MS-3_Prelim-Part-2.pdf

MEDICAL SURGICAL NURSING 3 1st Sem|Prelim|PPT|Lecture PNEUMONIA Most common form is bacteria infection One of the most common respiratory from aspira...

MEDICAL SURGICAL NURSING 3 1st Sem|Prelim|PPT|Lecture PNEUMONIA Most common form is bacteria infection One of the most common respiratory from aspiration of bacteria in the upper problems that can affect all stages of life airways e An inflammation of the lung parenchyma Most common causes: S. pneumonia, H. that is caused by many microorganisms influenza, and S. aureus (bacteria, mycobacteria, fungi, or viruses) PNEUMONITIS -describes the PATHOPHYSIOLOGY inflammatory process in the lung tissue Arises from normal flora from a patient with that can predispose and place a patient at altered resistance or from the aspiration of flora risk for microbial invasion. present in the oropharynx ↓ CLASSIFICATION Inflammatory reaction in the alveoli 1. Community-Acquired Pneumonia (CAP) ↓ Occurs in the community setting or within production of exudates that may interfere with O2 the 48 hours after and CO2 diffusion hospitalization/admission ↓ Usual needing admission if infectious WBCs enter the alveoli and fill up air field spaces agents are any of Streptococcus ↓ pneumoniae (most common), H. influenza, Decreased ventilation and causing obstruction of Legionella, and Pseudomonas aeruginosa the alveoli or bronchi 50% of specific causative agents are ↓ identified in infants or children viruses are Mixing of oxygenated blood and poorly the causative agent oxygenated blood ↓ 2. Hospital- Acquired Pneumonia hypoxemia (Nosocomial Pneumonia) Is defined as the onset of symptoms more CAUSES than 48 hours after admission in patients CAP with no evidence of infection at the time of Streptococcus pneumoiae- leading cause admission H. influenza- elderly Most lethal and leading cause of mortality Mycoplasma pneumoniae in patients with pneumonia Most common causative agent: HAP ○ Enterobacter species, Staphylococcus aureus- inhaled ○ Escherichia coli Impaired host defenses ○ influenza Comorbid conditions ○ klebsiella Prolonged supine position ○ Proteus Prolonged hospitalization ○ Serratia marcescens ○ S. aureus CLINICAL MANIFESTATIONS ○ S. pneumonia S/Sx varies depending on its type Usual presentation: pulmonary infiltrates Fever-rapidly rising on x-ray and more evidence of infection Pleuritic chest pain Rapid and bounding pulse 3. Pneumonia in the Immunocompromised Tachypnea Host Sputum- purulent Includes: pneumocystis pneumonia, fungal pneumonias, and mycobacterium Prevention tuberculosis Vaccination- pneumococcal vaccine Immunocompromised patients develop (65-85% effective in healthy patients) pneumonia from organisms of low Surveillance-infection and microbiologic virulence Complications 4. Aspiration Pneumonia Shock and respiratory failure Caused by the entry of endogenous or Pleural effusion exogenous substances into the lower airway ASSESSMENT AND DIAGNOSTIC FINDINGS History Taking-recent respiratory tract infection Physical Examination-breath sounds NCM 118| EBF & AM BSN 4K  MEDICAL SURGICAL NURSING 3 1st Sem|Prelim|PPT|Lecture Chest x-ray structural distribution Abscesses/infiltrates, empyema (staphylococcus). scattered or localized infiltration (bacteria) Diffuse/extensive nodular infiltrates (viral) Clear (mycoplasma) ABGs/pulse oximetry Gram stain/cultures Helps identify the causative organism CBC-leukocytosis, ↑ESR Serologic studies- viral or legionella titers Electrolytes Bilirubin Percutaneous aspiration/open biopsy of lung tissue MEDICAL MANAGEMENT Blood culture-identify Macrolides- for drug-resistant Hydration Antipyretics Bed rest 02 administration Pulse oximetry Aggressive respiratory measures- high concentration oxygen, ET intubation, mechanical ventilation NURSING MANAGEMENT Nursing Assessment Assess respiratory symptoms Assess