NUR 111 (Nursing Care of Clients with Life –

Threatening Conditions, Acutely Ill/Multi-organ

Problems, High Acuity and Emergency
STUDENT ACTIVITY SHEET Situation)
BS NURSING / FOURTH YEAR
Session # 4

Materials: MS notebook, paper, pen, index card,

LESSON TITLE: Pulmonary Arterial Hypertension
LEARNING TARGETS:
At the end of the lesson, the student nurses will be to:
1. Define pulmonary arterial hypertension;
2. Trace the pathophysiology of the disease condition;
3. Discuss the symptoms of pulmonary arterial
hypertension;
4. Formulate nursing diagnosis of the disease; and,
5. Develop nursing care plans in the care of the client
with the disorder.
and bond paper (short & long size)
References:
Smeltzer S.C., & Bare B.G. (2010) Brunner and
Suddarth’s Textbook of Medical- Surgical Nursing.
Lippincott William & Wilkins
Sommer S., Johnson J. (2013) RN Adult Medical
Surgical Nursing. Assessment Technology
Institute, LLC.
https://www.nurseslab.com

LESSON PREVIEW/REVIEW (10 minutes)

Instruction: Differentiate Community Acquired and Hospital Acquired Pneumonia.

Community Acquired Pneumonia_____________________________________________________________________

________________________________________________________________________________________________.
On the other hand, Hospital Acquired Pneumonia is ______________________________________________________
________________________________________________________________________________________________
MAIN LESSON (60 minutes)

Definition
 Pulmonary arterial hypertension exists when the mean pulmonary artery pressure exceeds 25 mm Hg with a
pulmonary capillary wedge pressure of less than 15 mm Hg (Badesch, Abman, Simonneau, et al., 2007).

There are two types of pulmonary arterial hypertension:

 Idiopathic (or primary) pulmonary arterial hypertension.
 Pulmonary arterial hypertension due to a known cause (Badesch, et al., 2007). It occurs most often in women 20
to 40 years of age, either sporadically or in patients with a family history, and is usually fatal within 5 years of
diagnosis.

Causes
 There are several possible causes, but the exact cause is unknown.
 A common cause of pulmonary arterial hypertension is pulmonary artery constriction due to hypoxemia from
COPD

Pathophysiology
 Conditions such as collagen vascular disease, congenital heart disease, anorexigens (specific appetite
depressants), chronic use of stimulants, portal hypertension, and HIV infection increase the risk of pulmonary
arterial hypertension in susceptible patients.
 Vascular injury occurs with endothelial dysfunction and vascular smooth muscle dysfunction, which leads to
disease progression (vascular smooth muscle hypertrophy, adventitial and intimal proliferation [thickening of the
wall], and advanced vascular lesion formation).
 Normally, the pulmonary vascular bed can handle the blood volume delivered by the right ventricle. It has a low
resistance to blood flow and compensates for increased blood volume by dilation of the vessels in the pulmonary

This document and the information thereon is the property of PHINMA

Education (Department of Nursing) 1 of 6
 circulation. However, if the pulmonary vascular bed is destroyed or obstructed, as in pulmonary hypertension, the
ability to handle whatever flow or volume of blood it receives is impaired, and the increased blood flow then
increases the pulmonary artery pressure.
 As the pulmonary arterial pressure increases, the pulmonary vascular resistance also increases. Both pulmonary
artery constriction (as in hypoxemia or hypercapnia) and a reduction of the pulmonary vascular bed (which occurs
with pulmonary emboli) result in increased pulmonary vascular resistance and pressure. This increased workload
affects right ventricular function.
 The myocardium ultimately cannot meet the increasing demands imposed on it, leading to right ventricular
hypertrophy (enlargement and dilation) and failure. Passive hepatic congestion may also develop.

Symptoms /Clinical Manifestation

 Dyspnea, the main symptom of pulmonary hypertension, occurs at first with exertion and eventually at rest
 Substernal chest pain also is common.
 Other signs and symptoms include weakness, fatigue, syncope, occasional hemoptysis, and signs of right-sided
heart failure (peripheral edema, ascites, distended neck veins, liver engorgement, crackles, heart murmur).
 Anorexia and abdominal pain in the right upper quadrant may also occur.

