Pulmonary Hypertension for Progressive Care Certified Nurse (PCCN)

Pulmonary Hypertension

Definition/Etiology:

• Increased pressure in the arteries of the lungs from the right side of the heart
• Causes:
  • Pulm artery compromised
  • Heart disease
  • Lung disease
  • Hypoxia 
  • Blockages
  • May be idiopathic

Pathophysiology:

• Narrowing of blood vessel
• hard to get blood to lungs for oxygenation
• heart has to work harder and harder

Will draw on picture to show where increased pressure is.

Noticing: Assessment & Recognizing Cues:

• Initial s/s
  • Shortness of breath (normal activity)
  • Asymptomatic or mild
  • Worsens over time
• Later s/s
  • Cyanosis
  • Chest discomfort (pain or pressure)
  • Syncope
  • Palpitations
  • Dyspnea 
  • Jugular vein distention
  • Swelling in extremities and abdomen

Interpreting: Analyzing & Planning:

• Diagnostics (evaluate current situation)
  • Right heart catheterization
  • Chest CT scan
  • Chest x-ray
• Other (to find cause)
  • Echocardiogram
  • Complete metabolic panel
  • Complete blood count
  • Sleep study
  • V/Q scan

Responding: Patient Interventions & Taking Action:

• Calcium channel blockers
• Diuretics
• Oxygen therapy
• Pulmonary vasodilators (e.g. sildenafil citrate)

Reflecting: Evaluating Patient Outcomes:

• Education
  • Dietary/Lifestyle changes
  • Medications to prevent/manage other conditions
  • Oxygen therapy
  • Smoking Cessation
  • Surgery (e.g. mitral valve repair)
• Prevent Complications
  • Anemia
  • Arrhythmias
  • Blood clots
  • Pericardial effusion
  • Cor pulmonale

Linchpins (Key Points):

• It’s all about pressure