain stem herniation.

Closely monitor your patient’s serum electrolyte levels, including his potassium, sodium, and chloride levels. Also, check his BUN, creatinine, and arterial blood gas (ABG) levels and blood pH. Obtain a complete blood count, as well.

Treatment Plan

During the acute phase of your patient’s condition, orient him and his family to the unit. Explain the treatment plan, including the diagnostic tests that will be performed.

Before discharge, explain the need for strict compliance with the prescribed antihypertensive drug regimen. Stress the importance of reducing risk factors that can exacerbate his hypertension. Be sure to describe the underlying disorder that led to his severely high blood pressure and subsequent hypertensive encephalopathy.

If your patient will be discharged to his home, the home care nurse should evaluate his compliance with the drug regimen and recommended lifestyle changes. She should monitor his blood pressure and be alert for the recurrence of neurologic deficits, such as localized weakness, agitation, confusion, blurred vision, dizziness, and light­headedness.

A patient who has had hypertensive encephalopathy may need extensive rehabilitation. His home care nurse should oversee the rehabilitative therapies he’ll need, such as exercise and physical therapy. And she should reevaluate his plan of care regularly to determine whether it remains realistic and whether the goals are being met.