Med-Surg Respiratory System, part 7: Interstitial Lung Disease, Pulmonary Hypertension
by Cathy Parkes August 27, 2021 Updated: December 29, 2021 6 min read
This article will discuss two disorders of the lungs: interstitial lung disease and pulmonary hypertension. The Med-Surg Nursing video series follows along with ourMedical-Surgical Nursing Flashcards, which are intended to help RN and PN nursing students study for nursing school exams, including the ATI, HESI, and NCLEX.
Interstitial Lung Disease
Interstitial lung disease is an umbrella term used for a group of restrictive lung disorders that cause stiff and non-compliant lungs. Restrictive lung disorders affect the lungs by impeding the ability to inhale and get air into the lungs.
The pathophysiology underlying this condition is chronic inflammation of the lungs that causes the replacement of healthy lung tissue with fibrotic scar tissue.
This is the opposite of obstructive lung disorders, which occur when a patient is unable to exhale completely, that is, to get air out of the lungs. Examples of obstructive lung diseases include asthma, chronic obstructive pulmonary disease (COPD), and cystic fibrosis.
The risk factors associated with interstitial lung disease include:
- Environmental inhalants, e.g., asbestos
- Immune dysfunction
- Sarcoidosis, an auto-immune disorder that causes the formation of abnormal masses or nodules (called granulomas), which consist of inflamed tissues in the lungs.
Signs and Symptoms
Signs and symptoms of interstitial lung disease may include:
- Dyspnea (difficulty breathing)
- Chest discomfort
- Clubbing, which is an enlargement of the fingertips, resulting in spoon-shaped fingernails, that is, the fingertips resemble rounded, upside-down spoons
To diagnose this group of disorders, the patient may require a pulmonary function test (PFT), a chest X-ray, or a lung biopsy.
There are a number of possible treatments to help someone suffering from a restrictive lung disorder like interstitial lung disease. These include oxygen therapy — a treatment that provides the patient with extra oxygen to breathe, also called supplemental oxygen. Or we can administer anti-inflammatory medications, such as corticosteroids. In more extreme cases, a lung transplant may be necessary.
As the name suggests, pulmonary hypertension is high blood pressure in the lungs.
Pulmonary hypertension is caused by the narrowing of the arteries in the lungs and increased vascular resistance. When blood flows through the heart, it enters the right atrium and then the right ventricle before flowing to the lungs. When there is increased resistance in the lungs, the blood backs up into the right ventricle and causes enlargement of that ventricle. This is known as “cor pulmonale,” the abnormal enlargement of the right side of the heart as a result of disease of the lungs or the pulmonary blood vessels.
Cor pulmonale is a key complication of pulmonary hypertension.
The risk factors associated with pulmonary hypertension include:
- Cardiac defects or heart disease
- Lung disease
- Pulmonary embolism (a blood clot in an artery of the lung)
Signs and symptoms
Signs and symptoms of pulmonary hypertension may include dyspnea (difficulty breathing), fatigue, pallor, or chest pain upon exertion.
When blood backs up into the right ventricle, the patient is at risk of right-sided heart failure, which can cause edema (swelling caused by excess fluid trapped in the body's tissues).
Labs and diagnostics
When it comes to diagnosing pulmonary hypertension, the patient may require an echocardiogram to produce a visual display of the lungs using ultrasound waves.
Another measure of diagnosing pulmonary hypertension is cardiac catheterization, a procedure in which a catheter is guided through a blood vessel into the heart to diagnose or treat certain heart conditions.
Or we could test the patient's hemodynamics, which means taking basic measures of cardiovascular function, such as arterial pressure or cardiac output.
Treatment for pulmonary hypertension can include administering diuretics to the patient, which help rid the body of excess fluid; administering digoxin, which helps the heart beat more effectively; or using vasodilators, medications that open (dilate) blood vessels.
When caring for a patient with pulmonary hypertension, options include administering oxygen or implementing fluid restrictions for right-sided heart failure, if indicated.