clinical manifestations Physical assessment Assessment in elderly NCM 118| EBF & AM BSN 4K  MEDICAL SURGICAL NURSING 3 1st Sem|Prelim|PPT|Lecture RESPIRATORY FAILURE infection, sleep apnea, Respiratory failure is a condition in which there is hemorrhage) not enough oxygen or too much carbon dioxide in ○ Neuromuscular dysfunction (e.g. the body. There is a sudden and life-threatening Guillain-Barre Syndrome. deterioration of the gas exchange function of the Myasthenia Gravis, ALS, or spinal lungs. There is a need to provide adequate cord trauma) oxygenation or Ventilation for the blood. ○ Musculoskeletal dysfunction (e.g. chest trauma, kyphoscoliosis, This is a condition where there is: malnutrition Not enough oxygen in the lives of your ○ Pulmonary dysfunction (e.g. body (hypoxia) COPD, asthma, cystic fibrosis) 100 much carbon dioxide in your blood Oxygenation failure mechanisms (hypercapnia) ○ Pneumonia ○ ARDS This is a medical emergency ○ CHF Can come on suddenly (acute) or over ○ COPD time (chronic) ○ PE ○ Restrictive lung diseases interstitial TYPES OF RESPIRATORY FAILURE lung disease, pulmonary fibrosis, 1. Hypoxemic Respiratory Failure (Type 1) sarcoidosis Happens when you don't have Post-operative Period enough oxygen in the blood ○ Major thoracic or abdominal (hypoxemia) surgery may cause inadequate Also known as hypoxic respiratory ventilation and respiratory failure failure ○ Caused by: anesthesia, analgesics Causes: heart and lung conditions or sedatives 2. Hypercapnic Respiratory Failure (Type CLINICAL MANIFESTATIONS II) Early signs: Too much carbon dioxide in the Impaired oxygenation blood ○ Restlessness If your body.can't get rid of carbon ○ Fatigue dioxide there won't be enough ○ Headache mom for blood cells to carry ○ Dyspnea oxygen ○ Air Hunger Causes heart, lung, muscle, and ○ Tachypnea neurological conditions ○ Increased Bp (Guillain-Barre Syndrome, Myasthenia Gravis, Polymyositis or As hypoxemia progresses Multiple Sclerod Confusion COPD Lethargy 3. Perioperative respiratory failure Tachycardia, tachypnea Surgery Central cyanosis Anesthesia can affect breathing Diaphoresis that could lead air sacs to collapse Respiratory arrest (atelectasis) and further leading oxygen out from the blood Physical findings 4. Respiratory Failure due to Shock ARDS (increased use of accessory Causes low blood pressure, muscles) pulmonary edema and other Decreased breath sounds (if patient conditions like sepsis, heart cannot adequately ventilate) attacks, or blood loss. Related to underlying disease Hypotension with signs of poor perfusion PATHOPHYSIOLOGY suggests severe sepsis on severe Impaired ventilation or perfusion pulmonary embolism mechanisms Hypertension with signs of poor perfusion ○ Impaired function of the CNS (e.g. suggests cardiogenic pulmonary edema drug overdose, head trauma, NCM 118| EBF & AM BSN 4K  MEDICAL SURGICAL NURSING 3 1st Sem|Prelim|PPT|Lecture Symptoms depend on the cause: ABC's Dyspnea ○ Ensure airway is adequate Tachypnea ○ Ensure adequate supplemental Fatigue oxygen and assisted ventilation, if Heart palpitations indicated. Support circulation as Hemoptysis needed Diaphoresis Treatment of a specific cause when Restlessness possible Pallor ○ Infection Cyanosis Antimicrobials, source Blurred vision control Agitation, confusion ○ Airway obstruction Behavioral changes Bronchodilators, glucocorticoids DIAGNOSIS ○ Improve cardiac function HISTORY Positive airway pressure, Sepsis diuretics vasodilators Pneumonia morphine, inotropes Pulmonary embolus suggested by sudden Mechanical ventilation onset of shortness of breath or chest pain ○ Non-invasive COPD exacerbation suggested by history Mask usually orofacial to of heavy smoking, cough, sputum start production ○ Invasive Cardiogenic pulmonary edema suggested Endotracheal tube (ETT) by chest pain, paroxysmal nocturnal