Evaluation and Management of the Adult Patient With Pulmonary Hypertension

Abstract

P ulmonary hypertension (PH) is a progressive and ultimately fatal disease that presents as an elevated blood pressure in the pulmonary arteries. PH evolves as a comorbidity of other diseases or conditions, such as connective tissue diseases, lung diseases, liver disease, pregnancy, HIV infection, left heart failure, and the usage of the diet medication Fen-Phen, a combination of the 2 drugs fenfluramine (Pondimin) and phentermine (Lonamin). Although triggered by other diseases or conditions, the specific etiology of PH is not known. PH and comorbidity conditions affect a diverse segment of the population.The demographic profile of adult PH patients includes men and women of all ages, racial, and ethnic groups. Between 2000 and 2002, the Centers for Disease Control and Prevention reported 807,000 adults were hospitalized with PH. Of these adults, 61% were women and 66% were 65 or older. 1 During the time period of 1980-2002, the number of PH deaths increased from 10,922 to 15,668, respectively; however, the greatest increase was observed only among women. 1 Among all racial populations, the number of adult PH deaths has increased mostly among the African American population. 1 Death rates are higher among the elderly, especially men 85 or older, women 65 or older, whites 75 or older, and African Americans 65 or older. 1 Regardless of gender, age, or race, PH patients require continuous evaluation and management by an interdisciplinary team to alter disease progression and the resultant impact on multiple organ systems.PH affects both the pulmonary and cardiovascular systems, with a potential negative impact on quality of life. PH patients have many acute and chronic health care needs that require meticulous evaluation, management, and care coordination. The nurse practitioner (NP) collaborates within an interdisciplinary team to effectively ABSTRACTThe prevalence of adult pulmonary hypertension (PH) in the United States has escalated in all races, gender, and ethnic populations. Nurse practitioners (NPs) are encountering adults with PH with increasing frequency. Through increased knowledge of the pathophysiological changes, diagnostic measures, and treatments for adults with PH, NPs collaborate with interdisciplinary teams to manage and improve client outcomes and quality of life.

Sürekli İntravenöz Prostasiklin Tedavisi Alan Pulmoner Arteriyel Hipertansiyon Hastalarının Hemşirelik Bakımı ve Eğitimi

“…Düşük kalp debisi ve arteriyel hipokseminin sonucu olarak hastalarda sağ kalp yetersizliği semptomları gelişmektedir. [10,11,12] Pulmoner Arteriyel Hipertansiyon Semptomları PAH semptomları spesifik değildir ve hastalarda temel olarak progresif sağ ventrikül disfonksiyonu semptomları gözlenmektedir. Başlangıçta semptomlar hareketle birlikte ortaya çıkmaktadır.…”

“…İleri evre hastalarda jügüler ven basınç artışı, hepatomegali, asit, periferik ödem ve soğuk ekstremite bulguları görülmektedir. [2,7,12,13] Pulmoner Arteriyel Hipertansiyon Tedavisi PAH tedavisinde son yıllarda giderek artan bir gelişme sağlanmakta, hastaların yaşadıkları semptomlar önemli ölçüde önlenebilmektedir. PAH tedavisi genel önlemler (fiziksel aktivite ve gözetim altında rehabilitasyon, gebelik, doğum kontrolü ve menopoz sonrası hormon tedavisi, elektif cerrahi, enfeksiyondan korunma, psikososyal destek, tedavilere uyum, genetik danışmanlık ve seyahat) destek tedavi (oral antikoagülanlar, diüretikler, O2, digoksin), ve PAH'a özgül tedavilerden (kalsiyum kanal blokerleri, endotelin reseptör antagonistleri, fosfodiesteraz tip 5 inhibitörleri ve guanilat siklaz uyarıcıları, prostasiklinler) oluşmaktadır.…”

Caregiver reactions in pulmonary hypertension

“…Average time from initial symptoms to diagnosis is two to three years (Brown et al, 2011;Traiger, 2007) due to multiple differential diagnoses. Because PH can frequently be misdiagnosed as a cardiac or pulmonary problem, diagnosis confirmation often occurs following permanent damage to the pulmonary vascular bed (Tartavoulle, 2011). Deaths from PH increased from 10,922 in 1980 to 15,668 in 2002, with a greater increase observed in women.…”

“…While there is no cure, symptoms are managed with use of diuretics, digoxin, calcium channel antagonists, oxygen therapy, and anticoagulants (Hoeper, McLaughlin, Al Dalaan, Satoh, & Galiè, 2016;Sastry, 2006;. Treatment for PH can consist of endothelin receptor antagonists (bosentan and ambrisentan), phosphodiesterase-5 inhibitors (sildenafil and tadalafil), as well as prostacyclins (epoprostenol, treprostinil, and iloprost) (Pohar, Clark, & Spry, 2009;Tartavoulle, 2011). Rarely, certain calcium channel blockers are used (Hopkins, Rubin, Mandel, & Finlay, 2017).…”

“…The prostacyclin drug family is essential to New York Heart Association (NYHA) functional class III-IV PH patients, who are the most severely functionally impaired, as they can be used intravenously as potent vasodilators in the case of failure with oral therapy and the treatment is among the most dangerous. (Oudiz et al, 2004;Smyth, Grosser, Wang, Yu, & Fitzgerald, 2009;Tartavoulle, 2011). Surgical options for PH patients include lung transplantation and pulmonary thromboendarterectomy when indicated (Haythe, 2012;Tartavoulle, 2011).…”