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
Diagnostic Procedure

ECG(Echocardiogram)

Test that measures the electrical activity of the heart. The heart is a
muscular organ that beats in rhythm to pump the blood through the
body. The signals that make the heart's muscle fibres contract come
from the sinoatrial node, which is the natural pacemaker of the heart.

In an ECG test, the electrical impulses made while the heart is beating
are recorded and usually shown on a piece of paper. This is known as
an electrocardiogram, and records any problems with the heart's
rhythm, and the conduction of the heart beat through the heart which
may be affected by underlying heart disease.

Specific indication
# t is a good idea to have an ECG in the case of symptoms such as
dyspnea (difficulty in breathing), chest pain (angina), fainting,
palpitations or when someone can feel that their own heart beat is
abnormal.

Result: The ECG for pulmonary hypertension reveals right ventricular

hypertrophy, right axis deviation and tall peaked P waves in inferior
leads; tall anterior R waves and ST-segment depression,T-wave
inversion or both anteriorly.

Nursing resp.
1.Explain the procedure to the client
2. Obtain the complete history the client regarding the drugs and past
illnesses
3.Review medical record.
4. Assist client while preparing for the test
PRIORITIZATION

Nursing Diagnosis Prioritization Ratonale

Impaired gas 1 This is 1st prioritized
exchange r/t increase problem because
pulmonary resistance based on the ABC
airway and breathing
must be managed
first.
Activity Intolerance r/t 2 It is ranked 2nd
imbalance between because it may cause
oxygen supply and client to become
demand unable to his/her
activity of daily living
Anxiety r/t change in 3 This is the third
health status prioritized nursing
problem because
worrying about his
condition may cause
further emotional stress.
 CUES NURSING SCIENTIFIC GOAL NURSING RATIONALE EVALUATION
DIAGNOSIS EXPLANATION INTERVENTION
Subjective: Impaired gas Obstructed After 30 INDEPENDENT: After 30
“Hirap ako exchange r/t pulmonary mimutes of -Promote client -helps limit mimutes of
huminga” as increase vascular bed nursing adequate rest oxygen nursing
verbalized by pulmonary intervention and limit needs/consumpti intervention
the client resistance client will have activities within on client have
Impaired blood adequate client tolerance adequate
flow oxygenation -Assess for oxygenation
hypoxia(pulse -to manage
Objective: Increased blood oximetry) oxygen therapy
Dyspnea flow -Monitor VS
Restlessness After 24 hours of -Encourage After 24 hours of
VS: Pulmonary nursing client deep- -promotes chest nursing
BP:140/90 artery pressure intervention rbeathng expansion. intervention
Temp:36.8 increased client will be free exercise. client will is free
PR:102 from signs and -Provide -To improve from signs and
RR:23 Increased symptoms of nebulizers, ventilation. symptoms of
pulmonary respiratory incentive respiratory
vascular distress spirometry and distress
resistance postural -to maintain
drainage airway
-Elevate head of
Impaired gas bed/position
exchange client -To mobilize if
appropriately there is
-Maintain secretions
adequate intake
and output -To treat
DEPENDENT: condition
-Administer
medication as
prescribed by
the physician.
-Administer -to improve
oxygen respiratory
COLLABORATIVE function/oxygen
: carrying
-Assist with capacity.
procedures
 CUES NURSING SCIENTIFIC GOAL NURSING RATIONALE EVALUATION
DIAGNOSIS EXPLANATION INTERVENTION
Subjective: Decreased blood After 4 hours of Adjust activities >Prevent over After 4 hours of
Activity flow NI, the client will exertion NI, the client
“Medyo hindi ko Intolerance r/t be able to report increase
magawa ang imbalance Powerlessness report increase Plan care to Reduce fatigue in activity
dati kong between oxygen in activity balance the rest tolerance
gawain“ as supply and Activity tolerance periods After 2 days of
verbalized by demand intolerance Help minimize nursing
the client Provide client frustration and intervention the
After 2 days of adequate rest rechannel client participate
nursing period energy willingly in
Objective: intervention the desired activities
Pallor client will be
BP:140/90 able to Promote comfort Enhance ability
Temp:36.8 participate measure to participate in
PR:102 willingly in activities
RR:23 desired activities
 CUES NURSING SCIENTIFIC GOAL NURSING RATIONALE EVALUATION
DIAGNOSIS EXPLANATION INTERVENTION
Subjective: Anxiety r/t After 2 hours of -Provide client -To reduce After 2 hours of
“Nagaalala ako change in health nursing comfort and rest anxiety nursing
sa puwedeng status intervention periods. intervention
mangyari sa client will be able client to identify
akin” as to identify ways -Encourage ways to deal with
verbalized by the to deal with and patient to -To help release and express
client express anxiety. express feelings tension anxiety.
and concerns,

Objective: After 24 hours of -Answer clients -Helps client to After 24 hours of

-worried nursing question identify what is nursing
-restless intervention concisely and reality based intervention
-anxious client will be able accurately. client report
BP:130/90 to report anxiety -For clients anxiety is
TEMP.36.8 is reduced to a -Explain therapy awareness reduced to a
RR:23 manageable and describe manageable
PR:102 level. how to recognize level.
untoward effects
early.
DRUG CLASSIFICATIO DOSE,ROUTE, MECHANISM CONTRAINDICA SIDE EFFECTS NURSING
N/ FREQUENCY OF ACTION TION RESPONSIBILIT
INDICATON IES
Generic Name: Anticoagulant 2-10 mg daily Interferes with Hypersensitivity -bleeding, -Review
Warfarin hepatic to warfarin or Fever, lethargy, patients
Prophylaxis and synthesis of any component malaise, medical record
Brand name: treatment of vitamin K- of the asthenia, pain, -Monitor for
Coumadin venous dependent formulation; headache, signs and
thrombosis, coagulation dizziness, stroke symptoms of
pulmonary factors (II, VII, IX, bleeding
embolism and X) -Rash, -Monitor VS
thromboembolic dermatitis, -Check for
disorders. presence of
-Anorexia, rash
nausea,
vomiting,
stomach cramps,
abdominal pain,
diarrhea,
flatulence,
gastrointestinal
bleeding, taste
disturbance,
mouth ulcers