PULMONARY HYPERTENSION (2) SYMPTOMS

• Is a type of high blood pressure that affects the arteries in the lungs and
the right side of the heart. In one form of pulmonary hypertension,
called pulmonary arterial hypertension (PAH).
• Pulmonary hypertension is dangerous because it disrupts the flow of
blood through the heart and lungs.
• High blood pressure in the pulmonary arteries causes these arteries to
become narrow. As a result, the heart must work harder to pump
oxygen-poor blood to your lungs.
• Over time, PH damages the heart and causes problems throughout the
body. It can be fatal without treatment. CLINICAL PRESENTATION
• The symptoms of pulmonary hypertension develop slowly. You may
not notice them for months or even years. Symptoms get worse as
the disease progresses.
1. Shortness of breath, at first while exercising and
eventually while at rest.
2. Blue or gray skin color due to low oxygen levels. Chest
pressure or pain.
3. Dizziness or fainting spells (syncope)
4. Fast pulse or pounding heartbeat.
5. Fatigue.
6. Swelling in the ankles, legs and belly area.

• Mean Pulmonary Arterial Pressure is ≥ 25 mmHg • Look for evidence of Right Heart Failure
1. Jugular venous distention
2. Ascites
ANATOMY 3. Hepatomegaly
4. Pedal edema
5. Loud S2 sound
Classic Symptom of pulmonary hypertension is exertional dyspnea.

RISK FACTORS
• Pulmonary hypertension is usually diagnosed in people ages
30 to 60.
1. A family history of the condition.
2. Being overweight.
3. Smoking.
4. Blood-clotting disorders or a family history of blood clots
5. Exposure to asbestos.
6. Congenital heart defect.
7. Living at a high altitude.
8. Use of certain drugs, including some weight-loss medicines and
illegal drugs such as cocaine or methamphetamine.

PATHOPHYSIOLOGY COLLABORATIVE MANAGEMENT

Assessment
*Types of Pulmonary Hypertension
− Nursing History
• Type I – hypertension is caused by blood vessels that are highly − Physical examination
vasoconstricted. − Diagnostic assessment:
− Increase in the peripheral vascular resistance will give strain 1. Chest X-ray- rule out Type 3
to the right side of the heart causing it to hypertrophy (cor 2. ECG – look for hypertrophy
pulmonale), eventually right sided heart failure. 3. Echocardiography – rule out Type 2
Causes: 4. V/Q Scan or pulmonary angiography – rule out Type 4
1. Idiopathic (diagnosis of exclusion) 5. High resolution CT scan-rule out Type 3 & 5
2. Hereditary – BMPR2 gene
3. Connective tissue disease (SLE, Scleroderma) Right Sided Heart Failure
4. HIV
5. Portal Pulmonary Hypertension (damaged liver)
6. Left-Right shunting (patent foramen ovale)

• Type II – Due to Left heart diseases

− Left sided heart failure increases pulmonary venous
backflow that leads to congestion, increases the
pulmonary artery pressure, strains the heart, causing – – The right lung has nearly no
right heart failure. blood flow. The left lung has multiple
• Type III – Due to Lung diseases wedge shaped blood flow defects
− In lung diseases like COPD, there are areas in the lungs
that are poorly ventilated. Blood does not go to these  A ventilation/perfusion lung scan, also called a V/Q lung scan, or
areas of low ventilation so blood vessels constrict. ventilation/perfusion scintigraphy, is a type of medical imaging using
Decreased ventilation leads to hypoxic scintigraphy and medical isotopes to evaluate the circulation of air and
vasoconstriction, increasing resistance. blood within a patient's lungs, in order to determine the
• Type IV – Due to chronic blockage ventilation/perfusion ratio.
− Pulmonary emboli increases the resistance due to the
clot that blocks the blood vessel.
• Type V – Due to granuloma (sarcoidosis), or tumor
− Granuloma compresses the blood vessels increasing
the resistance
 • Medications
• Oxygen Therapy
Independent nursing Interventions
• Health Teaching
• Health Promotion

