Pulmonary Embolism Flashcards
Obstructed pulmonary bloodflow can lead to?
- Reduced oxygenation of the whole body
- tissue hypoxia
- potential death
What is a pulmonary embolism?
A collection of particles that intravenous circulation and lodges in the pulmonary vessels
What is the most common cause of a pulmonary embolism in a hospital patient?
A blood clot from a DVT breaks loose from one of the veins in the legs or in the pelvis. The clot breaks off, travels through the vena cava and to the right side of the heart, and then lodges in the pulmonary artery or one of the more of its branches. Platelets collect on the embolus, triggering the release of substances that cause blood vessel constriction. The vessel constriction and pulmonary hypertension impaired gas exchange causing hypoxemia
What is hypoxemia
Low arterial blood oxygen level
Major risk factors for DVT leading to PE are:
Prolonged immobility Central venous catheters Surgery Obesity Advancing age Conditions that increase blood clotting History of thromboembolism
Also (smoking, pregnancy, estrogen therapy, stroke, cancer, trauma and Trousseaus syndrome)
What does Plavix do
Reduce platelet aggregation
Chart 34-1. Prevention of PE
- ROM
- Ambulate after surgery
- SCD stockings
- Avoid tight garters, girdles and constricting clothing
- prevent pressure under popliteal space
- elevate affected limb 20 degrees or more above level of heart to encourage venous return
- no massaging
- no crossing legs
- avoid Valsalva maneuver
- smoking cessation
What is the biggest sign to look for to start assessing for PE?
Sudden onset of breathing difficulty
Main symptoms that occur with a PE?
Dyspnea (difficulty breathing)
Rapid heart rate
Pleuritic chest pain (sharp, stabbing-type pain on inspiration)
Other s/s of PE
Apprehension, restlessness Feeling of impending doom Cough Hemoptysis (bloody sputum) Tachypnea Crackles Tachycardia Low grade fever Petachiae over chest
Priority nursing diagnoses for PE
- Decreased cardiac output related to acute pulmonary hypertension
- anxiety related to hypoxemia and life threatening illness
Non priority (impaired gas exchange, fatigue, impaired oral mucus membrane, acute confusion, sleep deprivation)
If you suspect a PE what should you do?
- when patient has sudden onset of dyspnea and chest pain, immediately notify the rapid response team.
- Elevate HOB
- prepare oxygen therapy and blood gas while continuing to monitor and assess for other changes
Expected outcomes after a PE?
- ABGs within normal limits
- Pulse oximetry above 95%
- Cognitive status not compromised
- Absence of pallor and cyanosis
Goals of management for PE:
- increase gas exchange
- improve lung perfusion
- reduce risk for further clot formation
- prevent complications
Priority nursing interventions for PE
Oxygen therapy
Administering anti coagulants
Monitor patient response to interventions
Provide psychosocial support