Tracheostomy-if upper dyspnea, and orthopnea airway is obstructed PHYSICAL FINDINGS Indications for Mechanical Ventilation Hypotension usually with signs of poor Cardiac or respiratory arrest. perfusion suggests severe sepsis or Tachypnea or bradypnea with respiratory massive pulmonary embolus. fatigue. Hypertension usually with signs of poor Acute respiratory acidosis perfusion suggests cardiogenic pulmonary Inability to protect the airway associated edema. with depressed level of of consciousness Wheezing suggests airway obstruction: Shock associated with excessive Bronchospasm respiratory work Secretions Inability to clear secretions with Impaired Pulmonary edema gas exchange Stridor suggests upper airway obstruction Short-term adjunct in management of Elevated jugular venous pressure acutely increased intracranial pressure suggests right ventricular dysfunction due ICP to accompanying pulmonary hypertension Consider Non-invasive ventilation, particularly Tachycardia and arrhythmias may be the in the following settings cause of cardiogenic pulmonary edema COPD exacerbation Cardiogenic pulmonary edema LABORATORIES Obesity hypoventilation syndrome ABG Complete blood count NURSING MANAGEMENT Cardiac serologic markers Assess the patient's tissue oxygenation Microbiology status regularly Pulmonary function tests/bedside Evaluate ABG results spirometry To enhance V/Q matching, turn the patient Bronchoscopy on a regular and timely basis to rotate and Chest radiography maximize lung zones. Electrocardiogram Regular, effective use of incentive Echocardiography spirometry Regular patient turning and repositioning enhances diffusion by promoting a MANAGEMENT healthy, well-perfused alveolar surface. NCM 118| EBF & AM BSN 4K  MEDICAL SURGICAL NURSING 3 1st Sem|Prelim|PPT|Lecture These actions, as well as suctioning, help mobilize sputum or secretions. Regular, effective use of incentive spirometry Regular patient turning and repositioning enhances diffusion by promoting a healthy, well-perfused alveolar surface. These actions, as well as suctioning, help mobilize sputum of secretions NCM 118| EBF & AM BSN 4K  MEDICAL SURGICAL NURSING 3 1st Sem|Prelim|PPT|Lecture PNEUMOTHORAX and a. COPD HEMOTHORAX b. Cystic fibrosis c. Lung cancer PNEUMOTHORAX is a collection of air outside d. Sarcoidosis the lung but within the pleural cavity. e. Tuberculosis It occurs when air accumulates between f. HIV/AIDS with pneumonia the parietal and visceral pleura inside the 3. Risk Factors chest a. Gender- Male In a normal lung, negative pressure exists b. Age- 20 to 30 y.o. b/n the visceral and parietal pleural c. Tall, thin (pleural space) d. Smoking This pleural space contains minimal fluid e. Pregnancy that serves as lubricant when the tissues f. Maran syndrome move. g. Family history of When air enters the space, pressure pneumothorax changes will cause the lungs lo collapse 4. Genetics (partial or complete) a. patients with Marfan syndrome, homocystinuria Types and Brad-Hogg-Dube Spontaneous pneumothorax - rupture of syndrome are linked with air-filled sacs on the lung surface spontaneous ○ Primary spontaneous pneumothorax, pneumothorax - occurs without an 5. Previous Hx of Pneumothorax evident a. Smoker ○ Secondary spontaneous b. Younger pneumothorax - occurs due to an c. Taller and thinner underlying illness (COPD, asthma, d. Hx of COPD, AlDs and tuberculosis, cystic fibrosis and pulmonary fibrosis other lung disease) e. May recur within the first 6 iatrogenic pneumothorax - occurs due to months to 3 years puncture or laceration of the lungs during 6. Review past medical procedures a medical procedure (lung biopsy, a. Transthoracic needle tracheostomy or catheter insertion! aspiration (main factor in Tension pneumothorax - occurs when iatrogenic pneumothorax) the air enters the pleural space and b. CVP insertion cannot escape