NON-SURGICAL MANAGEMENT

• • Pulmonary function Medications

tests (PFTs) are noninvasive tests 1. Vasodilators – to relax the blood vessels, thereby opening the narrowed
that show how well the lungs are blood vessels and improve blood flow
working.  (Iloprost (Ventavis) and treprostinil (Tyvaso)
• Includes
• Spirometry. A spirometer is a device with a 2. Guanylate cyclase (GSC) stimulators – to increase the level of nitric
mouthpiece hooked up to a small electronic machine. oxide which can relax the pulmonary arteries, thereby decreasing the
• Plethysmography. You sit or stand inside an air-tight pressure in them.
box that looks like a short, square telephone booth to  (Adempas, riociguat, vericiguat, Verquvo)
do the tests.
3. Phosphodiesterase inhibitors - are medications that cause blood
Laboratory Assessment vessels to relax and widen, improving circulation and lowering blood
• Liver Function Test (ALT, albumin, AST) pressure
• HIV testing (NATs)  (Sildenafil, Tadalafil)- avoid use with nitrates or alpha
• Antinuclear Antibodies (ANA) blockers, (↓BP)
• Scleroderma Antibodies
4. Endothelin receptor antagonists – to stop the endothelin from
Right Heart Catherization narrowing the arterial walls
 (ambrisentan (Volibris), bosentan (Tracleer),
• A special catheter (a small, macitentan (Opsumit)
hollow tube) called a
pulmonary artery (PA) 5. Calcium channel blockers – to relax the muscles in the arterial walls
catheter is inserted to the  (Nifedipine, Diltiazem)
right side of your heart,
passes the tube into the 6. Anticoagulants (usually warfarin) – to reduce the formation of blood
pulmonary artery and observe clots in the pulmonary arteries.
blood flow through heart and
measures the pressures inside 7. Digoxin – to help the heart pump more blood and treat arrhythmias,
the heart and lungs. under genus digitalis, in the cardiac glycosides family.
 (Lanoxin)
Planning and Implementation
8. Diuretics – to reduce excess fluid in the body through urination, thereby
Nursing Diagnoses decreasing cardiac workload
1. Ineffective Breathing Pattern  CAUTION
2. Decreased cardiac output related to arrhythmias secondary to − Diuretics remove excess fluid from the body. Many
pulmonary hypertension diuretics can cause potassium loss. A low level of
3. Acute Pain related to increased strain in cardiac muscles secondary potassium in the body can increase the risk of digitalis
to pulmonary hypertension toxicity.
4. Impaired Physical Mobility related to edema of lower extremities − Therefore, nurses should include in patient teaching the
secondary to pulmonary hypertension following:
5. Activity Intolerance • Maintain adequate hydration.
6. Fatigue • Observe for signs and symptoms of toxicity. First
symptoms of toxicity usually include abdominal
Nursing Diagnoses pain, anorexia, nausea, vomiting, visual
1. Ineffective Breathing Pattern disturbances, bradycardia, and other arrhythmias.
2. Decreased cardiac output related to arrhythmias secondary to
pulmonary hypertension
3. Acute Pain related to increased strain in cardiac muscles secondary
to pulmonary hypertension SURGICAL MANAGEMENT
4. Impaired Physical Mobility related to edema of lower extremities
secondary to pulmonary hypertension 1. Atrial septostomy – an open-heart surgery wherein an opening
5. Activity Intolerance between the two atria of the heart is created, effectively relieving the
6. Fatigue pressure in the right ventricle of the heart

2. Transplantation – this can be a lung or a heart-and-lung organ

transplant that are done for people with idiopathic PAH.

NURSING INTERVENTIONS SPECIFIC NURSING INTERVENTIONS

Dependent Nursing Interventions Lifestyle changes.

 • A low cholesterol, low fat diet to control cholesterol and
triglyceride levels is needed for a patient with pulmonary
hypertension.
• Weight management, reduced alcohol intake, and smoking
cessation
• Increased physical activity by doing at least 150 minutes of
moderate aerobic exercises will help promote an active lifestyle.
• Patients with pulmonary hypertension should avoid living or
traveling at high altitude.
• Educate patient on stress management, deep breathing exercises,
and relaxation techniques.

For Decreased Cardiac Output

• Assess the patient’s vital signs and characteristics of heartbeat at
least every 4 hours.
• Assess heart sounds via auscultation. Observe for signs of
decreasing peripheral tissue perfusion such as slow capillary refill,
facial pallor, cyanosis, and cool, clammy skin
• Administer prescribed medications for pulmonary hypertension.

For Ineffective Breathing Pattern

• Assess and monitor the patient’s respiratory status every 2 hours.
Document the respiratory rate, depth, and breath sounds via
auscultation
• Assist the patient in a sitting, semi-fowler’s, or high Fowler’s
position as tolerated.
• Administer supplemental oxygen, as prescribed. Discontinue if SpO2
level is within the target range, or as ordered by the physician.

For Impaired Physical Mobility

• Assess the patient’s functional level of mobility using the Bedside
Mobility Assessment Tool.
• Assess and monitor the skin integrity of both lower extremities.
Note for redness, degree of swelling, and ischemia, especially on
the bony prominences.
• Assess all joints in performing range of motions.
• Provide safety