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

September 7, 2019


– [Voiceover] Usually if
you have hypertension, your blood pressure gets higher and higher over the course of several years even. And this slow rise also
slowly causes complications. But because it’s happening so slowly, there usually aren’t any
symptoms directly caused by high blood pressure. It is possible though that
your blood pressure could rise quickly and severely
enough to be what we call a hypertensive crisis. And actually there are
essentially two categories of hypertensive crises. And the first is hypertensive urgency, and the other is hypertensive emergency. Let’s just go over urgency first. So this hypertensive urgency
is defined as the situation where your blood pressure
is super elevated, but there’s no acute or sudden damage to any of your target
organs like your kidneys, your heart, or your brain. How high are we talkin’ though? Well in general, it’d be
above about 180 millimeters of mercury on the systolic side or above about 110 millimeters of mercury on the diastolic side. So it’s like the blood
pressure goes up super high and really fast, but none
of those target organs get hit, right. But even though these
organs aren’t damaged, there can be symptoms associated
with hypertensive urgency like a severe headache
or shortness of breath, nosebleeds, and severe anxiety. This type of crisis, though,
can usually be managed using some type of oral
antihypertensive medication in an outpatient or a same day sort of observational setting. So urgency means no damage, right. We can probably take a guess as to what hypertensive
emergency is then, huh. An emergency is when
blood pressure is so high that it’s reached levels
that damage target organs. Sometimes this is also referred to as malignant hypertension. During one of these
hypertensive emergencies, systolic blood pressure might increase above 180 millimeters of mercury, while diastolic might be above
120 millimeters of mercury, but it can also happen at
lower pressures in patients whose bodies maybe aren’t as
used to higher blood pressures. Because target organs can be damaged, the consequences of hypertensive emergency are very, very serious and can have severe and permanent effects on the
brain, heart, and kidneys. Some signs and symptoms
of these emergencies can include chest pain,
shortness of breath, back pain, numbness and
weakness, change in vision, and difficulty speaking. One example of a serious
complication that can happen to your head and your brain
is called encephalopathy, where enceph means brain and pathy means disease. And this is when during
a hypertensive emergency, your extremely high
arterial pressure causes your cerebral arterials, which
are like these small arteries in your brain, to lose their
ability to regulate blood flow in the cerebral capillaries, which are even smaller
blood vessels in your brain. As pressure goes up and up,
fluid or blood essentially leaks out into the interstitial
space causing cerebral edema or fluid buildup, which also
causes an increased pressure in the skull and eventually
brain dysfunction. Due to the severity of encephalopathy and other target organ complications, speedy treatment is extremely important, so much so that IV or
intravenous medications are used instead of oral medications, basically to get the
drugs into the bloodstream and working as quickly as possible. An IV vasodilators, IV
calcium channel blocker, or IV beta blocker might be given. Each of these helps the arteries
and the arterials relax. Whichever one is used, the
goal is always the same: to safely reduce the blood
pressure before the pressure causes serious and irreversible
damage to a target organ. Since hypertensive emergency tends to be quite a bit more serious
than hypertensive urgency, it’s usually gonna be managed
in an intensive care unit or other closely-monitored setting.

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  1. i am so glad i found this channel! i have a test on perfusion next week and this helped sooooo much! This will help me a lot with my nursing classes! please make more videos!

  2. Could hypertensive crisis cause dizziness? In case it does, which of the 2 categories would it belong to then?

  3. WTF? The frontal lobe of the brain is in the back? You do such a fabulous thing and ruine it by missing the Beta blockers and making a man's occiput in his eyes?

  4. It would be extremely helpful if you add more NCLEX-nursing related info, such as interventions and name of medications. Other than that, always good videos from you guys!

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  8. I am lucky to be here. I have a home Dr. Last week my blood pressure was taken, then Dr. says I have to call an ambulance now. My blood pressure was 298/198. I never heard of Hypertensive Crisis until it happened to me. The EMT's came, they couldn't get a reading on their machine because my blood pressure was too high to read. That was a first for them. They didn't know what to do but get me to the hospital as fast as they could. I am on good High Blood Pressure meds now.

  9. Human body is such a joke. For the most stupid reasons the body will crank its blood pressure risking killing itself, even when the conscious brain is aware of it, the brain still takes no action to kill off this sudden rise of blood pressure. Body just let's itself kill itself, bunch of automated systems with no overall control that run wild and cause irreversible damage.

    Human body can be amazing in some instances, but ultimately it's a machine that is surprisingly stupid.

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