Last updated on December 28th, 2023
Here we will formulate sample Hypertensive Crisis nursing care plans based on a hypothetical case scenario.
It will include three hypertensive crisis nursing care plans with NANDA nursing diagnoses, nursing assessment, expected outcome, and nursing interventions with rationales.
Hypertensive Crisis Case Scenario
A 56-year-old male presents to the ED with complaints of severe headache, shortness of breath, chest pain, and anxiety.
The patient reports having a headache for several days which has increased in intensity in the last few hours. He does not have a primary care physician and hasn’t seen a doctor in 15 years.
Due to this, the patient has no past medical history and doesn’t take any medications at home. The patient reports 4/10 chest pain but says “it pales in comparison to this horrible headache.”
Upon assessment, the patient is slightly confused regarding the date and time. His speech is clear and muscle strength is equal.
The patient weighs 113 kg and appears overweight. His temperature is 37.5 ˚C, heart rate is 84 BPM, blood pressure is 187/117 mmHg, respirations are 20 breaths per minute, and oxygen saturation is 97% on room air.
The blood pressure is repeated on the opposite arm and reveals 192/115 mmHg. The patient’s lung sounds are clear and no heart murmurs are heard.
A 12-lead EKG is performed revealing normal sinus rhythm with no evidence of ischemia. The patient’s lab work reveals normal cardiac enzymes but a slightly elevated BUN and creatinine of 27.5 mg/dL and 1.7 mg/dL respectively.
The patient is taken for a head and chest CT, both of which are unremarkable.
The patient is admitted with Hypertensive Crisis.
#1 Sample Hypertensive Crisis Nursing Care Plan – Risk for decreased cardiac output
Nursing Assessment
Subjective Data:
- The patient reports severe headaches, shortness of breath, and chest pain.
Objective Data:
- The patient’s blood pressure is 187/117 mmHg.
- BUN and creatinine of 27.5 mg/dL and 1.7 mg/dL respectively.
Hypertensive crisis nursing diagnosis
Risk for decreased cardiac output related to elevated systemic vascular resistance secondary to hypertension as evidenced by systolic blood pressure > 179 and elevated BUN and creatinine.
Goal/Desired Outcome
Short-term goal: The patient’s blood pressure will decrease by 2o% in the first 1-2 hours.
Long-term goal: The patient will maintain normal blood pressure and will take oral antihypertensives as prescribed.
Hypertensive crisis nursing interventions with rationales – Risk for decreased cardiac output
| Nursing Interventions | Rationales |
| Titrate antihypertensives to reach the target range. | The blood pressure should be decreased by 20-25% in the first 1-2 hours, then to 160/100 mmHg in the next 2-6 hours. Lowering the blood pressure too abruptly can lead to compromised renal, cerebral, or coronary blood flow. |
| Differentiate between hypertensive urgency and hypertensive emergency. | Hypertensive urgency is a blood pressure > 179/109 mmHg without signs of organ damage. Hypertensive emergency is a blood pressure > 179/109 with signs of organ damage (i.e. elevated BUN and creatinine). Both of these fall under the umbrella term “hypertensive crisis.” |
| Frequently monitor blood pressure. | Blood pressure must be monitored every hour or more frequently as needed to ensure blood pressure is being lowered at an appropriate rate. |
| If indicated, assist in the insertion of an arterial line. | An arterial line may be indicated for continuous blood pressure monitoring. |
| Ensure correct cuff size for blood pressure readings. | Blood pressure cuffs that are too small or large can affect the blood pressure reading. To ensure accuracy, the inflatable portion of the cuff should cover about 40% of the circumference of the upper arm and should cover 80% of the area from the elbow to the shoulder. |
#2 Sample Hypertensive Crisis Nursing Care Plan – Acute pain
Nursing Assessment
Subjective Data:
- The patient complains of a headache and chest pain.
Objective Data:
- The patient’s blood pressure is 187/117 mmHg.
Hypertensive crisis nursing diagnosis
Acute pain related to increased cerebral pressure secondary to hypertension as evidenced by a severe headache.
Goal/Desired Outcome
Short-term goal: The patient will report 0/10 pain in both the head and chest by the end of the shift.
