A Nurse's Perspective on the Alert for Pulmonary Arterial Hypertension

Therefore, the overall prognosis is guarded in view of the underlying pathology, its extent and the post-operative respiratory insufficiency. The life expectancy is difficult to anticipate but the

When the organs fail the only option is a transplant. With lungs there is only a 50% rate of a five year survival rate after a lung transplantation involving the end-stage respiratory disease. With such a drastic survival rate a study was completed to determine if patients could have a better outcome. This study was done to help determine effective methods to enhance lung transplants before surgery; the Doctors placed the recipients on bi-level positive airway pressure ventilation (BIPAP.) “BIPAP is a noninvasive mode of ventilation administered through a tight-fitting mask to assist spontaneously breathing patients”

Ms. Eisen was suffering from severe pulmonary hypertension with a right to left shunt. After reading the case, there are various patience preference principles that the doctors and Ms. Eisen are adhering.

Post-transplant, patients are monitored very closely in the intensive care unit (ICU) and pharmacological and mechanical management is implemented when necessary. Within the first 24-48 hours after surgery, a patient is ventilated and their Po2 and Pco2 levels are scrutinized. Diuretics may be used in order to avoid any complications from fluid buildup or imbalances that may occur and help with pulmonary recovery.2 Other complications that may occur within the first two days of surgery include: technical complications, graft dysfunction, infections, and rejection. Stenosis of one or more of the anastomoses accounts for 15% the technical complications, which may lead to graft dysfunction.4 Other components of graft dysfunction incorporate pathology from

The human body is a very complex organism composed of different types of systems and functions. All the functions that each system has, is what makes possible for the body to obtain life. One of the most important systems in one’s body is the circulatory system, where the heart, the lungs, and the blood vessels work together to form the circle part of the circulatory system. The pumping of the heart forces the blood on its journey. The body’s circulatory system really has three parts: pulmonary circulation, coronary circulation, and systemic circulation. Each part must be working independently in order for them to all work together. However, when one of the parts of the circulatory system does not

fact related to high blood pressure and related conditions: - High blood pressure - Pulmonary hypertension - Heart

1. Which action will the nurse in the hypertension clinic take in order to obtain an accurate

blockage of the air passages, the lungs can hyperinflate or collapse (Ward et al., 2016, p. 737). The pulmonary surfactant that allows for alveolar re- expansion is also affected by the inhalation of meconium, leading to respiratory failure. El Shahed, Dargaville, Ohlsson, & Soll (2014) pointed out that “Meconium inhibits the surface tension-lowering properties of surfactant.” MAS is the most common cause of persistent pulmonary hypertension of the newborn (PPHN). It occurs when fetal circulation remains after birth due to vascular resistance in the pulmonary system, causing failure of transition to normal adult- type circulation (Ward et al., 2016, p. 738). Systematic reviews have been conducted to test the effectiveness of the interventions of MAS, leading to better clinical outcomes.

Most common presenting signs are dyspnea at rest, pleuritic pain, cough and orthopnea. Upon initial presentation of PE hemodynamic status should be assessed based and patients should be strafed into low risk, moderate or high risk. Majority of patients with PE are hemodynamically stable. Roughly 8% of the patient’s present with hemodynamic instability and circulatory collapse. These patient have either systolic blood pressure 15 minutes, hypotension requiring vasopressors or clear evidence of shock. However, there are a few patients who are hemodynamically stable but have significant ventricular dysfunction and borderline SBP due to extensive clot burden – these patients are characterized as intermediate risk or

(Marieb and Hoehn, 2010, p 703) defined Blood Pressure (BP) as ‘the force per unit area exerted on a vessel wall by the contained blood, and is expressed in millimetres of mercury (mm Hg)’. BP is still one of the essential and widely used assessment tools in healthcare settings. Nurses generally record the arterial BP which is the forced exerted blood that flows through the arteries, to establish a baseline and to determine any risk factors. BP

