MARY JOHNSTON HOSPITAL

Clinical Pathway for Hypertensive Urgency

Patient Name: __________________________________ Date of Admission: ____________________________

Age: _____ Sex: _____ Room No. __________________ Attending Physician: __________________________

Eligibility Criteria: BP >180mmHg systole, >120mmHg diastole

Exclusion Criteria: With end-organ damage (HTN encephalopathy, ICH, Unstable angina, Acute MI, Acute LV
failure, Pulmonary edema, Dissecting aortic aneurysm, Progressive renal failure)

Elements of Care Day 1 Variance Sign when done

(Date: ___/___/___) AM PM EVE

1. Assessment/Monitoring Admit patient to room of choice

Complete history and PE

Initial vital signs
2. Co-morbidities □ Hypertension:
Meds: ______________________________________
______________________________________
□ Diabetes mellitus:
Meds: ______________________________________
______________________________________
□ Bronchial asthma/COPD:
Meds: ______________________________________
______________________________________
□ Others, specify: _______________________________
Meds: ______________________________________
______________________________________

3. Lab Test/Procedures CBC

BUN, creatinine, K+

FBS, Lipid profile

Chest x-ray, 12-lead ECG

Urinalysis
□
2-D echocardiogram with Doppler studies
□
Serum Ca+2, P+4
□
Others:
____________________________________________
____________________________________________
4. IV Fluids □ D5W □ PNSS □ D5NSS □ Others: ______________
□ 500 ml □ 1 L
□ 6 hrs □ 8 hrs □ 10 hrs □ 12 hrs □ 16 hrs □ _____ hrs
5. Treatment  Antihypertensive medication/s, specify dosage/s:
____________________________________________
____________________________________________
 Nicardipine drip: D5W 90 ml + Nicardipine 10 mg to run
at □ 0.5 □ 1.0 □ 1.5 □ 2.0 □ 2.5 □ 3.0 □ _____ mg/hr
6. Nutrition □ NPO □ Low salt low fat
□ Others, specify: _______________________________

7. Activity/Safety Complete bed rest

8. Consults Notify AP: Dr._________________________________

Notify MRODs: Drs.____________________________
□ Referral to Cardiologist: Dr.______________________

9. Psychosocial Education to patient and relatives

10. Patient and Family Secure consent for admission and care
Education 
Instruct relatives on admission procedures

Reassurance of patient and relatives of the present
status

1
VARIANCE CODES:
A. PATIENT/FAMILY
1. Patient’s medical condition
2. Patient/Family decision
3. No funds
4. Other reasons
B. PHYSICIAN
1. Medical order
2. Provider(s) decision
3. Provider(s) response time
4. Other reasons
C. HOSPITAL
1. Results/Data availability
2. Supplies/Equipment related
3. Appointment availability
4. Weekend/Holiday
5. Other reasons
D. ENVIRONMENT
1. Transportation availability
2. Home care availability
3. Other reasons

ADDENDUM:

Activated by:

_____________________________ __________________
Attending physician Date and time

Acknowledged by:

_____________________________ __________________ _____________________________ __________________

Resident-in-charge Date and time Nurse-in-charge Date and time

2
 MARY JOHNSTON HOSPITAL
Clinical Pathway for Hypertensive Urgency

Patient Name: __________________________________ Date of Admission: ____________________________

Age: _____ Sex: _____ Room No. __________________ Attending Physician: __________________________

