Pathophysiology
All pathophysiology of pulmonary hypertension is related to _________ of the pulmonary arteries
vasoconstriction
This medications are used to manage fluid status in those with pulmonary hypertension...
Lasix/Bumex--Diuretics
Pulmonary Hypertension is diagnosed as a pulmonary artery pressure greater than
greater than 20-25mmHg
normal is 15-18mmHg
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.
Effective Pulmonary toileting (pulmonary hygiene) includes...(please list 3)
MOBILITY
Insentive Spirometry
Positioning
Suctioning
Oral care
This is a lung disease that often leads to pulmonary artery hypertension...
Chronic Obstructive Pulmonary Disease (COPD)
This drug was first used to treat angina and hypertension...then erectile dysfunction... and now pulmonary hypertension
Sildenafil---PDE-5 Inhibitors
tadalafil
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.
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**
What lab value is assessed to the level of heart failure in patients
B-type Natriuretic Peptide (BNP)
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
The half life of this intravenous drug is 2-3 minutes....
Epoprostenol (Velitri) (Flolan)
Assessment findings consistent with pulmonary hypertension include (please list at least 3):
fatigue
shortness of breathe & tachypnea
JVD, peripheral edema
palpitations
Split S2 sound
Nursing management of this patient may include implementing and monitoring a __________ through intake and output.
fluid restriction
An invasive monitoring system used to assess pulmonary arterial pressure is a ____________
Swann Ganz Catheter
Overproduction of ________.
Decreased production of _________.
endothelin 1 or thromboxane (BAD)
nitric oxide and prostacyclin-1 (GOOD)
What is the mechanism of action of sildenafil
Acts to inhibit phosphodiesterase 5 for smooth muscle relaxation
This test can identify the cause and formally diagnose Pulmonary Hypertension...
Right Heart Catheterization
Avoiding ___________ as a form of oxygenation is CRITICAL in this population.
intubation
List three topics of education the nurse can implement during
smoking cessation
fluid management
exercise/mobility
nutrition
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.
NCLEX NEXT GENERATION QUESTION 2
https://umaryland.az1.qualtrics.com/jfe/form/SV_efwJseK51WitIIm
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.
NCLEX Next Generation Question 3
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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.
NCLEX NEXT GENERATION QUESTION 4
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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.
NCLEX NEXT GEN QUESTION 5
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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.