Pathophysiology
Pharmacology
Assessment + Diagnosis
Management
Critical Care
100

All pathophysiology of pulmonary hypertension is related to _________ of the pulmonary arteries

vasoconstriction 

100

This medications are used to manage fluid status in those with pulmonary hypertension...

Lasix/Bumex--Diuretics

100

Pulmonary Hypertension is diagnosed as a pulmonary artery pressure greater than

greater than 20-25mmHg

normal is 15-18mmHg

100

What type of ABG imbalance would you expect in this patient initially diagnosed with pulmonary hypertension...

Respiratory Acidosis

Similar to COPD breathing quickly will make you RETAIN CO2. Retaining acid lowers your pH. low pH and high CO2= respiratory acidosis.


100

Effective Pulmonary toileting (pulmonary hygiene) includes...(please list 3)

MOBILITY

Insentive Spirometry

Positioning

Suctioning

Oral care

200

This is a lung disease that often leads to pulmonary artery hypertension...

Chronic Obstructive Pulmonary Disease (COPD)

200

This drug was first used to treat angina and hypertension...then erectile dysfunction... and now pulmonary hypertension

Sildenafil---PDE-5 Inhibitors


tadalafil

200

Chronic pulmonary hypertension will lead to a secondary diagnosis of ____________

Right Sided Heart Failure

This means that patients will present with what kind of signs? Chest Xray and electrocardiogram.


200

Who would be important members of the team for a patient newly diagnosed with pulmonary hypertension.

Respiratory therapy***

Doctor--pulmonologist, cardiologist

Social work/case manager & pharmacist--medication managment

Palliative Care**

200

What lab value is assessed to the level of heart failure in patients

B-type Natriuretic Peptide  (BNP)

300

The body compensates for the change in vasculature by __________... (but this does not help ): and causes the enlargement of pulmonary arteries we see on chest X-ray!

Vascular remodeling--all the cells!---endothelial cells, smooth muscle cells, fibroblasts, inflammatory cells

300

The half life of this intravenous drug is 2-3 minutes....

Epoprostenol (Velitri) (Flolan)

300

Assessment findings consistent with pulmonary hypertension include (please list at least 3):

fatigue

shortness of breathe & tachypnea

JVD, peripheral edema

palpitations

Split S2 sound

300

Nursing management of this patient may include implementing and monitoring a  __________ through intake and output.

fluid restriction

300

An invasive monitoring system used to assess pulmonary arterial pressure is a ____________

Swann Ganz Catheter

400

Overproduction of ________.

Decreased production of _________.



endothelin 1 or thromboxane (BAD)

nitric oxide and prostacyclin-1 (GOOD)


400

What is the mechanism of action of sildenafil

Acts to inhibit phosphodiesterase 5 for smooth muscle relaxation



400

This test can identify the cause and formally diagnose Pulmonary Hypertension...

Right Heart Catheterization

400

Avoiding ___________ as a form of oxygenation is CRITICAL in this population.

intubation

400

List three topics of education the nurse can implement during 

smoking cessation

fluid management

exercise/mobility

nutrition

500

pH 7.2p

pCO2- 50mmHg

RR- 30 bpm

Pulse Ox- 87%

Rationale: The client has signs and symptoms of infection and respiratory failure. The most urgent findings are related to respiratory failure. Those include a pH of 7.2 indicating an acidic state, PCO2 > 50, tachypnea (rr 30 bpm), and a pulse oximeter reading of 87% on high flow oxygen. The blood pressure is elevated but is not yet critical.

500

Crackles---ARDS + pneumonia

Sat 87%-- ARDS + pneumonia

pCO2-- ARDS

pH 7.2-- ARDS

Rationale: Bilateral crackles can be associated with both respiratory conditions and are common in respiratory illnesses. A pulse oximeter reading of 87% indicates there is a low level of oxygen within the blood which can be caused by either condition. A PCO2 of 51 and pH of 7.2 indicates respiratory acidosis and are consistent with acute respiratory failure.

500

Intubating for mechanical ventilation support

Rationale: Acute respiratory failure is characterized by the lung tissue’s inability to oxygenate properly. The client has had a poor response to maximum supplemental oxygen and now needs mechanical ventilation. The respiratory failure was most likely caused by pneumonia. Treating pneumonia should take place next. Aerosols and corticosteroids may be incorporated into the treatment plan but are not as critical as intubation.

500

Indicated: sedatives, repeat chest X-ray, administer antibiotics, obtain EKG

Not Indicated:  schedule suctioning q2, administer amiodarone, position supine with head midline

Rationale: Most intubated clients require sedation to prevent them from fighting the ventilator. A chest x-ray should be done after intubation to confirm endotracheal tube placement. Suctioning can be damaging to tracheal tissue and should be done as needed and not on a schedule. Antibiotics are indicated to fight infection. Amiodarone, an antiarrhythmic, would not be indicated for this client because no arrhythmia was identified. Positioning the client supine would not be indicated. Semi fowlers or prone would be best to help with postural drainage. The client has tachycardia and elevated blood pressure which makes obtaining an electrocardiogram important.

500

Start IV of 0.9% NS at 75%

Midazolam 2-4mg IVP every 1hr as needed for agitation

Call for chest Xray

Rationale: A chest X-ray is needed after intubation determine optimal endotracheal tube placement. The client does not yet have venous access. This should be established immediately so medications can be given. The B/P and heart rate are significantly elevated, and the client is agitated. Sedation should be given to decrease agitation and risk of self- extubation. Next an EKG can be done, and antibiotics can be given. The oxygen level is above 95% so adjustments are not needed and there is no indication suctioning is needed. The blood gas is not due. The urinary catheter can be placed after other treatments.

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