PATIENT’S PROBLEM LIST AND NURSING DIAGNOSIS

#1 #3
#2 #4
Allergies

Elements of Care Day 2 Variance Sign when done

(Date: ___/___/___) AM PM EVE

1. Assessment/Monitoring Continue vital signs monitoring
2. Co-morbidities □ Hypertension:
Meds: ______________________________________
______________________________________
□ Diabetes mellitus:
Meds: ______________________________________
______________________________________
□ Bronchial asthma/COPD:
Meds: ______________________________________
______________________________________
□ Others, specify: _______________________________
Meds: ______________________________________
______________________________________
□
3. Lab Test/Procedures 2-D echocardiogram with Doppler studies
□
Others:
____________________________________________
____________________________________________
4. IV Fluids □ D5W □ PNSS □ D5NSS □ Others: ______________
□ 500 ml □ 1 L
□ 6 hrs □ 8 hrs □ 10 hrs □ 12 hrs □ 16 hrs □ _____ hrs
□ IVF to consume
5. Treatment  Antihypertensive medication/s, specify dosage/s:
____________________________________________
____________________________________________
□ Nicardipine drip: D5W 90 ml + Nicardipine 10 mg to run
at □ 0.5 □ 1.0 □ 1.5 □ 2.0 □ 2.5 □ 3.0 □ _____ mg/hr
□ Others, specify dosage/s:
____________________________________________
____________________________________________
____________________________________________
6. Nutrition □ NPO □ Low salt low fat
□ Others, specify: _______________________________

7. Activity/Safety Complete bed rest

8. Consults Update AP: Dr.________________________________

Notify MRODs: Drs.____________________________
□ Referral to Cardiologist: Dr.______________________

9. Psychosocial Education to patient and relatives

10. Patient and Family Reassurance of patient and relatives of the present
Education status

11. Discharge Planning BP goal: 120/80mmHg in 48-72 hours

3
ADDENDUM:

Activated by:

_____________________________ __________________
Attending physician Date and time

Acknowledged by:

_____________________________ __________________ _____________________________ __________________

Resident-in-charge Date and time Nurse-in-charge Date and time

4
 MARY JOHNSTON HOSPITAL
Clinical Pathway for Hypertensive Urgency

Patient Name: __________________________________ Date of Admission: ____________________________

Age: _____ Sex: _____ Room No. __________________ Attending Physician: __________________________

PATIENT’S PROBLEM LIST AND NURSING DIAGNOSIS

#1 #3
#2 #4
Allergies

Elements of Care Day 3 Variance Sign when done

(Date: ___/___/___) AM PM EVE

1. Assessment/Monitoring Continue vital signs monitoring
2. Co-morbidities □ Hypertension:
Meds: ______________________________________
______________________________________
□ Diabetes mellitus:
Meds: ______________________________________
______________________________________
□ Bronchial asthma/COPD:
Meds: ______________________________________
______________________________________
□ Others, specify: _______________________________
Meds: ______________________________________
______________________________________
□
3. Lab Test/Procedures 2-D echocardiogram with Doppler studies
4. IV Fluids □ D5W □ PNSS □ D5NSS □ Others: ______________
□ 500 ml □ 1 L
□ 6 hrs □ 8 hrs □ 10 hrs □ 12 hrs □ 16 hrs □ _____ hrs
□ IVF to consume
5. Treatment  Antihypertensive medication/s, specify dosage/s:
____________________________________________
____________________________________________
□ Nicardipine drip: D5W 90 ml + Nicardipine 10 mg to run
at □ 0.5 □ 1.0 □ 1.5 □ 2.0 □ 2.5 □ 3.0 □ _____ mg/hr
□ Others, specify dosage/s:
____________________________________________
____________________________________________
____________________________________________
6. Nutrition □ NPO □ Low salt low fat
□ Others, specify: _______________________________

7. Activity/Safety Complete bed rest

8. Consults Update AP: Dr.________________________________

Notify MRODs: Drs.____________________________
□ Referral to Cardiologist: Dr.______________________

9. Psychosocial Education to patient and relatives

10. Patient and Family Reassurance of patient and relatives of the present
Education status

11. Discharge Planning BP goal: 120/80mmHg in 48-72 hours

Fill-up discharge form

Issue home medications

Issue home instructions

Issue follow-up instructions

Defer discharge if with unresolved medical problems
ADDENDUM:

5
Activated by:

_____________________________ __________________
Attending physician Date and time

Acknowledged by:

_____________________________ __________________ _____________________________ __________________

Resident-in-charge Date and time Nurse-in-charge Date and time