pulmonary Hypertension- Department of Nursing

Pulmonary Hypertension
University of Bosaso

Introduction
Pulmonary hypertension is an abnormal blood pressure, which occurs in the arterial blood vessels. The disorder is characterized by imbalance of pressure on the two sides of the heart. It occurs when right hand side of the heart pumps blood under high pressure than the left hand side. The disease causes heart attack especially when the heart tries to pump blood at higher pressure and yet there is little blood in the heart to pump. Following the concerns of dangers about the disease, I found it appropriate to write and educate people about the disorder. This research seeks to define the causes of pulmonary hypertension and vividly describe how the disease occurs, how the disorder can be managed, some of the drugs that are used to treat the disorder and some of the nursing intentions that can be used to avert the disorder.
Background Information
Thousands of patients die of heart attack because of various reasons. Ordinarily, the disorder is controllable and many people have equally survived after treatment. Some have redeemed their confidence after suffering from the disorder for a long time. Heart muscles need oxygen to survive but sometimes the inflow of blood is completely reduced. This makes blood to move slowly through the blood vessels while the blood itself exerting a lot of pressure on the walls of the blood vessels. The situation where the heart is starving from blood is called ischemia. According to FarnBurg (2009), more than 50% of heart attack cases that occur in the world at a given time are majorly caused by pulmonary hypertension.
How the disease Occurs
Pulmonary hypertension begins when pulmonary arteries and capillaries become narrower and blood force itself to flow through them. As a result, blood pressure through the vessels rises and exerts a lot of pressure in the right ventricle. When pressure increases beyond optimal limits, the victim is likely to suffer from heart attack also called myocardial infarction. Abnormal vasoconstriction within the arteries is likely to block blood from reaching the heart; a situation which will leave the heart without blood. This critical condition is called silent ischemia. In response to the disorder, the lower ventricle of the right hand side of the heart pumps less blood under very intensive pressure, becomes weakened and eventually fails (Humbert, 2008). This makes the right hand side of the heart to enlarge thus making the heart to be out of proportional.   Source Mirna Analytics (Mirna, 2016).     What causes the Arterial vasoconstriction? Many medical researchers have come to establish that an injury develops in the blood cells due to some reasons. This injury changes the modes and means the way the cells interact due to the fractures on the arterial muscles. The injured muscles contract more thus narrows the arterial and capillary diameter. As a result, pressure starts building in the blood vessels hence causing the disorder. Apart from the injury of cells, other factors can also cause pulmonary hypertension including liver problems, rheumatic disorders, which have a major effect on the blood flow. Rheumatic disorders are scleroderma that primarily affects blood vessels of the skin (Newman, 2009). Pulmonary hypertension may also lead internal bleeding within the lungs thus coughing out blood at times and heavy bloody sputum.
Managing Pulmonary Hypertension
Treating pulmonary hypertension involves complicated complex processes, which need highly skilled medical practitioners. Such treatments do require extensive and close nursing and the mode of care can be changed if the previous care is deemed ineffective. Physicians and nurses’ work in cohort with the patient to come up with a treatment plan.  Such procedures can involve complex therapies in which medications may be delivered through continuous intravenous injections, inhaled medications and medications administered orally (Robinovitch, 2007). The patient is put on the continuous assessment of the response to treatment and the possible need for treatment adjustment. In most cases, the nurses and doctors are available in hospitals to provide support and direction to patients concerning medications and psychological and social issues.      
Drugs used to treat Pulmonary Hypertension
Epoprostenol Epoprostenol (flolan) and iloprost (ventaris) are some of blood vessel dilators medicines, used in treatment of pulmonary hypertension disorder.  Epoprostenol is an intravenous medication, which is used to widen the narrowed blood vessels in the body parts and the lungs when administered properly. It helps by inhibiting platelets aggregation that result to reduced signs and symptoms and patients’ exercise capacity improvement. In the long term, the epoprostenol is applied in the body through a venous catheter that is centrally placed, with a small powered pump which keeps the liquid drug flowing into the body. Epoprostenol can also be applied into the body through a small intravenous fusion pump placed in the arm or hooked on the waist of the patient as shown below. Source Advances in PH Journal (McGoon& Severson, 2002).   The drugs cause side effects such as headache, nausea, dizziness, diarrhea, paining of the jaw, skin flushing, itching of the skin, smelling of the body, muscle or joint pain and low systemic blood pressure. Epoprostenol can successfully be used with other drugs, as there is no medication, which can prohibit its use. Unfortunately, there is no proper curative diagnosis of pulmonary hypertension but treatment is administered to control the symptoms and also help to prevent adverse effect on lungs. There are several of diagnostic ways that can be used in treatment of pulmonary hypertension. Iloprost (ventaris) and Warfrin Iloprost (ventaris) is another vasodilator, which can be used in the treatment of pulmonary hypertension just like epoprostenol. This drug is inhaled every 3 hours through a machine that vaporizes the medication making it more convenient since it is less painful to use. When inhaled, it diffuses to the lungs directly. Some of the side effects associated with Iloprost are chest pain, which is accompanied by headache, nausea and breathlessness. Anticoagulants such as warfarin (Coumadin and Jantova) are administered to patients with pulmonary hypertension. These drugs hinder blood clotting in the small pulmonary arteries. Any person who takes warfarin undergoes blood tests periodically to confirm the effectiveness of the drug. Any Anti-coagulants used may cause risks of bleeding problems and disorders (FarnBurg, 2009).