due to trauma (stab c. Tracheostomy wound, gunshot wound, fractured rib d. CPR e. ARDS Nursing Process f. NGT placement Check patient's ABCs and hemodynamic 7. Patient lifestyle and occupation stability a. Drug use (inhaled) ○ if the patient is stable and has marijuana or cocaine minimal air or fluid accumulation in b. Flying, scuba or deep sea the pleural space, no treatment diving (can cause drastic may be necessary as it may air pressure changes) resolve spontaneously. ○ But it severe immediate medical Physical Assessment care is needed 1. Symptoms a. Sudden chest pain - sharp, Nursing Assessment severe, and becomes worse with Review heath History inspiration that radiates to the 1. Determine cause ipsilateral shoulder a. Chest trauma/injury b. Dyspnea - becomes more severe b. Ruptured blebs or bullae with secondary pneumothorax (collection of air or fluid) 2. Monitor VS c. Underlying lung disease a. RR and PR d. Recent surgery or invasive b. BP & 02 saturation procedures c. Closely monitor changes for 2. Obtain past medical history. Note hemodynamic instability existing lung disease 3. Assess respiratory status NCM 118| EBF & AM BSN 4K  MEDICAL SURGICAL NURSING 3 1st Sem|Prelim|PPT|Lecture a. IPPA (inspection, palpation, them together to prevent percussion, and auscultation) reaccumulation of fluid or air in the i. Inspection: respiratory pleural space discomfort, airway patency, tracheal deviation Prevention ii. Palpitation: 1 tactile Stop smoking fremitus, asymmetrical Avoid activities with drastic changes in air expansion pressure iii. Percussion: hyper Limit air travel resonance Treat lung infection iv. Auscultation: lor absent breath sounds a. b. ⬆️ 4. Assess the cardiovascular status ⬇️HR BP c. Jugular vein distention d. Cyanosis e. Cardiac arrest Diagnostic Procedures 1. Chest x-ray 2. Imaging scans 3. ABGS Nursing Interventions Administer medications ○ Prophylactic antibiotics prior to chest tube insertion ○ Analgesics or nerve block Prepare for decompression ○ Inserting a large bore catheter into the chest wall to draw out excess air Assist in thoracostomy tube insertion ○ Placing a chest tube following needle decompression ○ Heimlich valves are one-way valves that allow air to escape without using suction ○ SSP typically requires suction Watchful approach to small pneumothoraces ○ For small asymptomatic, observation is advised with 02 therapy because it will likely resolve on its own O2 therapy ○ 3 Ipm via cannula or higher to treat hypoxemia Surgical intervention ○ Thoracoscopy ○ Electrocautery ○ Laser treatment ○ Resection of blebs or pleura ○ Open thoracotomy ○ VATS Decrease pneumothorax recurrence ○ Pleurodesis (sclerotherapy)- creates scar tissue b/n layers of the pleura causing the. sticking NCM 118| EBF & AM BSN 4K  MEDICAL SURGICAL NURSING 3 1st Sem|Prelim|PPT|Lecture PULMONARY HYPERTENSION There are multiple other subgroups A severe, rare lung disease characterised by high in group 1, including: blood pressure in the pulmonary arteries, which ○ Familial or Heritable deliver blood from the heart to the lungs, Pulmonary Hypertension The increased pressure in the blood (FPAH) or (HPH) vessels of the lungs means that your heart PAH caused by certain drugs or has to work harder to pump blood into the toxins including some recreational lungs. drugs and diet medications Is a serious health condition that results PAH associated with other when the arteries carrying blood from the conditions such as connective right side of the heart to the lungs are tissue diseases like: constricted, disrupting blood flow ○ Scleroderma or lupus Blood must travel through the lungs for air (connective tissue diseases exchange in order to pick up oxygen that it certain autoimmune delivers to all the organs, muscles, and diseases) tissue in the body. ○ Congenital heart pröblems When the arteries