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Pulmonary Hypertension Pulmonary hypertension is a condition that is not clinically evident until late in the disease.

The systolic pulmonary arterial pressure exceeds 30mmHg,and the mean pulmonary artery pressure is higher than 225mmHg at rest or 30mmHg with activity or exercise

Pathophysiology Predisposing: Risk factors: Advanced age congenital heart disease Portal hypertension Vascular disease Pulmonary Hypertension Primary Pulmonary Hypertension Secondary Pulmonary Hypertension (Idiopathc) Blood Right ventricle Obs tructed pulmonary vascular bed Impaired blood flow Increased blood flow Pulm onary artery pressure increased Increased pulmonary vascular resistance Impaired gas exchange s/sx: dyspnea,weakness,fatigue, hemoptysis,distended neck vein crackles

4. In an ECG test. tall anterior R waves and ST-segment depression. Obtain the complete history the client regarding the drugs and past illnesses 3. the electrical impulses made while the heart is beating are recorded and usually shown on a piece of paper. Result: The ECG for pulmonary hypertension reveals right ventricular hypertrophy. Assist client while preparing for the test . which is the natural pacemaker of the heart. and records any problems with the heart's rhythm. The signals that make the heart's muscle fibres contract come from the sinoatrial node.Explain the procedure to the client 2. The heart is a muscular organ that beats in rhythm to pump the blood through the body. right axis deviation and tall peaked P waves in inferior leads. and the conduction of the heart beat through the heart which may be affected by underlying heart disease.Diagnostic Procedure ECG(Echocardiogram) Test that measures the electrical activity of the heart. Specific indication # t is a good idea to have an ECG in the case of symptoms such as dyspnea (difficulty in breathing). 1.Review medical record. chest pain (angina).T-wave inversion or both anteriorly. This is known as an electrocardiogram. Nursing resp. palpitations or when someone can feel that their own heart beat is abnormal. fainting.

Activity Intolerance r/t imbalance between oxygen supply and demand Anxiety r/t change in health status 2 3 . It is ranked 2nd because it may cause client to become unable to his/her activity of daily living This is the third prioritized nursing problem because worrying about his condition may cause further emotional stress.PRIORITIZATION Nursing Diagnosis Impaired gas exchange r/t increase pulmonary resistance Prioritization 1 Ratonale This is 1st prioritized problem because based on the ABC airway and breathing must be managed first.

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respiratory incentive distress spirometry and postural drainage -Elevate head of bed/position client appropriately -Maintain adequate intake and output DEPENDENT: GOAL RATIONALE EVALUATION After 30 -helps limit mimutes of oxygen nursing needs/consumpti intervention on client have adequate oxygenation -to manage oxygen therapy -promotes chest expansion. -To improve ventilation. from signs and -Provide symptoms of nebulizers.CUES Subjective: “Hirap ako huminga” as verbalized by the client NURSING DIAGNOSIS Impaired gas exchange r/t increase pulmonary resistance SCIENTIFIC EXPLANATION Obstructed pulmonary vascular bed Impaired blood flow Objective: Dyspnea Restlessness VS: BP:140/90 Temp:36.8 PR:102 RR:23 Increased blood flow Pulmonary artery pressure increased Increased pulmonary vascular resistance Impaired gas exchange NURSING INTERVENTION After 30 INDEPENDENT: mimutes of -Promote client nursing adequate rest intervention and limit client will have activities within adequate client tolerance oxygenation -Assess for hypoxia(pulse oximetry) -Monitor VS After 24 hours of -Encourage nursing client deepintervention rbeathng client will be free exercise. -to maintain airway -To mobilize if there is secretions -To treat condition After 24 hours of nursing intervention client will is free from signs and symptoms of respiratory distress .

-Administer oxygen COLLABORATIVE : -Assist with procedures -to improve respiratory function/oxygen carrying capacity.-Administer medication as prescribed by the physician. .

8 PR:102 RR:23 NURSING DIAGNOSIS Activity Intolerance r/t imbalance between oxygen supply and demand SCIENTIFIC EXPLANATION Decreased blood flow Powerlessness Activity intolerance GOAL After 4 hours of NI. the client report increase Reduce fatigue in activity tolerance After 2 days of Help minimize nursing frustration and intervention the rechannel client participate energy willingly in desired activities .CUES Subjective: “Medyo hindi ko magawa ang dati kong gawain“ as verbalized by the client Objective: Pallor BP:140/90 Temp:36. the client will be able to report increase in activity tolerance NURSING INTERVENTION Adjust activities Plan care to balance the rest periods RATIONALE >Prevent exertion EVALUATION Provide client After 2 days of adequate rest nursing period intervention the client will be able to Promote comfort Enhance ability participate measure to participate in willingly in activities desired activities over After 4 hours of NI.

RATIONALE -To reduce anxiety EVALUATION After 2 hours of nursing intervention client to identify ways to deal with and express anxiety.CUES Subjective: “Nagaalala ako sa puwedeng mangyari sa akin” as verbalized by the client Objective: -worried -restless -anxious BP:130/90 TEMP. After 24 hours of nursing intervention client will be able to report anxiety is reduced to a manageable level.8 RR:23 PR:102 NURSING DIAGNOSIS Anxiety r/t change in health status SCIENTIFIC EXPLANATION GOAL After 2 hours of nursing intervention client will be able to identify ways -Encourage to deal with and patient to express anxiety. . After 24 hours of nursing intervention client report anxiety is reduced to a manageable level. -To help release tension -Helps client to identify what is reality based -For clients awareness -Explain therapy and describe how to recognize untoward effects early. express feelings and concerns. -Answer clients question concisely and accurately. NURSING INTERVENTION -Provide client comfort and rest periods.36.

-Anorexia. abdominal pain. diarrhea. IX. headache. Fever. asthenia. dermatitis. taste disturbance. VII. FREQUENCY 2-10 mg daily MECHANISM OF ACTION Interferes with hepatic synthesis of vitamin Kdependent coagulation factors (II. vomiting. flatulence. mouth ulcers NURSING RESPONSIBILIT IES -Review patients medical record -Monitor for signs and symptoms of bleeding -Monitor VS -Check for presence of rash . pulmonary embolism and thromboembolic disorders. stroke -Rash. nausea. stomach cramps. gastrointestinal bleeding.DRUG Generic Name: Warfarin Brand name: Coumadin CLASSIFICATIO N/ INDICATON Anticoagulant Prophylaxis and treatment of venous thrombosis. -bleeding. DOSE. dizziness.ROUTE. X) CONTRAINDICA SIDE EFFECTS TION Hypersensitivity to warfarin or any component of the formulation. malaise. lethargy. pain.