Closely monitor the patient's eyes (in case of ocular complications) and nose. Among the common symptoms of pulmonary hypertension are itchy eyes, a runny nose, sneezing, coughing, or a scratchy throat. Patients suffering pulmonary hypertension can be particularly troubled by nasal congestion, which makes breathing through the nose harder.
Monitor the patient's daily weight as weight gain is one of the first signs of fluid retention.
Finally, encourage the patient to take frequent rest periods due to fatigue associated with pulmonary hypertension.
Hi. I'm Cathy with Level Up RN. In this video, we are going to talk about interstitial lung disease as well as pulmonary hypertension. And at the end of the video, I'm going to give you guys a quick little quiz to test your knowledge of some of the key facts I will be covering in this video.
So interstitial lung disease is really an umbrella term used for a group of restrictive lung disorders that cause stiff and non-compliant lungs. So when we talked about asthma, COPD and cystic fibrosis, those are obstructive lung diseases. So the primary issue with obstructive lung diseases is the inability to exhale completely, get the air out of the lungs. With restrictive lung disorders, such as interstitial lung disease, we have issues getting air into the lungs because of those stiff and non-compliant lungs.
So the pathophysiology behind this condition is that we have chronic inflammation of the lungs that causes the replacement of healthy lung tissue with fibrotic scar tissue. Risk factors associated with this disorder include environmental inhalants like asbestos, immune dysfunction, and then something called sarcoidosis, which is an auto-immune disorder that causes the formation of these nodules in the lungs. In terms of the signs and symptoms of interstitial lung disease, your patient may have a cough, they may have dyspnea, so difficulty breathing, chest discomfort, fatigue, and clubbing. So clubbing, if you don't remember, is kind of the enlargement of the fingertips with spoon-shaped fingernails, so kind of rounded, upside-down spoons.
In terms of diagnosis, we can use pulmonary function tests, a chest X ray, and a lung biopsy to help diagnose this group of disorders. In terms of treatment, oxygen therapy can be used. We can also give the patient anti-inflammatories such as corticosteroids, and then long term, a lung transplant may be necessary.
Now, let's talk about pulmonary hypertension. And as the name suggests, we have hypertension, so high blood pressure in the lungs. And this is due to narrowing of the arteries in the lungs and increased vascular resistance. So if you think about the blood flow through the heart, we have blood coming in to the right atrium and then the right ventricle and then to the lungs. And if we have this increased resistance in the lungs, then that blood is going to back up into the right ventricle and cause enlargement of that right ventricle. So this is something called cor pulmonale. It's a key complication with pulmonary hypertension.
In terms of the risk factors associated with this condition, cardiac defects or disease will be some key risk factors, as well as lung disease and a pulmonary embolism. Symptoms may include dyspnea, so difficulty breathing, fatigue, pallor, chest pain upon exertion, and then with that backup of blood into the right ventricle, we may end up with right-sided heart failure, which can cause edema in the patient.
In terms of diagnosis, we can do a diagnosis of this condition using an echocardiogram, a cardiac catheterization, and then with hemodynamics, we'll find an increase in pulmonary artery pressure. Treatment includes diuretics to try to get rid of excess fluid, digoxin to help the heart beat more effectively, and vasodilators.
In terms of nursing care, we would administer oxygen as ordered. We would implement fluid restriction for right-sided heart failure if indicated. We also want to closely monitor the patient's eyes and nose, their daily weight, and also encourage the patient to take frequent rest periods because of the fatigue associated with pulmonary hypertension.
Okay. Time for a quiz. I have two straightforward questions for you. First question. Interstitial lung disease is an example of a restrictive or obstructive lung disease? The answer is restrictive. Question number two. What do you call right ventricular enlargement that occurs with pulmonary hypertension? The answer is cor pulmonale. Hope you did well, hope this video was helpful, and I'll see you on another video soon. Thanks for watching.
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