Pulmonary HTN

Question 1

define Pulmonary hypertension

Answer 1

• Elevated pulmonary artery pressure due to an increase in resistance to blood flow through pulmonary circulation
• Progressive, chronic, incurable
• Pulmonary artery mean (PAM) pressures >25 mmHg at rest, and >30 mmHg with exercise )

Question 2

what are the 2 types of pulmonary hypertension

Answer 2

primary pulmonary hypertension (PPH)

secondary pulmonary hypertension

Question 3

what is primary pulmonary hypertension (PPH)

Answer 3

no lung disorder and cause is unknown (idiopathic)

Question 4

what is secondary pulmonary hypertension

Answer 4

• Chronic increase pulmonary artery pressure from another disease
• Enlarged RV due to disorder of respiratory system; COPD

Question 5

clinical manifestations of pulmonary hypertension

Answer 5

1. Dyspnea (exertional dyspnea progressing to dyspnea at rest)
2. Fatigue
3. Lethargy
4. Chest pain (exertional)
5. Dizziness, syncope

Question 6

diagnostic studies used for pulmonary hypertension

Answer 6

1. Right sided heart catheterization*
   
   2. ECG
   3. Chest CT/Spiral CT
   4. Pulmonary function tests (PFTs)
   5. Vasoactivity Test
   6. Ventilation/perfusion scan
   7. Echocardiogram
      8. Pulmonary angiography
   8. 6-minute walk test
   9. Serology tests
   10. Sleep study

Question 7

complications of pulmonary hypertension

Answer 7

Cor-pulmonale (Right ventricular hypertrophy)

Heart failure (right-sided)

Question 8

management of pulmonary hypertension): medications

Answer 8

a) Calcium Channel blockers - diltiazem, nifedipine
b) Endothelin receptor antagonists - bosentan and ambrisentan
c) PDE-5 inhibitors (Phosphodiesterase inhibitors) –*sildenafil
and tadalafil– oral agents *Viagra
d) Vasodilators (IV or inhaled) – iloprost, treprostinil
e) Anticoagulants
f) Diuretics
g) Oxygen

Question 9

management of pulmonary hypertension): medical management

Answer 9

a) Oxygen (target O2 sat 90%)
b) Symptom limited physical activity

Note:

(1) Avoid use of beta-blockers, decongestants
(2) If on sildenafil – no nitrates

Question 10

management of pulmonary hypertension): surgical management

Answer 10

a) Atrial septostomy
b) Pulmonary thromboendarterectomy
c) Lung transplantation (whole lung transplant) or heart/lung
Transplant

Question 11

nursing diagnoses for pulmonary hypertension

Answer 11

(1) Impaired gas exchange r/t ventilation/perfusion mismatch
(2) Activity intolerance
(3) Decreased cardiac output

Question 12

nursing assessment for pulmonary hypertension

Answer 12

(a) Vital signs
(b) Manifestation RHF
(c) Respiratory rate, breathing pattern
(d) Oxygen saturation
(e) Activity tolerance
(f) Fluid balance
(g) Daily weight

Question 13

nursing actions for pulmonary hypertension

Answer 13

(a) Administer medications as ordered

(b) Na+ restriction

Question 14

nursing teaching for pulmonary hypertension

Answer 14

(a) Progressive disorder, no cure
(b) What to report to the health care provider
(c) Signs and symptoms of right ventricular failure, monitor sodium and fluid intake
(d) Medications
(e) Activity limitations – may need handicapped parking permit, avoid temperature extremes with indoor and outdoor activities, Medic alert identifier (pulmonary arterial hypertension, other precautions)
(f) Portable oxygen and oxygen basics
(g) Support