D.Y.

Patil Education Society (Institution deemed to be university)

D.Y. Patil College of Nursing, Kolhapur

LESSON PLAN
ON
Portal hypertension
Submitted by :
Mrs.Susmita Mark Dhanawade
MSc Nursing 1ST Year

Submitted to :
Mr. Rohan Phape
Assist. Professor
Dept Of Medical Surgical Nursing
Submitted on:
Programme : M.Sc. Nursing
Subject : Medical Surgical Nursing
Topic : Portal Hypertension
Group : 2nd Year Bsc Nursing
Teaching method : Lecture cum discussion
A.V.Aids : Black board, projector, charts, flash
cards
Student teacher : Mrs. Susmita Dhanawade
Guide : Mr. Rohan Phape
Evaluator : Mr. Rohan Phape
Venue : 2nd year B.Sc. (N) D Y Patil college of
nursing
Date :
Time :

Previous Knowledge of the students:

Students may have some knowledge regarding portal hypertension.

General objective:
At the end of the class, students will be able to gain adequate knowledge
regarding portal hypertension, its definition, aetiology, clinical manifestation.
This factors that the Physiology and management
Specific Objectives:

At the end of this session, the student will be able to

1. Define Portal hypertension.

2. Enumerate the Etiology and risk factors of portal hypertension.

3. Discuss in detail about the pathophysiology of portal hypertension

4. Explain about complication of portal hypertension.

5. Explain about clinical manifestation of hypertension.

6. Enlist diagnostic evaluation of portal hypertension.

7. Explain in detail about the management of portal hypertension.

8. Explain in detail about the nursing management of portal hypertension

Bibliography:

1. Smeltzer, S. C., Bare, B. G., Hinkle, J. L., & Cheever, K. H. (2010).

Brunner and Suddath’s textbook of medical-surgical nursing (12th ed.).
Philadelphia: Lippincott Williams & Wilkins.

2. Sommers m, Johnson s, beery t. DISEASES AND DISORDERS

DISEASES AND DISORDERS A Nursing Therapeutics Manual. 3rd ed.
Philadelphia: F. A. Davis Company; 2007.

3. Smeltzer, S. C., Bare, B. G., Hinkle, J. L., & Cheever, K. H. (2010).

Brunner and Siddharth’s textbook of medical-surgical nursing (10th ed.).
Philadelphia: Lippincott Williams & Wilkins.

4. Williams l, hopper p. Understanding medical surgical nursing. 5th ed.

Philadelphia: f.a. Davis company; 2011.

5. Kasper, Braunwald, Fauci, Harrison’s principles of internal medicine.

16th ed. New Delhi: McGraw-Hill medical publishing division; 2005
Srno Time Specific Content Teacher Studen AV Evaluatio
. Objective ’s t’s aids n
s Activity Activit
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1. 1 Self SELF INTRODUCTION Listenin
min introducti Good afternoon, everybody. I Mrs. Susmita Mark g
on st
Dhanawade, student of M.Sc. (N) 1 year.
As a part of my curriculum, I will be engaging your
class today.
We are today going to look forward on portal
hypertension.

2. 2min Explainin Anatomy Explaini Listenin

g the ng g
Portal vein This is formed by the union of several
anatomy.
veins each of which drains blood from the area
supplied by the corresponding artery: The splenic vein
drains blood from the spleen, the pancreas and part of
the stomach. The inferior mesenteric vein returns the
venous blood from the rectum, pelvic and descending
colon of the large intestine. It joins the splenic vein.
The superior mesenteric vein returns venous blood
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from the small intestine and the proximal parts of the
large intestine, i.e. the caecum, ascending and
transverse colon. It unites with the splenic vein to
form the portal vein. The gastric veins drain blood
from the stomach and the distal end of the
oesophagus, then join the portal vein. The cystic vein,
which drains venous blood from the gall bladder, joins
the portal vein

3. 2min Define the DEFINE Explaining Listening Roller

portal and board
hypertension. Portal hypertension exist when there is a persistent answering
increase in blood pressure in the portal venous system
occurring as a result of increased resistance to or
obstruction blood flow through the portal venous
system into a liver.
The normal portal pressure is 5 to 10 mm of Hg.

