Gas Exchange: Pulmonary Embolism Flashcards
What is a pulmonary embolism?
obstruction of blood flow in the pulmonary vascular system by embolus or thromboemboli
What are some things that can cause a pulmonary embolism?
- tumors
- fat or bone marrow
- amniotic fluid release
- IV injection of air/ foreign substance
- DVT
How many mL of air does it take to cause an air embolism?
at least 35 mL
What are treatments for amniotic fluid embolisms?
AOK: Atropine, ondansetron, and ketorolac
Why is a pulmonary embolism an emergency situation?
a majority who die do so within the first 2 hours of the embolic event
What are the top three risk factors for pulmonary embolism?
- stasis of blood flow
- vessel wall damage
- altered blood coagulation (hypercoagulability)
Why is pregnancy a risk factor for PE’s?
The gravid uterus increases pressure on the femoral arteries which causes an increased risk for DVT’s which in turn causes an increased risk for PE’s.
What are the other risk factors for PE’s?
- prolonged immobility
- trauma
- hip/femur fractures
- advancing age
- Surgery
- MI/heart failure
- obesity
- Oral contraceptives/estrogen therapy
- pregnancy/childbirth
- inherited thrombophilia
- certain cancers producing coagulation factors
What are the prevention strategies for PE’s?
- stop smoking
- reduce weight
- increase physical activity
- if traveling or sitting for long periods, get up frequently and drink plenty of fluids
- refrain from massaging or compressing leg muscles
What are the clinical manifestations of PE’s?
- dyspnea
- pleuritic chest pain
- anxiety/sense of impending doom
- cough
- sweating
- hemoptysis (coughing up blood)
- syncope
- cyanosis
- tachycardia/tachypnea
- crackles/cardiac gallop
- low-grade fever
- fat emboli
- petechiae
- flu-like symptoms
What is the first thing a nurse should do if a patient is suspected of having a PE?
O2 therapy ASAP from a mask or nasal cannula (mask is a better option!)
What are some interventions that prevent PE’s?
- early ambulation
- pneumatic compression devices
- elevating legs
- active/passive ROM
- avoid crossing the legs
- leg exercises
- compression stockings
- stop every 1-2 hours during long travel
What are the diagnostic tests used to confirm a PE?
- D-dimer
- Chest CT with contrast
- lung scans
- V-Q scan
- pulmonary angiography
- CXR
- ECG
- ABGs
- End-tidal carbon dioxide
- coagulation studies
What is the Gold standard diagnostic test used to confirm a PE?
Pulmonary angiography
What pharmacologic therapy is used for a PE?
- anticoagulants (heparin-bolus then infuse, warfarin- 5-7 days before heparin discontinued)
- fibrinolytic therapy
What lab value is looked at with Heparin?
PTT
What lab values are looked at with Warfarin?
PT/INR
What medication should people avoid taking if they are on anticoagulants?
aspirin or aspirin-containing drugs so as not to increase bleeding
How is surgery usually conducted or a PE?
- umbrella-like filter inserted into the inferior vena cave traps the large emboli and allows the blood flow to continue (the umbrella legs can break off and become another emboli source, so use this with caution)
- filter is inserted percutaneously (under the skin) in the femoral or jugular vein
What are some nursing interventions to compensate for impaired gas exchange?
- assess respiratory status
- Place in Fowler or high-Fowler position
- Monitor ABG results
- Maintain on bed rest (continue to do active/passive ROM; Q2hr turns; move in bed; cough/deep breathing every hour)
What are some nursing interventions to preserve cardiac output?
- auscultate heart sounds
- Assess skin color/temp
- Monitor cardiac rhythm
- Administer meds
- Monitor pressures, vein distension, edema
- Maintain IV access sites
- Instruct on symptom reporting
What are some nursing interventions to promote safety?
- assess signs of bleeding
- report coagulation study results
- Keep antidote at bedside
- Assess medication regime
- Avoid invasive procedures
- Maintain pressure on puncture/injection sites
- maintain adequate fluid intake (IV/PO)
What is the antidote for heparin?
protamine sulfate
What is the antidote for warfarin?
Vitamin K
What is the antidote for thrombolytic agents?
amino caproic acid (reverses hemorrhaging)
What are some nursing interventions to reduce anxiety?
- assess client’s anxiety level
- stay with client
- Explain procedures and treatments
- Reduce environmental stimuli
- Encourage family support
- administer morphine sulfate or anxiolytics
What is a normal PT level?
12-15 seconds
What is a normal PTT?
30-80
What is a normal INR on warfarin?
2.0-3.0
What are normal RBC levels?
4.5-5.0
What are normal WBC levels?
4-10
What acid-base imbalance is most common with pulmonary embolisms?
Respiratory alkalosis because of the increased respiratory rate leading to an excess loss of CO2 and a high level of pH.
