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Adult II Complex > Pulmonary Hypertension > Flashcards

Pulmonary Hypertension Flashcards

1
Q

What is pulmonary hypertension

A

Elevated pulmonary artery pressure due to an increase in resistance to blood flow through pulmonary circulation

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2
Q

Pulmonary hypertension is progressive, ____ , ______

A

chronic, incurable

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3
Q

Pulmonary Artery Mean (PAM) pressures

A

> 25 mmHg at rest
30 mmHg with exercise

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4
Q

Patho

A

Pulmonary arteries are blood vessels that carry blood from RIGHT side of heart to the LUNGS. So when arterial pressure rises blood backs up into the right side of the heart causing Greater resistance makes RIGHT SIDE of heart WORK HARDER to PUSH blood through the pulmonary arteries causing -> RIGHT VENTRICLE to thicken (vasoconstriction) and become enlarged and eventually fail causing RIGHT SIDED HEART FAILURE.

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5
Q

Types of PH

A
  1. Primary - Idiopathic
  2. Secondary - Chronic increase pulmonary artery pressure from another disease. Enlarged RV due to disorder of respiratory system, COPD or Interstitial lung disease; or clot.
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6
Q

Clinical Manifestation of Pulmonary Hypertension

A

Dyspnea
Fatigue
Lethargy
Weakness
Chest pain (exerctional)
Dizziness, Syncope

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7
Q

Diagnostic Studies

A
  1. Right sided heart catheterization* - measures pressures of blood vessels in lungs
  2. ECG
  3. Chest CT/Spiral CT
  4. Pulmonary function tests (PFTs) = not done in hospital, only done outpatient
  5. Vasoactivity Test
  6. Ventilation/perfusion scan
  7. Echocardiogram
  8. Pulmonary angiography= used dye, so watch for patients with kidney problems.
  9. 6-minute walk test = Outpatient
  10. Serology tests
  11. Sleep study= sometimes coexist with people with sleep apnea. Encourage people to use Cpap or Bipap because can lead to heart failure/issues.
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8
Q

Complications

A
  1. Cor-pulmonale (Right ventricular hypertrophy)
  2. Heart failure (right sided)
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9
Q

Right Sided Heart Failure Clinical Manifestations

A

Edema
Ascites
Liver Enlargement
JVD
Increased Right Arterial Pressure

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10
Q

Medications

A

a) Calcium Channel blockers (Lowers blood pressure) - diltiazem, nifedipine

b) Endothelin receptor antagonists (decrease pulmonary vascular pressure) - bosentan and ambrisentan

c) PDE-5 inhibitors (Phosphodiesterase inhibitors) (causes blood vessels to relax and widen, improving circulation and lower bp)–*sildenafil
and tadalafil– oral agents *Viagra (vasodilation)

d) Vasodilators (IV or inhaled) – iloprost, Treprostinil (monitor for hypotension because vasodilators can cause b/p to drop. Headaches are common. Also educate pt on orthostatic hypotension)

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11
Q

More Meds

A

e) Anticoagulants: give pt with a-fib heparin drip
f) Diuretics: give diuretics because pt might have heart failure
g) Oxygen: educate patient not to cook on gas stove or smoke if on oxygen, light candles, etc.

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12
Q

What medication for you avoid for pts with this

A

beta blockers and decongestants

*it can bronchoconstrict them

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13
Q

If a patient is on Sildenafil, no ____

A

nitrates

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14
Q

Surgical management

Atrial septostomy

A

remove part of atrium to get rid of some hyperany of muscle.

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15
Q

Surgical management

Pulmonary thromboendarterectomy

A

removes clotted blood from the pulmonary arteries. Cleans out arteries, may put stent

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16
Q

Surgical management

Lung transplantation (whole lung transplant) or heart/lung
Transplant

A

last one

17
Q

Nursing interventions

A
  1. Vitals
  2. Clinical Manifestations for RSHF
  3. RR and breathing pattern
  4. Activity intolerance- varies
  5. Fluid balance- Restricting fluids and Sodium. Low albumin can cause fluids to leak. If pt is volume depleted bp will be low, HR will be high. Right atrial pressure will be low. If pt was volume depleted Sodium would be HIGH ex. 150 or 155
  6. Daily weight- : if pt gained like 5 pounds in a day that’s too much fluid/volume. Measure same time, same scale, usually happens on night shift.
18
Q

Actions

A

(a) Administer medications as ordered
(b) Na+ restriction= for HEART FAILURE pts

19
Q

Teaching

A

(a) Progressive disorder, no cure= teach them compliance, its key.
(b) What to report to the health care provider= When pt has more chest pains than usual.
(c) Signs and symptoms of right ventricular failure, monitor sodium and fluid intake
(d) Medications
(e) Activity limitations – may need handicapped
parking permit, avoid COLD temperature extremes with indoor and outdoor activities, Medic alert identifier (pulmonary arterial hypertension, other precautions)
(f) Portable oxygen and oxygen basics
(g) Support= case management, social support, social work, home health.

Adult II Complex (15 decks)

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