However, there is a multitude of effective ways to treat the disease that can increase the lifespan of an affected person. Constant vigilance for changes in one’s health is crucial. The main goals of treating the disease are clearing out mucus from the lungs and pancreas to prevent infection and providing necessary nutrition due to metabolic problems. A common treatment is the use of antibiotics, which aid in thinning excess mucus, lowering the risk of infection and increasing metabolism. Devices called nebulizers, which convert liquid medicine into a breathable “mist”, are used to easily move medication into the lungs through inhalation. Another common treatment is anti-inflammatories, which lessen swelling in your airways. To address digestive problems, people may take supplements of pancreatic digestive enzymes to increase the amount of absorbed nutrients within the body. In severe cases, surgical procedures may be applied to control the disease. Procedures include nasal polyp removal, where doctors remove any obstructive buildups in the nose, Endoscopy, where mucus is physically removed through endoscopes. In the most critical or life-threatening cases, a lung transplant may be performed to completely rid the patient of mucus buildup in the thoracic cavity. Unfortunately, due to the way mucus builds up in the lungs, a lung transplant requires both lungs to be

In classical essential hypertension both the systolic and diastolic blood pressures are high, but isolated systolic and isolated diastolic hypertension are also seen. Malignant or accelerated hypertension is associated with a rapid rise in arterial pressure and, if untreated, results in rapid end-organ damage and death(3). Obesity-related hypertension is an important public health issue. As the prevalence of obesity increases, the prevalence of hypertension with its associated CV risk will increase as well. (4)

Modern medical advancements have significantly decreased the prevalence and severity of infectious disease as well as the treatment of acute, traumatic conditions. Pharmacological research has also gained insight into the management of chronic disease. Still, there is an epidemic of chronic, treatable diseases like stroke, heart disease, and kidney disease. Hypertension proves to be the underlying factor associated with these diseases. Hypertension is often referred to as the silent killer because of its indication in deadly disease, and the importance of monitoring ones blood pressure is vital. Lifestyle, diet, and genetic predisposition are all factors of high blood pressure. Chronic high blood pressure above safe levels, known as hypertension, puts elevated physical stress on the renal and cardiovascular systems. By controlling this factor in patients, healthcare providers can decrease cardiovascular events, improve health outcomes, and decrease overall mortality. Patient education is often overlooked in its role in the control and prevention of high blood pressure. This paper analyzes the causes and physiology behind high blood pressure as they relate to the current nursing interventions. The role of nurses is discussed in relation to patient education regarding high blood pressure, and educational approaches are analyzed.

Galie’s et al. compared the six-minute walk distance (6-MWD) in patients twelve years or older with symptomatic pulmonary arterial hypertension (PAH) who took placebo versus 4 doses of oral tadalafil with or without bosentan. This multi-center, double-blind, placebo-controlled, randomized controlled study lasted 16 weeks. The patients were placed into 5 different groups: tadalafil 2.5mg, 10mg, 20mg, 40mg, or placebo once daily, and stratification was based on walking distance of 325m, type of PAH, and bosentan use. Patients were not qualified to participate in this study if they had a 6-mintue walk distance <150m or > 450m. Safety was determined by the level of adverse events severity. It was shown that all doses, but 2.5mg, improved 6-MWD at week 16, although, the tadalafil 40mg was the only one that was statistically significant (p<0.01). Compared with placebo, tadalafil 40mg had statistical significance of 6-MWD without bosentan therapy at 44m, versus patients with bosentan with a 6-MWD of 23m. The WHO functional class was not statistically significant in comparison with placebo because patients with better WHO functional class showed no difference in comparison to people with worse WHO functional class. After the 341 patients completed the 16 week trial, 334 of them accepted participation in another 16 week trial. Their 6-MWD slightly improved from 37m to 38m after 44 weeks, which was shown to be statistically significant (95% CI, 29 to 47). In addition, WHO functional

“Perioperative management of the patient with pulmonary hypertension” is an evidenced-based research article discussing the increased risk for morbidity and mortality associated with surgery in patients with pulmonary hypertension. “Pulmonary hypertension is a mean pulmonary artery pressure greater than or equal to 25 mm Hg. Pulmonary arterial hypertension requires a pulmonary artery mean pressure greater than or equal to 25 mm Hg along with a pulmonary artery wedge pressure (PAWP) less than or equal to 15 mm Hg. A right heart catherization procedure is used to assess the severity and diagnose pulmonary hypertension. An echocardiography is also used to screen for pulmonary hypertension and evaluate right ventricular dysfunction (Bull, Fox &