between the heart and ○ High blood pressure in the lungs become narrowed and flow is liver constricted, the heart has to work extra ○ HIV hard to pump blood to the lungs. ○ Schistosomiasis (a type of Over time, the heart can grow weak and parasitic infection) proper circulation can diminish throughout ○ Sickle cell anaemia the body. ○ Liver disease 2. Group 2 PH (PH due to Left Heart CLASSIFICATION Disease) 1. Class I: Although you've been diagnosed Group 2 refers to pulmonary with pulmonary hypertension, you have no hypertension caused by left heart symptoms with normal activity. disease. 2. Class II: You don't have symptoms at rest, Long-term problems with the left but you experience symptoms such as side of the heart can lead to fatigue, shortness of breath or chest pain changes in the pulmonary arteries with normal activity. and cause pulmonary 3. Class Ill: You're comfortable at rest, but hypertension. have symptoms when you're physically This may include: active. ○ Left ventricular systolic 4. Class IV: You have symptoms with dysfunction: when the physical activity and while at rest. heart cannot pump blood effectively TYPES ○ Left ventricular diastolic 1. Group 1 PAH (Pulmonary Arterial dysfunction: when the Hypertension) heart cannot properly relax Pulmonary hypertension is to allow enough blood to associated with the narrowing of flow in the small blood vessels in the ○ Valvular disease: when lungs. the valves of the left side of It also is called Pulmonary the heart are allowing blood Arterial Hypertension (PAH) and to leak Includes cases where the ○ Congenital heart defects underlying cause of the narrowing (heart defects from birth): is not known (idiopathic pulmonary which can lead to problems hypertension). with blood flowing in or out of the heart NCM 118| EBF & AM BSN 4K  MEDICAL SURGICAL NURSING 3 1st Sem|Prelim|PPT|Lecture 3. Group 3 PH (PH due to Lung ○ Blood Disorders: such as Disease/Chronic Hypoxia) some types of anaemia Group 3 includes: pulmonary (polycythemia vera and hypertension resting from lung thrombocythemia diseases or shortage of oxygen in ○ Systemic Disorders: such the body (hypoxia). as Sarcoidosis (a condition The common diseases that results in inflammation associated are: of different organs like the ○ Chronic obstructive lungs and lymph nodes) pulmonary disease (COPD) and Histiocytosis (a rare ○ Interstitial lung disease disorder that causes (such as pulmonary scarring) fibrosis), which can cause ○ Metabolic Disorders: such scorning on lung tissue as glycogen storage ○ Sleep-disordered breathing, diseases and thyroid a group of diseases that disorders affect breathing during ○ Other Disorders: such as sleep like obstructive sleep chronic kidney failure or apnea (OSA) tumours obstructing ○ Chronic high-altitude pulmonary arteries exposure ○ Lung developmental PREDISPOSING FACTORS abnormalities Family history & Genetics ○ Alveolar hypoventilation ○ Certain genetic disorders, such as disorders Down syndrome, congenital heart 4. Group 4 PH (PH due to Thromboembolic disease, and Gaucher disease, Disease) can increase your risk of Refers to pulmonary hypertension developing pulmonary caused by blood clot obstructing hypertension. the pulmonary arteries. ○ A family history of blood clots or This also can be referred to as pulmonary embolism also chronic thromboembolic pulmonary increases your risk of developing hypertension (CTEPH). Pulmonary hypertension. ○ Clots are the body's Age response to bleeding and ○ Risk goes up as you get older, injuries, but can harm the although it may occur at any age. heart and lungs when they ○ Typically diagnosed between ages occur without an apparent 30 and 60. cause. Pulmonary emboli Sex are blood clots that travel to ○ Common in women than in men. the lungs, and pulmonary ○ Pulmonary hypertension with thrombosis are clots that