Pulmonary Embolism

Question 0

Pulmonary Embolism

-Where do thrombi turn into Emboli?

Answer 0

1. Thrombi may break loose in the popliteal and ileofemoral veins and become embolus

Question 1

Pulmonary Embolism

-Leading Cause of PE?

Answer 1

1. Thrombus arising from the deep veins of the legs

Question 2

Pulmonary Embolism

-Contraindicated Pillow location

Answer 2

1. Don’t put pillow under knees

Question 3

Pulmonary Embolism

-Common Causes

Answer 3

1. DVT
2. Thrombus from the right heart
3. Trauma, Surgery

Question 4

Pulmonary Embolism

-How Many People Die Annually?

Answer 4

1. 200,000 people die yearly

Question 5

Pulmonary Embolism

-Time from onset to death?

Answer 5

1. 2 hours (EMERGENCY)

Question 6

Pulmonary Embolism

-Risk Factors

Answer 6

1. Similar to DVT
2. Stasis of venous blood (bedrest, immobility)
3. Vessel wall damage and altered blood coagulation

Question 7

Pulmonary Embolism

-S/S

Answer 7

1. SUDDEN ONSET of dyspnea and pleuritic chest pain
2. Anxiety and sense of impending doom
3. May or may not have Fever

Question 8

Pulmonary Embolism

-Best Treatment

Answer 8

1. Prevention
   - Ambulate night of surgery
   - Compression stockings

Question 9

Pulmonary Embolism

-Drug of choice?

Answer 9

1. Morphine

- Decreases anxiety as well as pain management

Question 10

Pulmonary Embolism

-Purpose of Analgesics

Answer 10

1. Lower anxiety

2. Relieve pleuritic pain

Question 11

Pulmonary Embolism

-Diagnostic Tests

Answer 11

1. D-Dimer: Shows Fibrin in blood
2. CT w/ Contrast: Shows dark spot where clot is
3. Lung Scan: Location of clot
4. End Tidal CO2: Measurement of Co2 exhaled (30-45 is normal)

Question 12

Pulmonary Embolism

-Coagluation Studies

Answer 12

1. Used to monitor response to Heparin and Coumadin

Question 13

Pulmonary Embolism

-Therapeutic Level for Heparin

Answer 13

1. PTT 1.5-2 times the control value

Question 14

Pulmonary Embolism

-Levels for Coumadin/Warfarin

Answer 14

1. INR 2.0-3.0

Question 15

First thing you would do for a Pt who walked into ER with Chest Pain?

Answer 15

1. Give oxygen and take vital signs

- Always take V/S before administering medicaiton

Question 16

Pulmonary Embolism

-Heparin and Coumadin

Answer 16

1. Give Heparin first and start Coumadin with the Heparin until Coumadin reaches the therapeutic dose (usually 4 days)
2. Usually Pt is on Coumadin for 2 months.

Question 17

Pulmonary Embolism

-Fibrinolytic Therapy

Answer 17

1. Used to lyse a MASSIVE clot

- Very dangerous because of the risk of bleeding

Question 18

Contraindication to Coumadin

Answer 18

1. Recent Hx of surgery

2. Recent CVA

Question 19

Pulmonary Embolism

-Nurses Primary Role?

Answer 19

PREVENTION
PREVENTION
PREVENTION TEST

Question 20

Pulmonary Embolism

-Assessment (Emergency)

Answer 20

1. Very focused, emergency assessment
2. Health Hx
   - Chest pain, SOB, other related symptoms
3. Physical exam
   - LOC, RR, P, Skin color Temp VS

Question 21

Pulmonary Embolism

-Teaching

Answer 21

1. Take break while driving q1-2hrs
2. Avoid crossing legs
3. No pillows under knees
4. Stop Smoking
5. Elastic Hose if you stand all day

Question 22

Pulmonary Embolism

-Teaching for Pt discharged on Coumadin

Answer 22

1. Recognize S/S of bleeding
   - Gums bleed for no reason // Nosebleed // bruising for no reason
2. Electric Razor
3. No flossing and soft toothbrush

Question 23

Pulmonary Embolism

-Nursing Dx

Answer 23

1. Impaired Gas Exchange
2. Decreased CO
3. Ineffective Protection
4. Anxiety

Question 24

Pulmonary Embolism

-Oxygen Saturation above?

Answer 24

1. Maintain o2 sat above 94%

Question 25

Pulmonary Embolism

-Impaired Gas Exchange Implementation

Answer 25

1. Assess VS, lungs, and O2 sats Q2hrs

2. Place Pt in high fowlers

Question 26

Pulmonary Embolism

-CO implementation

Answer 26

1. Skin color assessment

2. Look at lungs and edema for back up into the lungs or system