4. 7 min. Enumerat ETIOLOGY AND RISK FACTORS: Explaini Listenin Pamp

e the -Increased resistance of flow. ng g and hlet
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etiology -Presinusoidal obstruction writing
and risk -Portal vein obstruction
factors. -Schistosomiasis
-Congenital hepatitis fibrosis
-Sarcoidosis
-Cirrhosis
-Alcoholic hepatitis
-Increased portal blood flow
-Arterioportal fistula
-Constructive pericarditis

PATHOPHYSIOLOGY: Explaini Listenin Chart

5. 7 min
Describin ng g and
g Due To Cause (Main Cause Is Cirrhosis) answeri
pathophys ng
Increased Resistances
iology of
portal
hypertensi
on. Obstruction (Outside The Liver Or Within In)

Increase Inflow Beyond The Capacity Of The

Complaint Portal Vessels To Absorb
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5. 05 min Describin Clinical manifestation: Explaini Listenin Hand

g the ng g and outs
clinical -An enlarged and palpable spleen. answeri
manifestat ng
-oedema on the leg
ions of questio
portal - blood in vomit ns
hypertensi
on. - blood in stool

- rapid weight gain

- Bruits(may be heard in upper abdomen)

05 min
6. COMPLICATIONS:
Explaine Listenin
 Variceal bleeding d and g and Chart
 Congestive gastropathy asking answeri
 Hypersplenism question ng.
Explain  Ascites s
the  Iron deficiency anemia
complicati  Renal failure
ons of
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portal  Hepatic encephalopathy.
hypertensi
on.
7. 5 min Explain Diagnostic Evaluation: Explaini Listenin PPT
the ng g And
diagnostic History and Physical Examination constitutional questio
evaluation complaints such as weight loss, malaise, and weakness ning
of portal - past history of chronic alcoholism, hepatitis,
hypertensi complicated biliary disease-exposure to hepatotoxins
on leads one to include cirrhosis in the differential
diagnosis.

 USG-

-splenomegaly, ascites and anatomy of intra

and extrahepatic portal vessels

-Reverse flow or significantly decreased blood

flow velocity or the detection of portocaval
collaterals are reliable findings in portal
hypertension.

 Elastography-liver and spleen stiffness

measurement with different elastography for
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the assessment of the presence and severity of

portal hypertension.
 Endoscopic Examinations
 Liver biopsy
 Portal vein blood pressure determination.

8. 5min MANAGEMENT : Explaine Listenin PPT What is

Explain Medical management – d and g and sclerothera
the - Control haemorrhage: asking answeri py?
managem - Sclerotherapy: - question ng
ent of To perform sclerotherapy, the operator passé s
portal endoscope into the esophagus and injects a sclerosing
hypertensi agents.
on. - Vasopressin: -
-IV administration to stop variceal bleeding
-to achieves temporary lowering of pressure
-Beta adrenergic blocking agent: -
- in the management of acute variceal
bleeding in limited because they reduce heart rate.
-Balloon tamponade: -
-applying pressure to ruptured varices via
balloon tamponade may stop haemorrhage.
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Surgical Management: -
-endoscopic bond ligation
-trans jugular intrahepatic portosystemic shunt
-portosystemic shunt

Nursing Management

9. 5 min.
1.Diagnosis: -

Ineffective tissue perfusion related to portal

hypertension and rupture and haemorrhage of
esophageal varices.

Outcomes: -
Explain
the Haemorrhage will be controlled as evidenced by the Explaini Listenin
nursing return of vital signs to normal and no further ng g and
managem bleedings. taking
ent of notes
portal Intervention: -
hypertensi
-Prevent haemorrhage
on.
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-Avoid straining maneuvers that increase intra-

abdominal or intra thoracic pressure

-Avoid rough food

-Develop emergency plan

-Monitor for haemorrhage

2.Diagnosis: -

Impaired gas exchange related to decreased oxygen

supply secondary to aspiration pneumonitis or
obstruction occurring after balloon tamponade with
the Sengstaken-Blakemore tube.

Outcome:-

The client will not suffer injury related to Sengstaken-

Blakemore to as evidenced by the absence of
respiratory distress, the absence of aspiration and the
absence of esophageal ischemia.

Intervention:-
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-Prevent esophageal necrosis

-prevent aspiration pneumonia

-prevent airway obstruction

5. 3 min Summary:
I would like to summarize my topic. So today in this
topic, we have studied about portal hypertension, its
definition, etiology, clinical manifestations. risk
factors, pathophysiology and management.

I.ASSIGNMENT: Write Down Nursing Care Plan On Portal Hypertension