Hypertension emergency refers to the sudden increase of blood pressure and diastolic blood pressure in a short time due to some inducement, accompanied by serious dysfunction or irreversible damage of important organs and tissues such as heart, brain, kidney, fundus and aorta. If not treated in time, it will be life-threatening. Nurses should attach great importance to the monitoring and nursing of hypertension emergency, reduce blood pressure and control the disease as soon as possible to prevent irreversible damage to important organs.
1, once found hypertension emergency, immediately notify the doctor and cooperate with the rescue in time.
2, assist patients to take appropriate posture. If the patient suddenly has symptoms of acute left heart failure such as palpitation, chest tightness and asthma, cyanosis of lips and pink foam sputum, he should immediately ask his legs to droop and take a supine position; Or the patient's blood pressure suddenly rises, accompanied by severe headache, nausea and vomiting, palpitation, blurred vision and other manifestations of hypertensive encephalopathy, immediately ask the patient to lie flat, raise the bedside by 30℃ and stay in bed absolutely.
3. Oxygen supply can improve the symptoms of cerebral hypoxia and reduce the burden on the heart. When vomiting, tilt your head to one side, suck sputum, remove oral vomit, keep respiratory tract unobstructed, and intubate to prevent suffocation if necessary.
4, ECG monitor, closely monitor vital signs.
5, immediately establish venous access, according to the doctor's advice symptomatic use of rescue drugs.
6. Comfort patients and maintain emotional stability. Avoid all bad stimuli, explain the relationship between mood changes and blood pressure to patients and their families. Good mood can promote the early recovery of the disease, and give small doses of sedatives to patients with negative emotions and uncooperative.
7. Observation of the condition: The condition of hypertension emergency changes rapidly, and carefully observe the functions of important organs such as heart, brain, kidney and retina. The patient's consciousness, pupil and bulbar conjunctiva should be closely observed.
Symptoms such as swelling, vomiting, urine output, physical activity, blurred vision, palpitation, shortness of breath, chest tightness, pink foam phlegm, etc. Report to the doctor in time if there is any abnormality.
8. Pay attention to medication. Sodium nitroprusside is the fastest and most effective drug of choice in the treatment of hypertensive emergencies. It has the advantages of quick onset, strong action, short duration and continuous and reliable curative effect. It is suitable for all kinds of hypertension emergencies. The use of sodium nitroprusside should be strictly protected from light, and it should be prepared now. After 24 hours of preparation, it should be replaced whether it is used up or not. Long-term use should prevent cyanide poisoning. Strictly control the speed; Should not be compatible with other drugs; Closely observe blood pressure and mental symptoms to prevent postural hypotension; Side effects include headache and nausea, so make an explanation. Patients with restlessness and convulsions should be given barbiturates intramuscular injection or chloral hydrate enema. At the same time, dehydration agents such as mannitol should be used in time according to the doctor's advice when complicated with hypertensive encephalopathy.
9. Observation of curative effect. Strictly follow the doctor's advice, monitor blood pressure, record the effect of blood pressure reduction, pay attention to observe adverse drug reactions, and prepare other first-aid drugs.
10, health education in rehabilitation.
(1) Good eating habits and low salt (
(2) Develop a good lifestyle. Quit smoking and drinking, control weight, ensure adequate sleep, good quality, keep defecation unobstructed, maintain emotional stability, family support, and take blood pressure every day.
(3) Reasonable exercise, combining work and rest. Moderate aerobic exercise, such as Qigong and Tai Ji Chuan. Exercise 3-5 times a week for 20-60 minutes each time, and keep the heart rate at (170- age) times/minute.
First aid and nursing measures of hypertension emergency II
According to experts, hypertensive emergencies include malignant hypertension, hypertensive crisis, hypertensive encephalopathy, hypertension complicated with acute left heart failure, acute coronary insufficiency, intracranial hemorrhage, and clonine acute withdrawal syndrome.
According to whether there is acute target organ damage, it can be divided into two categories.
In the first category, acute target organ damage is caused by a sharp increase in blood pressure, such as hypertensive encephalopathy, cerebral hemorrhage, acute left heart failure complicated with pulmonary edema, aortic dissection hematoma, pregnancy and eclampsia toxemia, unstable angina pectoris or acute myocardial infarction. The treatment needs to reduce blood pressure 1 hour after symptoms appear to avoid serious consequences.
The second type is hypertensive emergency without acute target organ damage, such as acute or malignant hypertension without complications and severe perioperative hypertension. Its treatment can reduce blood pressure within 24 hours. If you can't clearly distinguish which category you belong to, treat it as the first category.
When dealing with the first kind of hypertension emergency, antihypertensive drugs should be injected immediately to make the blood pressure drop partially as soon as possible, but to prevent excessive blood pressure drop. If the blood pressure drops excessively beyond the limit of automatic regulation of cerebral circulation and the basal perfusion pressure of the heart, it will go to the opposite side. According to the blood pressure level before treatment, it is generally required that the systolic blood pressure be reduced by 6.67 ~ 10.7 kPa (50 ~ 80 mmHg) and the diastolic blood pressure be reduced by 4 ~ 4.67 kPa (30 ~ 50 mmHg), and it is not required to be reduced to the normal level, but it is generally required to be slightly higher than the normal level.
