Pulmonary hypertension (PH) is a complex cardiovascular condition characterized by elevated blood pressure in the pulmonary arteries, leading to right heart strain and potentially life-threatening complications. This nursing diagnosis focuses on identifying symptoms, managing complications, and improving patient outcomes through evidence-based interventions.
Causes (Related to)
Pulmonary hypertension can develop from various underlying conditions and factors that affect pulmonary circulation:
- Primary (idiopathic) pulmonary arterial hypertension
- Secondary causes including:
- Left heart disease
- Chronic lung diseases
- Blood clotting disorders
- Connective tissue diseases
- Sleep apnea
- HIV infection
- Risk factors including:
- Family history
- Obesity
- Pregnancy
- Living at high altitudes
- Use of certain medications or drugs
Signs and Symptoms (As evidenced by)
Pulmonary hypertension presents with characteristic signs and symptoms that nurses must recognize for accurate assessment and intervention.
Subjective: (Patient reports)
- Progressive dyspnea, especially with exertion
- Fatigue and weakness
- Chest pain or pressure
- Dizziness and syncope
- Exercise intolerance
- Peripheral edema
- Chronic cough
- Anxiety and depression
Objective: (Nurse assesses)
- Elevated pulmonary arterial pressure (>25 mmHg at rest)
- Right ventricular hypertrophy
- Decreased exercise capacity
- Cyanosis
- Jugular vein distention
- Peripheral edema
- Abnormal heart sounds (S3, P2)
- Decreased oxygen saturation
Expected Outcomes
The following outcomes indicate successful management of pulmonary hypertension:
- The patient will maintain optimal oxygenation status
- The patient will demonstrate improved exercise tolerance
- The patient will report decreased dyspnea
- The patient will maintain a fluid balance
- The patient will adhere to the prescribed medication regimen
- The patient will demonstrate effective coping strategies
- The patient will avoid complications
Nursing Assessment
Monitor Hemodynamics
- Track vital signs, including blood pressure
- Assess heart rhythm and rate
- Monitor pulmonary artery pressures if available
- Evaluate peripheral perfusion
- Document edema
Assess Respiratory Status
- Monitor respiratory rate and pattern
- Assess oxygen saturation
- Auscultate lung sounds
- Evaluate work of breathing
- Document activity tolerance
Evaluate Cardiac Function
- Assess for signs of right heart failure
- Monitor for chest pain
- Check for peripheral edema
- Document exercise tolerance
- Monitor fluid balance
Check for Complications
- Monitor for signs of right heart failure
- Assess for syncope
- Watch for bleeding complications
- Check for thrombotic events
- Monitor for anxiety and depression
Review Medication Management
- Assess medication compliance
- Monitor for side effects
- Document response to therapy
- Check drug interactions
- Evaluate the need for adjustments
Nursing Care Plans
Nursing Care Plan 1: Impaired Gas Exchange
Nursing Diagnosis Statement:
Impaired Gas Exchange related to ventilation-perfusion mismatch secondary to pulmonary hypertension as evidenced by dyspnea, decreased oxygen saturation, and fatigue.
Related Factors:
- Altered blood flow through pulmonary vessels
- Increased pulmonary vascular resistance
- Ventilation-perfusion mismatch
- Right ventricular strain
Nursing Interventions and Rationales:
- Monitor oxygen saturation continuously
Rationale: Ensures early detection of deterioration - Position patient to optimize breathing
Rationale: Improves ventilation and reduces work of breathing - Administer oxygen therapy as prescribed
Rationale: Maintains adequate tissue oxygenation
Desired Outcomes:
- The patient will maintain oxygen saturation >92%
- The patient will report decreased dyspnea
- The patient will demonstrate improved activity tolerance
Nursing Care Plan 2: Decreased Cardiac Output
Nursing Diagnosis Statement:
Decreased Cardiac Output related to increased right ventricular afterload as evidenced by fatigue, decreased exercise tolerance, and peripheral edema.
Related Factors:
- Right ventricular dysfunction
- Increased pulmonary vascular resistance
- Cardiac remodeling
- Volume overload
Nursing Interventions and Rationales:
- Monitor vital signs and hemodynamics
Rationale: Detects changes in cardiac function - Implement prescribed activity restrictions
Rationale: Prevents overexertion and reduces cardiac workload - Administer cardiac medications as ordered
Rationale: Optimizes cardiac function and reduces symptoms
Desired Outcomes:
- The patient will maintain stable hemodynamics
- The patient will demonstrate improved exercise tolerance
- The patient will report decreased fatigue
Nursing Care Plan 3: Activity Intolerance
Nursing Diagnosis Statement:
Activity Intolerance related to imbalance between oxygen supply and demand as evidenced by excessive fatigue and dyspnea with minimal exertion.
Related Factors:
- Decreased cardiac output
- Impaired gas exchange
- Reduced oxygen delivery
- Deconditioning
Nursing Interventions and Rationales:
- Assess activity tolerance using standardized scales
Rationale: Provides an objective measure of functional capacity - Plan activities with rest periods
Rationale: Prevents overexertion and conserves energy - Implement a graduated activity program
Rationale: Builds endurance safely
Desired Outcomes:
- The patient will participate in planned activities without excessive fatigue
- The patient will demonstrate improved exercise tolerance
- The patient will maintain energy conservation techniques
Nursing Care Plan 4: Anxiety
Nursing Diagnosis Statement:
Anxiety related to chronic progressive disease process as evidenced by expressed concerns about prognosis and verbalized feelings of apprehension.
Related Factors:
- Chronic illness
- Changes in health status
- Fear of complications
- Social isolation
Nursing Interventions and Rationales:
- Provide emotional support and active listening
Rationale: Reduces anxiety and builds a therapeutic relationship - Teach relaxation techniques
Rationale: Helps manage anxiety symptoms - Facilitate access to support resources
Rationale: Enhances coping mechanisms
Desired Outcomes:
- The patient will demonstrate reduced anxiety levels
- The patient will utilize effective coping strategies
- Patient will verbalize understanding of disease management
Nursing Care Plan 5: Risk for Ineffective Self-Management
Nursing Diagnosis Statement:
Risk for Ineffective Self-Management related to the complex therapeutic regimen as evidenced by expressed difficulty with medication management and lifestyle modifications.
Related Factors:
- Complex medication regimen
- Required lifestyle modifications
- Limited knowledge of the disease process
- Financial constraints
Nursing Interventions and Rationales:
- Provide comprehensive patient education
Rationale: Improves understanding and compliance - Develop an individualized self-management plan
Rationale: Promotes patient engagement and adherence - Connect patient with resources and support services
Rationale: Facilitates successful disease management
Desired Outcomes:
- Patient will demonstrate an understanding of disease management
- The patient will adhere to the prescribed treatment regimen
- The patient will utilize available resources effectively
References
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