Nursing care of the inpatient with hypertension and a hypertensive crisis on the ward
- Safe practice
The nurse measures blood pressure well, checks before each antihypertensive, recognises very high pressure with symptoms, and teaches lifelong control.
What it is
Most people with high blood pressure feel nothing, so correct measurement is the nurse's first tool. On the ward the nurse measures with the right technique, gives antihypertensives with their checks, prevents falls from low pressure when standing, and watches for very high readings. Very high pressure with symptoms such as severe headache, chest pain, breathlessness, confusion, vision changes, weakness or little urine can mean organ damage: it is an emergency for the medical team, which sets the treatment and the target. Teaching covers salt, alcohol, activity, tobacco and taking medicines every day.
What it requires
- Accurate measurement: rest beforehand, the right cuff, a supported arm, and noting caffeine or tobacco just before.
- Checks before each antihypertensive and the hold limits in the order.
- Recognising very high pressure with signs of organ damage and calling at once.
- Fall prevention when pressure drops on standing.
- Teaching for long-term control and adherence.
How it is applied (and why)
- Let the patient rest before measuring and note caffeine or tobacco in the last half hour — avoids a falsely high reading.
- Use the right cuff on a suitable arm and repeat an abnormal reading — one reading can mislead.
- Before each antihypertensive, check pressure, and pulse for a beta blocker, against the order's limits — avoids low pressure and slow pulse.
- Ask the patient to sit, then stand slowly, and report dizziness — these medicines can drop pressure on standing.
- With a very high reading, repeat it, ask about headache, chest pain, breathing, vision, weakness and confusion — symptoms change the urgency.
- Call the doctor at once if there are symptoms or signs of organ damage — the team sets the treatment and how fast to lower pressure.
- During IV treatment, measure pressure as often as the protocol sets and record urine and mental state — the team sets the target.
- Teach salt and alcohol limits, activity, no tobacco, weight and adherence — control is lifelong.
In nursing practice
- Call at once for very high pressure with headache, chest pain, breathlessness, confusion, sleepiness, vision change, weakness, seizure or little urine.
- Call for low pressure with dizziness or fainting after an antihypertensive, or a pulse below the order's limit.
- Call for swelling of the face, lips or tongue, or difficulty swallowing or breathing, in a patient on an ACE inhibitor or ARB.
- Report a persistent cough on an ACE inhibitor and high potassium results.
- Refer to the chronic-disease programme and check the follow-up visits before discharge.
Common mistakes
- Measuring right after the patient walks, talks or smokes, or with the wrong cuff.
- Giving a beta blocker without counting the pulse.
- Giving an extra dose for a high reading without an order.
- Not repeating a very high reading or not asking about symptoms.
- Telling the patient they can stop the medicine once the pressure is normal.
Test yourself
Think of the answer, then tap the question to see it.
Which symptoms with very high blood pressure need immediate medical attention?
Severe headache, chest pain, breathlessness, confusion or sleepiness, vision changes, weakness or numbness, seizures or little urine.
What is checked before giving a beta blocker?
Blood pressure and the apical pulse; if the pulse is below 60 or the order's limit, the dose is held and the prescriber is informed.
What adverse effect of an ACE inhibitor is an emergency?
Angioedema: swelling of the face, lips or tongue, or difficulty swallowing or breathing.
Why should a patient on antihypertensives rise slowly?
Because pressure can drop on standing and cause dizziness, fainting and falls.
Elsewhere in DurgiPedia
Connections
Educational content for students; it does not replace your institution's protocols, supervised clinical training or a prescriber's order. Dose-calculation examples use made-up numbers: they are educational, not a clinical order.
Sources: Hypertension: fact sheet (World Health Organization (WHO), 2025); Malignant hypertension: MedlinePlus Medical Encyclopedia (MedlinePlus, US National Library of Medicine, 2026); Nursing Pharmacology, 6.10 Antihypertensives (Open RN (Chippewa Valley Technical College), LibreTexts, 2020); Nursing Skills, 3.3 Blood Pressure Assessment (Open RN (Chippewa Valley Technical College), LibreTexts, 2021).
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Representative model, for educational purposes only.