Commonly used drugs are: add 25 ~ 100 mg to 500 ml of 5% glucose water, and drip in the dark, with the drip rate starting from 10 ~ 25 mg per minute, and then increase the drip rate every 5 ~ 10 minutes according to the blood pressure response until the blood pressure drops to a satisfactory level. Sodium nitroprusside can take effect immediately, and the effect will be 3. Nitroglycerin, 5 ~ 10 mg, was added to 250 ~ 500 ml glucose water, which played a hypotensive role within 2 ~ 5 minutes, and was dripped at a rate of 5 ~ 10 mg per minute, and then the dosage was gradually increased according to the blood pressure response. Low pressure azole, 50 ~ 150 mg intravenous injection; Phentolamine 5 ~ 65438±05mg was added into 65438 000 ml of 5% glucose water for intravenous drip. Furosemide, 40 mg intravenously.
In the emergency treatment of the second kind of hypertension, oral drugs can generally be used to control blood pressure. Commonly used drugs are 25 ~ 50 mg taken orally or sublingually, and can be given repeatedly when necessary; Clonin 0. 1 ~ 0.2 mg orally, every hour 1 time if necessary; Pyridine 10 ~ 20 mg under long pressure is taken orally or sublingually, and can be administered repeatedly after 30 minutes.
How to nurse hypertension
Self-psychological adjustment
First of all, patients with hypertension should not have a negative attitude when they are treated. What we need to do is to adjust their psychology, which is the first step of nursing. Relieve mental stress and maintain mental balance. Long-term mental stress and depression are one of the important causes of chronic diseases such as hypertension. For patients with hypertension, this mental state often leads them to adopt unhealthy lifestyles, such as drinking and smoking, which reduces or resists the compliance of hypertension treatment. For people with great mental stress and psychological imbalance, it takes long-term and meticulous work to change their mental outlook.
After weight control, it is nursing for patients' special physique. For example, obese patients should control their weight, which is helpful for high blood pressure. It is suggested that the body mass index (BMI) should be controlled below 24kg/m2. Weight control is very beneficial to health, for example, the average weight of people decreases by 5 kg, and the weight of patients with hypertension decreases by 10%. On the one hand, the way to lose weight is to reduce the total calorie intake, emphasize less fat and limit the intake of too many carbohydrates.
Exercise in moderation. In the process of treatment, physical activity should be appropriately increased. Proper exercise is good care for patients with hypertension. However, it should be noted that everyone who participates in sports, especially middle-aged and elderly people and patients with hypertension, had better know their physical condition before exercise to decide their exercise type, intensity, frequency and duration. For middle-aged and elderly people, aerobic exercise, stretching exercise and muscle strengthening exercise should be included, and specific items such as walking, jogging, Tai Ji Chuan, gateball, Qigong and disco can be selected.
Although there are many nursing methods for hypertension, nursing should be "personalized". At the same time, there are many problems that need attention, not only in diet, but also in psychology. If you don't know how to care for patients with hypertension, you should consult a doctor.
Dietary factors of hypertension
low-salt
Studies have found that high salt intake can raise blood pressure, and low salt diet can lower blood pressure. So how much salt should a normal adult consume every day?
According to the dietary characteristics of Chinese residents, China Hypertension Union suggested that the daily salt intake of healthy adults (including the amount of salt in soy sauce and other foods) should not exceed 6g.
general idea
We can reduce salt intake by the following measures:
1 First of all, we should consciously correct the bad habit of adding too much salt and soy sauce, control the total daily salt intake, and use measuring tools such as salt-limiting spoons. If there is no such thing, we can remove the rubber pad from the lid of the ordinary beer bottle and put the lid on it, which is equivalent to 5 to 6 grams of salt.
People who are used to salty taste can put a little vinegar in cooking to improve the umami taste of dishes and help them adapt to less salty food. Vinegar has the functions of lowering blood pressure, reducing blood fat, preventing arteriosclerosis, moistening skin and resisting aging.
3. Pay attention when cooking, if sugar is added, it will cover up the salty taste, so it is more accurate to judge whether the salt exceeds the standard only by tasting.
4. Pay attention to reducing the intake of salty foods such as pickles and pickled foods.
5, try not to drink vegetable soup, salt is soluble in water, and vegetable soup has high salt content; Add salt when the dish is ripe or before cooking, so that the dish will have a taste without salt.
6. While paying attention to reducing salt intake, we should pay attention to the sodium content in food. MSG contains a certain amount of sodium, so it should be put less. Dried noodles contain more sodium and should be eaten less. When steaming steamed bread, alkali should be avoided and yeast should be used instead. Salt substitutes such as salt-free soy sauce can usually be used.
