Pulmonary Embolism

Question 1

Pulmonary Embolism

Answer 1

1) occurs when a substance (solid, gaseous, or liquid) enters venous circulation and forms a blockage in the pulmonary vasculature
2) emboli originating from DVT are most common cause. Tumors, bone marrow, amniotic fluid, and foreign matter can also become embolie.
3) increased hypoxia to pulmonary tissue and impaired blood flow can result from a large embolus
4) it is a medical emergency
5) prevention, rapid recognition, and treatment are essential for positive outcome

Question 2

Risk factors for PE

Answer 2

1) long-term immobility
2) oral contraceptive use and estrogen therapy
3) pregnancy
4) tobacco use
5) hypercoagulability (elevated platelet count)
6) obesity
7) surgery (especially orthopedic surgery of lower extremities or pelvis)
8) HF or chronic atrial fibrillation
9) autoimmune hemolytic anemia (sickle cell)
10) long bone fractures
11) advanced age: certain pathological conditions and procedures that predispose clients to DVT formation (PVD, hypertension, hip and knee orthoplasty) are more prevalent in older adults

Question 3

Manifestations of PE

Answer 3

1) anxiety
2) feelings of impending doom
3) pressure in chest
4) pain upon inspiration
5) dyspnea and air hunger
6) pleurisy
7) tachycardia
8) hypotension
9) tachypnea
10) adventitious breath sounds (crackles) and cough
11) heart murmur in S3 and S4
12) diaphoresis
13) decreased O2 saturation levels
14) petechiae and cyanosis
15) pleural effusion (fluid in lungs)

Question 4

Laboratory Tests

Answer 4

1) ABG analysis
- PaCO2 levels will be low (expected reference range 34-45 mmHg) due to initial hyperventilation (respiratory alkalosis). As hypoxemia progresses, respiratory acidosis occurs
2) CBC analysis
3) D-dimer
- elevated above expected range in response to clot formation and release of fibrin degradation products (expected reference range is 0.43-2.33 mcg/mL)

Question 5

Pulmonary Edema

Answer 5

1) chest x-ray and computed tomography (CT) scan:
- provide initial identification of a PE
- CT scan most commonly used
- chest x-ray can show large PE
2) ventilation and perfusion scan (V/Q scan)
- images show the circulation of air and blood in the lungs and can detect a PE
3) pulmonary angiography:
- most thorough test to detect a PE, but it is invasive and costly
- catheter inserted into vena cava to visually see a PE

Question 6

Medications Used in the Treatment of Pulmonary Embolism

Answer 6

1) anticoagulants
- enoxaparin (Lovenox), heparin, and warfarin (Coumadin)–used to prevent clots from getting larger or other clots from forming
2) thrombolytic therapy
- alteplase (Activase) and streptokinase (Streptase)–used to dissolve blood clots and restore pulmonary blood flow

Question 7

Surgical Interventions for Pulmonary Embolism

Answer 7

1) embolectomy–surgical removal of embolis
2) vena cava filter–insertion of a filter in the vena cava to prevent further emboli from reaching the pulmonary vasculature

Question 8

Client Education: Treatment and Prevention of Pulmonary Embolism

Answer 8

1) promote smoking cessation if client smokes
2) encourage client to avoid long periods of immobility
3) encourage physical activity such as walking
4) encourage client to wear compression stockings to promote circulation
5) encourage client to avoid crossing legs
6) advise client to monitor intake of foods high in vitamin K (green, leafy vegetables) if taking warfarin. vitamin K can reduce the anticoagulant effects of warfarin
7) advise client to adhere to schedule for monitoring PT and INR, follow instructions regarding medication dosage adjustments (for clients on warfarin), and adhere with the need for weekly blood draws.
- remind client that taking warfarin increases risk for bruising and bleeding