Assessment and Diagnostic Findings

Several tests are used to determine if there is a known cause for the pulmonary hypertension. If the diagnostic tests and
thorough evaluation of the patient reveal no known cause, a diagnosis of primary pulmonary hypertension is made.
 Complete diagnostic evaluation includes a history, physical examination, chest x-ray, pulmonary function studies,
electrocardiogram (ECG), echocardiogram, ventilation–perfusion scan, sleep studies, autoantibody tests (to
identify diseases of collagen vascular origin), HIV tests, liver function testing, and cardiac catheterization.

Treatment/ Medical Management

The goal of treatment is to manage the underlying condition related to pulmonary hypertension of known cause.
Recommendations regarding therapy are tailored to the patient’s individual situation, functional New York Heart
Association class, and specific needs (Badesch, et al., 2007).
 Anticoagulation should be considered for patients with pulmonary hypertension and patients with an indwelling
catheter for administration of medications. Most patients with pulmonary hypertension do not have hypoxemia at
rest but require supplemental oxygen with exercise.
 Diuretics and oxygen should be added as needed.
 Different classes of medications are used to treat pulmonary hypertension; these include calcium channel
blockers, phosphodiesterase-5 inhibitors, endothelin antagonists, and proteinoids. The choice of therapeutic
agents is based on the severity of the disease

Nursing Management
 The major nursing goal is to identify patients at high risk for pulmonary arterial hypertension, such as those with
COPD, pulmonary emboli, congenital heart disease, and mitral valve disease.
 The nurse must be alert for signs and symptoms, administer oxygen therapy appropriately, and instruct the
patient and family about the use of home oxygen therapy.
 In patients treated with prostanoids (ie, epoprostenol or treprostinil), education about the need for central venous
access (epoprostenol), subcutaneous infusion (treprostinil), proper administration and dosing of the medication,
pain at the injection site, and potential severe side effects is extremely important.
 Emotional and psychosocial aspects of this disease must be addressed.
 Formal and informal support groups for patients and families are extremely valuable.

CHECK FOR UNDERSTANDING (25 minutes)

You will answer and rationalize this by yourself. This will be recorded as your quiz. One (1) point will be given to correct
answer and another one (1) point for the correct ratio. Superimpositions or erasures in you answer/ratio is not allowed.
You are given 25 minutes for this activity:

Multiple Choice

1. The physician diagnosed the patient with Class III Primary Pulmonary Hypertension. The nurse is aware that the
characteristic of this condition is:
A. No manifestation at rest and mild to moderate physical activity induces dyspnea, fatigue, chest pain, or
lightheadedness.
B. No or slight manifestation at rest and mild (less than ordinary) activity induces dyspnea, fatigue, chest pain or

This document and the information thereon is the property of PHINMA

Education (Department of Nursing) 2 of 6
 lightheadedness.
C. Dyspnea and fatigue is present at rest, unable to carry out any level of physical activity without manifestations, and
manifestations of right sided heart failure apparent (engorged neck veins, dependent edema and enlarged liver).
D. Pulmonary hypertension diagnosed by pulmonary function test and right sided cardiac catheterization, no limitation
of physical activity, and moderate physical activity does not include dyspnea, fatigue, chest pain or light headedness.
ANSWER: ________
RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________

2. The morning weight for a client with emphysema indicates that the client has gained 5 pounds in less than a week,
even though his oral intake has been modest. The client's weight gain may reflect which associated complication of
COPD?
A. Polycythemia
B. Cor Pulmonale
C. Left Ventricular failure
D. Compensated acidosis
ANSWER: ________
RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________

3. Hypertension is known as the silent killer. This phrase is associated with the fact that hypertension often goes
undetected until symptoms of other system failures occur. This may occur in the form of:
A. Cerebrovascular accident
B. Liver disease
C. Myocardial infarction
D. Pulmonary disease
ANSWER: ________
RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________