Potassium supplementation
Eat more foods rich in potassium and low in sodium. Potassium can resist the harmful effects of salt on raising blood pressure and damaging blood vessels, and has an independent effect on preventing stroke. Limiting salt and supplementing potassium is more effective than limiting salt in preventing and treating hypertension and stroke.
general idea
Foods rich in potassium, such as kelp, laver, fungus, yam, potato, fish, tomato, mushroom, black date, beans, almonds, walnuts, potatoes, peanuts, bamboo shoots, fish, lean meat, poultry, amaranth, rape, green onions and other root vegetables and fruits such as bananas, peaches and oranges, are also rich in potassium.
Supplement calcium and magnesium
Calcium can not only maintain the strength of bones, but also be needed by soft tissues. Foods rich in calcium are good for controlling blood pressure.
general idea
Foods rich in calcium are the first to promote dairy products. Sunflower seeds, soybeans, peanuts, walnuts, fish and shrimp, red dates, garlic sprouts, kelp and seaweed are also important.
Foods rich in magnesium, such as beans and bean products, millet, fish, buckwheat noodles, nuts, green leafy vegetables, peanut butter, yogurt, etc., pay attention to supplementing magnesium, which is helpful to control blood pressure.
Low-fat
Hyperlipidemia and obesity are closely related to the occurrence and development of hypertension. Therefore, the daily diet should adopt a low-fat diet and eat less foods containing more lipids, such as fat, lard and animal offal. Eating too much will make the body fat and cholesterol content exceed the standard, which is very unfavorable for the prevention and treatment of hypertension.
general idea
We can take the following healthy behaviors:
1, eat more green vegetables and fresh fruits, which is beneficial to myocardial metabolism and promote cholesterol excretion.
2. Reduce the intake of animal fat and use vegetable oil when cooking. The total daily intake of animal oil and vegetable oil should not exceed 1. Eat less fried food and animal offal.
3. Eat high-fiber food properly, with food with thick and thin collocation, advocate eating corn, millet, oats, brown rice and whole wheat, and eat less sugar and sweets. Eat 3-6 staple foods (rice, steamed bread, pie, porridge, etc. ) All day.
4, you can eat more marine fish, which can lower blood cholesterol. It is recommended to eat fish 1-2 times a week.
Causes of hypertension
1. Genetic factors
About 60% patients with hypertension have a family history. At present, it is believed that it is caused by polygene inheritance, and 30%~50% of hypertensive patients have genetic background.
2. Mental and environmental factors
Long-term mental stress, excitement, anxiety, noise or bad visual stimulation can also cause hypertension.
3. Age factor
The incidence rate tends to increase with age, and the incidence rate is high in people over 40 years old.
4. Life habit factors
Unreasonable dietary structure, such as excessive sodium salt, low potassium diet, heavy drinking and excessive intake of saturated fatty acids, can all increase blood pressure. Smoking can accelerate the process of atherosclerosis and is a risk factor for hypertension.
5. Effects of drugs
Contraceptive pills, hormones, anti-inflammatory painkillers, etc. Will affect blood pressure.
6. Effects of other diseases
Obesity, diabetes, sleep apnea hypopnea syndrome, thyroid disease, renal artery stenosis, renal parenchyma injury, adrenal space-occupying lesions, pheochromocytoma, other neuroendocrine tumors, etc.
Daily nursing care of hypertension
First of all, to avoid drinking and strong tea, you must give up smoking.
Second, appropriate intake of sugar to supplement calories, but not too much, so as not to increase blood lipids and accelerate arteriosclerosis.
Third, limit the amount of salt in the diet. Generally, the daily salt intake of patients with renal hypertension does not exceed 5g. If accompanied by severe edema, cardiac insufficiency and severe hypertension, the daily salt intake should be limited to 3g or less.
Fourth, the combination of work and rest is an important part of life nursing for hypertensive nephropathy. Reduce the workload and intensity of the work appropriately, and you can take a half-day break or a full break.
Five, renal hypertension may come from both physical and mental aspects, so once the symptoms of hypertension appear, we should treat them correctly psychologically, don't be too nervous and worried, which will raise blood pressure, so we should relax, remain optimistic and adjust ourselves to the best psychological state.
Six, sleep enough, can't sleep too late. Patients with hypertensive nephropathy should avoid overwork, so regular etiology is also an essential part of life care for hypertensive nephropathy.
Seven, mild patients can exercise on time. For example, walking, doing gymnastics, playing Tai Ji Chuan and so on. Be sure not to feel tired. Because regular exercise can bring good mental feelings, relax and be beneficial to the body. However, severe patients, patients with renal insufficiency or hypertension should limit exercise.
Eight, control the intake of animal fat, because animal fat will aggravate vascular sclerosis, which is not conducive to protecting renal function. You should eat more vegetable oils, such as soybean oil, peanut oil and sesame oil. Because vegetable oil contains more unsaturated fatty acids, it can lower cholesterol.