Hypertensive crisis | Circulatory System and Disease | NCLEX-RN | Khan Academy

Hypertensive crisis | Circulatory System and Disease | NCLEX-RN | Khan Academy

Hypertensive crisis | Circulatory System and Disease | NCLEX-RN | Khan Academy

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Content

3.599 -> - [Voiceover] Usually if you have hypertension,
5.005 -> your blood pressure gets higher and higher
6.686 -> over the course of several years even.
9.026 -> And this slow rise also slowly causes complications.
12.164 -> But because it's happening so slowly,
14.595 -> there usually aren't any symptoms directly caused
16.838 -> by high blood pressure.
18.603 -> It is possible though that your blood pressure could rise
20.975 -> quickly and severely enough to be what we call
23.056 -> a hypertensive crisis.
25.295 -> And actually there are essentially two categories
27.534 -> of hypertensive crises.
29.719 -> And the first is hypertensive urgency,
32.418 -> and the other is hypertensive emergency.
35.921 -> Let's just go over urgency first.
37.478 -> So this hypertensive urgency is defined as the situation
41.554 -> where your blood pressure is super elevated,
43.735 -> but there's no acute or sudden damage
46.507 -> to any of your target organs like your kidneys,
48.8 -> your heart, or your brain.
51.352 -> How high are we talkin' though?
53.346 -> Well in general, it'd be above about 180 millimeters
56.697 -> of mercury on the systolic side
58.405 -> or above about 110 millimeters of mercury
61.754 -> on the diastolic side.
63.665 -> So it's like the blood pressure goes up super high
65.76 -> and really fast, but none of those target organs
68.304 -> get hit, right.
70.122 -> But even though these organs aren't damaged,
71.733 -> there can be symptoms associated with hypertensive urgency
75.296 -> like a severe headache or shortness of breath,
79.076 -> nosebleeds, and severe anxiety.
82.825 -> This type of crisis, though, can usually be managed
85.31 -> using some type of oral antihypertensive medication
88.784 -> in an outpatient or a same day sort
90.791 -> of observational setting.
93.377 -> So urgency means no damage, right.
96.35 -> We can probably take a guess
97.393 -> as to what hypertensive emergency is then, huh.
100.84 -> An emergency is when blood pressure is so high
103.853 -> that it's reached levels that damage target organs.
106.592 -> Sometimes this is also referred
108.186 -> to as malignant hypertension.
111.366 -> During one of these hypertensive emergencies,
114.014 -> systolic blood pressure might increase
115.786 -> above 180 millimeters of mercury,
118.2 -> while diastolic might be above 120 millimeters of mercury,
122.134 -> but it can also happen at lower pressures in patients
124.535 -> whose bodies maybe aren't as used to higher blood pressures.
128.888 -> Because target organs can be damaged,
131.035 -> the consequences of hypertensive emergency
133.316 -> are very, very serious and can have severe
136.109 -> and permanent effects on the brain, heart, and kidneys.
141.126 -> Some signs and symptoms of these emergencies
143 -> can include chest pain, shortness of breath,
146.286 -> back pain, numbness and weakness, change in vision,
150.41 -> and difficulty speaking.
153.409 -> One example of a serious complication that can happen
155.814 -> to your head and your brain is called encephalopathy,
159.052 -> where enceph means brain
160.748 -> and pathy means disease.
162.967 -> And this is when during a hypertensive emergency,
166.054 -> your extremely high arterial pressure causes
168.413 -> your cerebral arterials, which are like these small arteries
171.942 -> in your brain, to lose their ability to regulate blood flow
174.899 -> in the cerebral capillaries,
176.476 -> which are even smaller blood vessels in your brain.
180.143 -> As pressure goes up and up, fluid or blood essentially leaks
184.003 -> out into the interstitial space causing cerebral edema
187.473 -> or fluid buildup, which also causes an increased pressure
191.052 -> in the skull and eventually brain dysfunction.
195.999 -> Due to the severity of encephalopathy
198.722 -> and other target organ complications,
200.641 -> speedy treatment is extremely important,
203.193 -> so much so that IV or intravenous medications
206.221 -> are used instead of oral medications,
208.655 -> basically to get the drugs into the bloodstream
210.506 -> and working as quickly as possible.
212.932 -> An IV vasodilators, IV calcium channel blocker,
216.473 -> or IV beta blocker might be given.
219.495 -> Each of these helps the arteries and the arterials relax.
223.018 -> Whichever one is used, the goal is always the same:
225.689 -> to safely reduce the blood pressure before the pressure
228.465 -> causes serious and irreversible damage to a target organ.
233.129 -> Since hypertensive emergency tends to be
235.54 -> quite a bit more serious than hypertensive urgency,
238.72 -> it's usually gonna be managed in an intensive care unit
241.407 -> or other closely-monitored setting.

Source: https://www.youtube.com/watch?v=ePWrbBJgssw