By Bisognano JD; When Blood Pressure goes up, up and Away Nursing made Incredibly Easy; July/August 2005;

Lippincott Williams & Wilkins;pp 42-44

When a patient arrives to the emergency department with a complain of headache, severe occipital pain, blurred vision and appears flushed skin and then checking the blood pressure of the patient and the result is high at 220/150mmHg. When you assessed the patient, youll ask if the patient has maintenance for hypertension, then youll ask what kind of drug it is. Then upon assessing you discovered that the patient wasnt able to take medications for 3 weeks for the reason that he dont have money to refill a combination drugs, Prinzide and lisinopril. Hypertensive crises have two types: hypertensive emergency and hypertensive urgency. Hypertensive emergency, the BP is elevated, and theres organ damage (brain, eyes, blood vessel, heart and kidneys). In hypertensive urgency, the BP is elevated but no target organ damage. If hypertensive emergency is suspected lab testing is required: CBC, cardiac enzymes, BUN, creatnine, UA and urine toxicology screen. Other diagnostic procedure is also required, ECG, tomography scan of chest, abdomen and brain. When a patient diagnosed hypertensive emergency fast acting therapies is needed. In this situation Labetalol, an adrenergic receptor blocker with both selective alpha adrenergic and non selective betaadrenergic receptor b locking actions. It can be IV or oral. Nitroglycerine is used to treat hypertensive emergency. The goal of this medication is to lower the MAP by 25% in the first 2 hours, then achieve a BP of 160/100 in 6 hrs. This journal concludes that if the problem is the money. Individual drugs are generally less expensive than combination drug products