Pulmonary Embolism Flashcards
?
Can be solid, liquid, or gas
- Usually, it’s an embolus that breaks from a thrombus in the venous system and travels through the right side of the heart and into the capillary bed of the pulmonary system
- Here, it blocks perfusion and oxygenation of the RBCs that normally pick up oxygen in this capillary bed
Pulmonary embolism (PE)
Risk Factors for VTE (venous thromboembolism)
- Immobility
- Central venous catheters
- Surgery
- Obesity
- Advanced age
- History of VTE
- Smoking
- Estrogen therapy
- Trauma
- Cancer (prostate, lung)
- Heart failure, stroke
A young man with no risks for VTE has developed 2 in the past month. What genetic test should he be tested for?
Factor V Leiden
Preventative Measures
- Early mobility after surgery
- Change client position every 2 hours
- Weight loss
- Smoking cessation
- Avoid crossing legs
- Antiembolism stockings
- Pneumatic compression devices
- Anticoagulation/antiplatelet therapy
- Avoid pressure and constriction
S/S of Pulmonary Embolism (PE)
- Tachypnea
- Crackles/wheezes
- Pleural friction rub
- Tachycardia
- S3 or S4 heart sounds
- Diaphoresis
- Low grade fever
- Decreased oxygen saturation
- MI/shock
- Increased RR
- Petechiae (over chest and axillae)
- Dyspnea (sudden onset)
- Stabbing chest pain
- Apprehension (restlessness)
- Impending doom/anxiety
- Dry cough
- Hemoptysis
- Transient EKG changes:
> T wave & ST segment changes
> L or R axis deviations
Lab Data
ABG’s early for larger PE’s →
Hyperventilation (blowing off of CO2) occurs caused by hypoxia will cause respiratory alkalosis or acidosis ?
(Respiratory) Alkalosis
With continued shunting of blood from the right to left side of the heart without picking up oxygen, and less oxygen available for the tissues, the person will tire and the PaCO2 levels rise causing respiratory acidosis or alkalosis ?
(Respiratory) Acidosis
ABG’s late →
Continued hypoxemia causes anaerobic metabolism and increased lactic acid levels causing
respiratory OR metabolic
alkalosis OR acidosis ?
Metabolic Acidosis
Lab Data
A normal or low level of this hematological study can rule out PE. A high value requires more assessment
D-dimer
Imaging Assessment
___ is the gold standard
CT scan helical/Pulmonary Angiography - rule in a PE or other pulmonary anomaly
Ventilation-perfusion scan - rule in a PE. Does not use contrast dye
Pulmonary angiography
Chest x-ray - rule in another etiology for symptoms
Doppler US - rule in a VTE
Interventions - Surgical
- Embolectomy
- IVC filter
Interventions - Non-surgical
- Oxygenation including mechanical ventilation
- Place in high-Fowler’s position
- Anticoagulation or fibrinolytic (thrombolytic) rx’s
- Teach/assess bleeding precautions
- Assess cardiac and respiratory status/telemetry monitoring equipment
- Reassurance
With heparin-based medications:
the nurse needs to monitor platelet counts due to a condition called ?
heparin-induced thrombocytopenia
Drug class is ?
anticoagulant
The antidote for heparin is ?
protamine sulfate
__ and __ coagulation studies need to be monitored on a regular basis
- Prevents the growth of current and future clots
PTT; aPTT
Warfarin (Coumadin):
- Prevents the growth of current and future clots
Drug class is ?
anticoagulant
Antidote for warfarin is ?
Vitamin K1 (phytonadione)
Lab values to be monitored are INR and __
PT
Goal INR is between __ and __
2.0 - 3.0
Possible food interaction with ___
Vitamin K foods (green vegetables - lettuce, spinach, broccoli, kale, brussels sprouts)
INR ranges
For 1st PE: 2.5 - 3.0
For recurrent PE: 3.0 - 4.5
For AF: 2.0 - 3.0
alteplase (Activase) and tPA - promotes the lysis of current, large PE
Drug class is ___
Antidote(s) is ___
Thrombolytic, fibrinolytic
Amicar (aminocaproic acid); clotting factors; FFP
10 Precautions to Prevent Bleeding
- Use an electric shaver
- Use a soft-bristled toothbrush
- Avoid contact sports
- Avoid hard foods that scrape the inside of the mouth
- Check skin and mouth for bruises, swelling, or petechiae
- Take a stool softener to prevent straining during a bowel movement
- Do not use enemas or rectal suppositories
- Do not wear tight fitting clothes or shoes
- Avoid blowing your nose or placing objects in your nose
- Avoid anal intercourse
Yes or No?
Will we wait for assessment data to return prior to treating a client that is dyspneic, hypotensive, and with chest pain?
No
Complications of PE
- Pulmonary infarction and ___
- Acute respiratory failure
- Acute __ __ __
- Hypotension; shock/death
HTN
(Acute) respiratory distress syndrome (ARDS)
