Reference no: EM131614742

Joan smith, a 55year old, is a female patient who presents to the intensive care unit with. antihypertensive suddenly because of the cost of the medications and she recently lost her job to outsourcing. The patient is slightly drowsy and complain of headache and blurring vision. The patient's blood pressure is 220/130 mm Hg upon presentation. The physician orders nicardipine hydrochloride 25mg/250ml, NS for peripheral IV starting at 2.5mg/hr, and titrate by 2.5mg/hr every 15 minutes to reach the goal for the first hour, which is to achieve 25% reduction of the initial MAP.

• Call the physician if the dosing range of 15mh/hr has been reached and the MAPis still not at target goal for the first hour treatment or up to four dose increases.
• Lower the BP within 6hours to 160/100mmhg
• Adjust the IV rate so that the IV fluids plus the nicardipine drip are equal to100ml/hr. in total. Cal the physician if the IV fluids must go above 100ml/hr to provide the nicardipine.

a. Explain what rate to set initially for both the nicardipine drip and the NS maintenance fluids

b. Explain the process of titrating the nicardipine drip for the first hour to achieve the final MAP goal of 25% reduction of the original MAP