Long-term goal: The patient will be able to recognize the symptoms of hypertensive crisis and will take antihypertensives as prescribed.
Hypertensive crisis nursing interventions with rationales – Acute pain
| Nursing Interventions | Rationales |
| If indicated, provide acetaminophen or morphine. | Pain medications may be of little effect until the blood pressure is lowered. |
| Initiate IV antihypertensives. | Typical IV infusions include nitroprusside, nicardipine, and labetalol. Oral antihypertensives are not indicated in the acute phase because the onset is less predictable and they are difficult to titrate. |
| Explore the causes of hypertensive crisis. | Hypertensive crisis can be due to serious conditions such as aortic dissection, myocardial infarction, heart failure, stroke, or kidney failure. The patient should receive a full workup to rule out these conditions. |
| Following the acute phase, bridge to oral antihypertensives. | The patient will likely be sent home on antihypertensives. Beta-blockers, ACE inhibitors, and calcium channel blockers are frequently used for blood pressure control. |
| Utilize non-pharmacological pain control measures. | Strategies such as applying heat or cold, applying peppermint oil to the temples, and lowering the lights can help decrease headache pain. |
#3 Sample Hypertensive Crisis Nursing Care Plan – Knowledge deficit
Nursing Assessment
Subjective Data:
- The patient does not have a primary care physician and hasn’t seen a doctor in 15 years.
Objective Data:
- The patient’s blood pressure is 187/117 mmHg.
- The patient is overweight.
Hypertensive crisis nursing diagnosis
Deficient knowledge related to management of new diagnosis as evidenced by lack of primary care physician and critically high blood pressure.
Goal/Desired Outcome
Short-term goal: The patient will state a few long-term side effects of failing to manage hypertension.
Long-term goal: The patient will take his antihypertensives as prescribed and will maintain a normal BMI.
Hypertensive crisis nursing interventions with rationales – Deficient knowledge
| Nursing Interventions | Rationales |
| Educate the patient about the long-term side effects of hypertension. | Unmanaged hypertension can lead to an increased risk of stroke, heart failure, myocardial infarction, kidney disease, metabolic syndrome, and sexual dysfunction. |
| Educate the patient about the link between obesity and hypertension. | When a patient is overweight, the heart has to work harder to pump blood to the body, which puts strain on the arteries and raises the blood pressure. This results in a cascade of cardiac, renal, and metabolic disorders. |
| Educate the patient about a healthy diet. | The DASH diet (Dietary Approaches to Stop Hypertension) is recommended for patients with hypertension. It is rich in fruits, vegetables, whole grains, and low-fat dairy foods. It is low in sugar, red meat, and added fat. |
| Provide salt substitutes. | A low sodium diet is recommended because sodium directly increases blood pressure and fluid accumulation in the body. Herbs and spices can be used to flavor food instead of salt. |
| Encourage exercise after discharge. | Regular physical activity has been shown to lower blood pressure and contribute to weight loss. 30 minutes of physical exercise a day is recommended. |
Conclusion
To conclude, here we have formulated a scenario-based sample nursing care plan for Hypertensive Crisis. Prioritized nursing diagnosis includes Risk for decreased cardiac output, acute pain, and deficient knowledge.
Additionally, these sample hypertensive crisis nursing care plans comprise nursing assessment, NANDA nursing diagnosis, goal, and interventions with rationales.
Recommended Readings & References
Ackley, B., Ladwig, G., Makic, M., Martinez-Kratz, M., & Zanotti, M. (2020). Nursing Diagnoses Handbook: An Evidence-based Guide to Planning Care (12th ed.). Elsevier.
Comer, S. and Sagel, B. (1998). CRITICAL CARE NURSING CARE PLANS. Skidmore-Roth Publications.
Doenges, M., Moorhouse, M., & Murr, A. (2013). Nurse’s Pocket Guide: Diagnoses, Prioritized Interventions, and Rationales (13th ed.). F. A. Davis Company.
Herdman, T., Kamitsuru, S. & Lopes, C. (2021). NURSING DIAGNOSES: Definitions and Classifications 2021-2023 (12th ed.). Thieme.
Swearingen, P. (2016). ALL-IN-ONE CARE PLANNING RESOURCE (4th ed.). Elsevier/Mosby.