Endothelium receptors
Endothelium receptors factors such as tracleer (bosentan) and ambrisentan are used for the treatment pulmonary hypertension. They reverse the effect of endolin in the walls of arteries and capillaries that makes them to narrow. These drugs have adverse effects on the liver when not administered correctly. The patients who take these drugs undergo monthly liver monitoring to check the conditions of the liver. However, for pregnant women are discouraged from taking these drugs. Channel blockers that contain calcium which are taken in high dosage such as amlodipine (Norvasc), diltazen (Cardizam,Tiazac) and nifedipine (Adalat, procardia) are also used in managing pulmonary hypertension. However, they are very selective such that only a few people respond to them. They help in relaxing muscles along the walls of the vessels of blood by widening the them, which facilitates the flow of blood flowing through them. Water pills and help in treating pulmonary hypertension. They get rid of excess body fluids from the body thereby reducing the quantity of work the heart has to do. Because of this, they are used to hinder the building up of fluid in the lungs. Patients with pulmonary hypertension require constant supply of oxygen. Oxygen therapy treatment is recommended for them especially for those patients who live in high altitudes or those with sleep apnea.
Nursing Interventions
A patient suffering from pulmonary hypertension can adopt a number of home-based cares and lifestyles. Firstly, the patient should get plenty of rest, which can make his blood to flow at a rate that is normal without fatigue. Secondly, the patient should stay active as much as possible by doing some of the exercises and activities that facilitate flow of blood. Thirdly, the patient should not smoke since smoke will stop the functioning of lungs and adversely affect the heart. Fourthly, Women should avoid becoming pregnant and use of ant pregnancy pills since gravidity can cause life threat to both the mother and the child. Ant pregnancy pills can cause clotting and bring about death of the unborn child. Fifthly, avoid any occasions that can cause stress since lifespan of pulmonary hypertension patients is reduced when posed to stress (Giaid, 2005). Finally eat balanced diet at all times to get the best nutrients for the body to stay healthy at all times. This is important especially on the patients having adverse effects of this order. Keep in mind processed food often have high content of salt which is not advisable for such patient. The patient should eat plenty of fruits, vegetable that are nutritious for that matter.  
Conclusion
Pulmonary hypertension is a heart disorder that causes the right ventricle to experience a lot of blood pressure thus making it to swell. The disorder makes the heart to fail thus   causing heart attack. In case the failure is critical, the patient is likely to die. Epoprostenol is one of the commonly used drugs that is used to treat the disorder. The medicine reduces the number of pulmonary vascular resistance and slightly vasodilate the arterial walls to allow blood to flow through them. It is commonly on patients who have prolonged cases of pulmonary hypertension. However, the drugs should not be entirely relied on since they can cause side effects that may turn to be awful to the health of the patient. In case a patient is severely affected by the disorder, the medicalcare firm should consider administering the patient with palliative care with long-term diagnosis with a number of therapies to reduce the sternness of the disorder. Articular changes and strain caused by the disorder brings about discomfort to patients and sometimes cause acute pain across the chest. It is therefore the mandate of the caregivers to help patients to carry out regular exercises, adhere to dosage of the drug and eat balanced diet to prolong their lives.
References
FarnBurg. (2009). Human Pulmonary Hypertension. In FarnBurg, Serotonin -induced smooth Muscle (pp. 709-800). 622s. Newman,J. (2009). Pulmonary Hypertension Patients Survival Guide. Retrieved June 24, 2016, from Pulmonary Hypertension Association: http://www.phassociation.org/Patients/SurvivalGuide Minra. (2016). Diagnostic Company with a New Edge. Retrieved June 24, 2016, from Minra Analytics: http://www.phassociation.org/Patients/SurvivalGuide McGoon,M & Severson,C. (2002). Continuous Intravenous Epoprostenol for PAH: Highlighting Practical Issues, Special Considerations. Retrieved June 24, 2016, from Minra Analytics: http://www.phaonlineuniv.org/Journal/Article.cfm?ItemNumber=1740 Chin,K. (2008). Pulmonary Artery Hypertension. Coll Cardial, 1-33. Langleden. (1993). How to Diagnose Pulmonary Hypertension. Dorent Publishers. Humbert,M. (2008). Update in Pulmonary Artery Hypertension. In H. M, Medical Care (pp. 574-579). Care Med. Robinovitch. (2007). Path biology of Pulmonary Hypertension. In Robinovitch, Rev Pathol (pp. 369-399). Pentice Hall.