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Manage episode 518796340 series 3700394
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Episode Notes
Key Concepts & Takeaways
Hypertensive Crisis Types
Urgent: BP >180/120 without organ damage.
Oral meds (Clonidine, Captopril).
Gradual BP reduction over 24–48 hrs.
Watch for rebound hypertension (Clonidine) and angioedema (Captopril).
Emergent: BP >180/120 with organ damage.
IV meds (Labetalol, Nicardipine, Nitroprusside).
ICU monitoring and titration within minutes–hours.
Watch for bronchospasm (Labetalol) and cyanide toxicity (Nitroprusside).
Aortic Dissection Sequence Rule
Beta blocker first (Esmolol) to slow HR to ~60 before adding vasodilator.
Giving vasodilator first can trigger reflex tachycardia → aortic rupture.
Target BP: 100–120 systolic.
Anticoagulation & Clot Prevention
Valvular disease (e.g., mitral stenosis + AFib): Warfarin or DOACs (rivaroxaban, apixaban, dabigatran).
Monitoring: PT/INR for Warfarin, none for DOACs.
Endocarditis prophylaxis: Amoxicillin pre-dental procedure; Clindamycin or Azithromycin if allergic.
Pulmonary Embolism
Stable: Start anticoagulation immediately (Heparin or LMWH).
Unstable (shock): Thrombolysis with Alteplase (TPA).
Contraindications: recent stroke, surgery, trauma, active bleeding, severe hypertension.
Pediatric Cardiac Pharm
Prostaglandin E1 (Alprostadil): Keeps PDA open; monitor for apnea, hypotension.
Digoxin Safety: Hold if HR <90–110 in infants (toxicity risk).
Rapid-Fire NCLEX Scenarios
Nitroprusside toxicity: Stop infusion immediately → give sodium thiosulfate.
INR 5.5 on Warfarin: Hold dose → give Vitamin K.
Aspirin allergy in ACS: Substitute Clopidogrel.
Nursing Pearls
Organ damage = emergency = IV meds.
Always beta-block first in aortic dissection.
Stop the drip first in cyanide toxicity.
Hold digoxin in infants <90–110 HR.
Never give thrombolytics with recent head injury or surgery.
NCLEX Practice Question
A patient with an aortic dissection is started on IV nitroprusside before receiving a beta blocker. What is the nurse’s priority concern?
A. Reflex tachycardia worsening the dissection
Correct Answer: A
Rationale: Vasodilators lower BP rapidly but can trigger compensatory tachycardia, increasing aortic wall stress and risking rupture. Always administer a beta blocker first.
Check out Thinklikeanurse.org for study guides, notes, downloads, and other cool stuff!
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