Pulmonary Embolism

Question 1

define pulmonary embolism

Answer 1

1. Blockage of 1 or more branches of pulmonary artery
2. Causes impaired ventilation-perfusion ratio (ventilation-perfusion
   mismatch]

Question 2

VTE risk factors

Answer 2

Immobility
surgery within 3 months
h/o VTE
cancer
obesity
oral contraceptives/hormone therapy
smoking
prolonged air travel
heart failure
pregnancy
clotting disorders

Question 3

MOST COMMON clinical manifestations of pulmonary embolism (PE)

Answer 3

a) *Dyspnea
b) Pleuritic chest
c) Tachypnea
d) Tachycardia
e) Cough, crackles, wheezing, hemoptysis

Question 4

other clinical manifestations of pulmonary embolism

Answer 4

Anxiety
diaphoresis
fever
syncope
hypoxia
right heart failure

Question 5

clinical manifestation for a massive PE

Answer 5

change in LOC
hypotension
apprehension

Question 6

complications of PE

Answer 6

pulmonary infarction and pulmonary HTN

Question 7

diagnostic and lab studies for PE

Answer 7

a) D-dimer
b) Spiral (helical) CT scan/CT angiography(CTA)
c) Ventilation-perfusion (V/Q) scan

Other studies: not diagnostic

(1) ABGs
(2) Chest x-ray
(3) 12 lead ECG
(4) Troponin level
(5) BNP
(6) Pulmonary angiography
(7) Ultrasound

Question 8

prevention for PE

Answer 8

Risk assessment on admission and daily discussion

DVT or VTE prophylaxis

(1) Sequential compression devices or compression stockings
(2) Early ambulation
(3) Prophylactic anticoagulation
(4) Place a vena cava filter in high risk clients
(5) Early fixation of long bone fracture
(6) Early diagnosis and treatment to prevent PE

Question 9

medical management for PE

Answer 9

Support cardiopulmonary status

1) intubation, mechanical ventilation
2) prevent atelectasis
3) manage shock 
4) manage HF 
5) manage pain

medications

(1) Anticoagulants: Low molecular weight heparin, unfractionated IV heparin, warfarin or alternative (3 months or longer)
(2) Fibrinolytic agents: tissue plasminogen activator (tPA), alteplase
(3) Analgesics

Question 10

surgical management for PE

Answer 10

a) Embolectomy

b) Inferior vena cava filter (IVC)

Question 11

nursing diagnoses for PE

Answer 11

(1) Hypoxemia
(2) Ineffective breathing pattern
(3) Impaired gas exchange
(4) Decreased cardiac output
(5) Acute pain
(6) Potential for bleeding

Question 12

assessment for PE

Answer 12

(a) Chest pain
(b) Vital signs, cardiopulmonary status
(c) ABGs (initial)
(d) Coagulation studies, CBC
(e) Urine output

Question 13

actions for PE

Answer 13

(a) Administer oxygen/mechanical ventilation
(b) Administer anticoagulants
(c) Administer thrombolytics if ordered
(d) Implement bleeding precautions
(e) Increase head of bed, bedrest
(f) Administer IV fluids

Question 14

teaching for PE

Answer 14

(a) Disease process
(b) Risks of PE and avoidance of future occurrences
(c) Medication teaching
(d) Adequate hydration
(e) Exercise
(f) Smoking cessation
(g) Signs and symptoms VTE
(h) Followup with HCP and lab monitoring