4. A client is receiving spironolactone to treat hypertension. Which of the following instructions should the nurse provide?
A. Eat foods high in potassium
B. Take daily potassium supplements
C. Discontinue sodium restriction
D. Avoid salt substitute
ANSWER: ________
RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________

5. The most important long-term goal for a client with hypertension would be to:
A. Learn how to avoid stress
B. Explore a job change or early retirement
C. Make a commitment to long term therapy
D. Control high blood pressure
ANSWER: ________
RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________

6. A nurse in the emergency department is assessing a client who was in a motor vehicle crash. Findings include absent
breath sounds in the left lower lobe with dyspnea, blood pressure 118/68 mm Hg, heart rate 124/min, respiratory rate
38/min, temperature 38.6° C (101.4° F), and SaO2 92% on room air. Which of the following actions should the nurse
take first?
A. Obtain a chest x-ray.
B. Prepare for chest tube insertion.

This document and the information thereon is the property of PHINMA

Education (Department of Nursing) 3 of 6
 C. Administer oxygen via a high-flow mask.
D. Initiate IV access.
ANSWER: ________
RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________

7. Which of the following regarding pulmonary hypertension is false:

A. PH has many underlying etiologies
B. The disease affects the left side of the heart
C. The hemodynamic definition of PH is a mean pulmonary arterial pressure (PAP) greater than 25 mmHg.
D. Pulmonary arterial hypertension is a subset of pulmonary hypertension.
ANSWER: ________
RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________

8. Which of the following statement is not correct regarding pulmonary hypertension.

A. The disease affects men more than women.
B. Non- specific symptom such as fatigue and edema are present clinically.
C. Catheterization is required when PH is suspected.
D. Underlying causes are evaluated.
ANSWER: ________
RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________

9. Which of the following statement about pulmonary arterial hypertension is incorrect.

A. Vasoconstriction is an issue
B. Vascular wall re-modelling is an issue
C. There is a cure for pulmonary arterial hypertension.
D. The balance of vasoconstriction and vasodilatation may indicate PAH.
ANSWER: ________
RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________

10. All of the following are true regarding calcium channel blockers in pulmonary arterial hypertension.
A. Calcium channel blockers have a selective effect on vascular smooth muscles.
B. Normal physiologic doses are sufficient for treatment purposes.
C. Adverse effect must be considered.
D. Long -term clinical response is less than 10%.
ANSWER: ________
RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________

RATIONALIZATION ACTIVITY (THIS WILL BE DONE DURING THE FACE TO FACE INTERACTION)
The instructor will now rationalize the answers to the students. You can now ask questions and debate among yourselves.
Write the correct answer and correct/additional ratio in the space provided.

1. ANSWER: ________
RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________

This document and the information thereon is the property of PHINMA

Education (Department of Nursing) 4 of 6
2. ANSWER: ________
RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________

3. ANSWER: ________
RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________

4. ANSWER: ________
RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________

5. ANSWER: ________
RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________

6. ANSWER: ________
RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________

7. ANSWER: ________
RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________

8. ANSWER: ________
RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________

9. ANSWER: ________
RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________

10. ANSWER: ________

RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________

This document and the information thereon is the property of PHINMA

Education (Department of Nursing) 5 of 6
LESSON WRAP-UP (25 minutes)

You will now mark (encircle) the session you have finished today in the tracker below. This is simply a visual to help you
track how much work you have accomplished and how much work there is left to do.

You are done with the session! Let’s track your progress.

Al Strategy: Buzz Group)

Instruction: You will form into groups (compose of 4-6 students) in order to discuss answer to question prompt by the
instructor. You will be given 3 minutes to discuss among yourselves prior to sharing it with the class.

Activity 2:

NCP Making. Using the same groupings, each group will be instructed to prepare one nursing care plan for clients with
pulmonary arterial hypertension.

(For Related Learning Experience, please refer to your clinical instructor.)

This document and the information thereon is the property of PHINMA

Education (Department of Nursing) 6 of 6