Lesson 6

PULMONARY HYPERTENSION

CONTENTS

I. Introduction
II. Assessment
a. Risk Factors / Predisposing Conditions
b. Clinical Manifestations
c. Diagnostic Examination/ Laboratory Tests
III. Treatment
IV. Nursing Intervention/Goals
V. Self Test / Self Directed Learning / Critical Thinking Drill
VI. References/Further Readings

I. Introduction
 Pulmonary hypertension is an increase in pressure in the blood vessels that carry blood to the lungs.
 Pulmonary arteries are the blood vessels that carry blood from heart to the lungs. These arteries can
narrow or become blocked or damaged, thus cannot carry as much blood to the lungs.
 This causes pressure to build up in the narrowed arteries and puts strain to the heart. Over time, this
weakens the heart, and can develop into heart failure.

II. Assessment

A. Risk Factors
a. Primary: Idiopathic (hereditary)
b. Secondary: (various conditions)
1. COPD
2. Congestive heart failure
3. Birth defects in the heart
4. Blood clots in the pulmonary arteries
5. Liver disease/cirrhosis
6. Connective tissue diseases such as lupus or scleroderma
7. Pulmonary fibrosis (a condition that causes scarring in the lungs)
8. Certain medicines or street drugs
B. Clinical Manifestations
1. Lightheadedness
2. Increased shortness of breath, with or without activity
3. Fatigue
4. Chest pain
5. Increased HR
6. Decreased appetite
7. Dizziness or fainting
8. Swelling of the ankles, legs and abdomen
9. Cyanosis

C. Diagnosis
1. Chest X-ray, CT scan or MRI
2. Pulmonary function test
3. Echocardiogram

III. Treatment
a. Diuretics: to reduce fluid build-up in your body.
b. Anticoagulants: prevent blood clots from forming or getting bigger.
c. Oxygen therapy: assists in elevating oxygen levels
d. Digitalis: to improve heart’s pumping action
e. Vasodilators: to increase passage and decrease pressure
f. Atrial septostomy – an open-heart surgery wherein an opening between the two atria of the heart
is created, effectively relieving the pressure in the right ventricle of the heart
g. Transplantation – this can be a lung or a heart-and-lung organ transplant that are done for people
with idiopathic PAH

IV. Nursing Intervention

Goal No. 1: To maintain adequate cardiac output
1. Assess the patient’s vital signs and characteristics of heartbeat at least every 4 hours. Assess heart
sounds via auscultation.
2. Observe for signs of decreasing peripheral tissue perfusion such as slow capillary refill, facial
pallor, cyanosis, and cool, clammy skin
3. Administer supplemental oxygen, as prescribed. Discontinue if SpO2 level is within the target
range, or as ordered by the physician.
 4. Educate patient on stress management, deep breathing exercises, and relaxation techniques

Goal No. 2: To demonstrate relief of pain as evidenced by a pain score of 0 out of 10, stable vital signs,
and absence of restlessness.

1. Administer prescribed medications that alleviate the symptoms of pain. Aspirin may be given to
reduce the ability of the blood to clot, so that the blood flows easier through the narrowed
arteries. Nitrates may be given to relax the blood vessels. Other medications that help treat chest
include anti-cholesterol drugs (e.g. statins), and calcium channel blockers.
2. Assess the patient’s vital signs and characteristics of pain at least 30 minutes after administration
of medication.
3. Elevate the head of the bed if the patient is short of breath. Administer supplemental oxygen, as
prescribed. Discontinue if SpO2 level is within the target range, or as ordered by the physician.
4. Place the patient in complete bed rest when in severe pain. Educate patient on stress management,
deep breathing exercises, and relaxation techniques.