certain types of heart failure is also are formed in the lungs, more common in women. which can block the Lifestyle Habits pulmonary arteries. ○ Unhealthy lifestyle habits can 5. Group 5 PH (Multifactorial) increase the risk of pulmonary The last category and includes hypertension. other less-common causes that do Illegal Drugs not fit in arly of the other four ○ Such as cocaine and groups. amphetamines These are widely split into four Smoking categories: Overweight NCM 118| EBF & AM BSN 4K  MEDICAL SURGICAL NURSING 3 1st Sem|Prelim|PPT|Lecture Appetite suppressant medications travel to the lungs, leading to a form of pulmonary hypertension CLINICAL MANIFESTATIONS that can generally be reversible Early symptoms include: with time and treatment. ○ Shortness of breath during routine ○ Having pulmonary hypertension activity and eventually while at rest makes it more likely you'll develop ○ Fatigue clots in the small arteries in your ○ Chest pain (angina) lungs, which is dangerous if you ○ Racing heartbeat already have narrowed or blocked ○ Pain in upper right side of blood vessels. abdomen Arrhythmia ○ Decreased appetite ○ Irregular heartbeats (arrhythmias) Later symptoms include: from the upper or lower chambers ○ Feeling light-headed, especially of the heart are complications of during physical activity pulmonary hypertensión. These ○ Dizziness or fainting (syncope) can lead to palpitations, dizziness ○ Swelling in the ankles or legs or fainting and can be fatal. ○ Bluish color to lips or skin Bleeding (cyanosis) ○ Pulmonary hypertension can lead to bleeding into the lungs and LABORATORY & DIAGNOSTIC TESTS coughing up blood (hemoptysis. Echocardiogram This is another potentially fatal Chest X-ray complication. Electrocardiogram Right heart catheterization NURSING MANAGEMENT Blood tests Although medical treatment can't cure Cardiac MRI pulmonary hypertension, it can lessen symptoms. COMPLICATIONS Lifestyle changes also can help Right-sided Heart Enlargement and improve your condition such as: Heart Failure (cor pulmonale) ○ Get plenty of rest: Resting can ○ In cor pulmonale: your heart's reduce the fatigue that might come right ventricle becomes enlarged from having pulmonary and has to pump harder than usual hypertension. to move blood through narrowed or ○ Stay as active as possible: Even blocked pulmonary arteries. the mildest forms of activity might ○ At first, the heart tries to be too exhausting for some people compensate by thickening its walls who have pulmonary hypertension. and expanding the chamber of the For others, moderate exercise right ventricle to increase the such as walking might be amount of blood it can hold. But beneficial — especially when done this thickening and enlarging works with oxygen. Discuss the level of only temporarily, and eventually activity with your doctor about the right ventricle fails from the specific exercise restrictions. Avoid extra strain. straining or lifting heavy weights. Blood Clots Rest when you need to. ○ Clots help stop bleeding after ○ Don't smoke: If you smoke, the you've been injured. But most important thing you can do sometimes clots form where theyre for your heart and lungs is to stop. not needed. A number of small If you can't stop smoking by clots or just a few large ones yourself, ask your doctor to dislodge from these veins and prescribe a treatment plan to help NCM 118| EBF & AM BSN 4K  MEDICAL SURGICAL NURSING 3 1st Sem|Prelim|PPT|Lecture you quit. Also, avoid secondhand fat and cholesterol. Aim to maintain smoke if possible. a healthy weight. ○ Avoid pregnancy and birth ○ Physical rehabilitation: to control pills: If you're a woman of improve your ability to exercise childbearing age, avoid pregnancy. and also boost your quality of life Pregnancy can be life-threatening ○ Ask your doctor about for both you and your baby. Also medications: Take all your avoid using birth control pills, medications as prescribed. Ask which can increase your risk of your doctor about any other blood clots. Talk to your doctor medications before taking them, as about alternative forms of birth some can interfere with your control. If you do become medication or worsen your pregnant, it's important to consult condition. with your doctor as pulmonary ○ Watch your weight: A daily record hypertension can cause serious of your weight can help you be complications to both you and the aware of rapid weight gain, which fetus. may be a sign that your pulmonary ○ Avoid travelling to or living at hypertension is worsening. high altitudes: High altitudes can ○ Anticoagulation or blood worsen the symptoms of thinners: to prevent blood clots in pulmonary hypertension. If you live people whose pulmonary at an altitude of 8,000 feet (2,438 hypertension is caused by chronic meters) or higher, your doctor blood clots in the lungs. These might recommend that you move thinners also can help some to a lower altitude. Be cautious people who have. pulmonary about air travel or high-latitude arterial hypertension, heart failure, locales. You may need to travel or other risk factors for blood clots. with extra oxygen. ○ Digitalis or digoxin: to control the ○ Get vaccines: Your doctor may rate blood is pumped throughout recommend getting influenza and the body. pneumonia vaccines. as these conditions can cause serious SURGICAL MANAGEMENT issues for people with pulmonary Atrial septostomy: If medications don't hypertension. control your pulmonary hypertension, this ○ Get support: If you're feeling open-heart surgery might be an option. In stressed or worried due to your an atrial septostomy, a surgeon will create condition, get support from family an opening between the upper left and or friends. Or, consider joining a right chambers of your heart (atria) to support group with others who relieve the pressure on the right side of have pulmonary hypertension your heart. ○ Heart-healthy eating: which ○ Atrial septostomy can have serious includes eating less salt, to lower complications, including heart blood pressure or cholesterol. High rhythm abnormalities levels of these contributed to the (arrhythmias). cause of your pulmonary Transplantation: In some cases, a lung hypertension. Eating less salt will or heart-lung transplant might be an help control your body fluids and option, especially for younger people who may improve heart function. Aim to have idiopathic pulmonary arterial eat a healthy diet of whole grains, hypertension. a variety of fruits and vegetables, ○ Major risks of any type of jean meats and low-fat dairy transplantation include rejection of products. Avoid saturated fat, trans the transplanted organ and serious NCM 118| EBF & AM BSN 4K  MEDICAL SURGICAL NURSING 3 1st Sem|Prelim|PPT|Lecture infection, and you must take immunosuppressive drugs for life. to help reduce the chance of rejection. Oxygen therapy if oxygen levels in the blood are too low. Balloon atrial septostomy to decrease pressure in the right heart chambers and improve the output of the left heart and oxygenation of the blood. In this procedure, a small hole is made in the wall between the right and left atria to allow blood to flow from the right. to the left atrium. Balloon pulmonary angioplasty to lower the blood pressure in your. pulmonary artery and improve heart function in people who cannot have a pulmonary endarterectomy. Pulmonary endarterectomy surgery to remove blood clots from the inside of the blood vessels of the lungs. Blood pressure medicines such as angiotensin-converting enzymes inhibitors, beta blockers; or calcium channel blockers when left heart disease is the cause Blood transfusions or Hydroxyurea to treat sickle cell disease Heart valve repair NCM 118| EBF & AM BSN 4K