Pulmonary Embolism

Question 1

What is Pulmonary Embolism

Answer 1

Blockage of pulmonary arteries by thrombus, fat or air embolus, or tumor tissue

Obstructs alveolar perfusion

Most commonly affects lower lobes

Question 2

Risk Factors

Answer 2

Deep vein thrombosis (90%)

Immobility or reduced mobility

Surgery

History of DVT

Malignancy

Obesity

Oral contraceptives/ hormones-

Secondary to estrogen and progesterone increasing clotting factors

Smoking

Heart failure

Pregnancy/delivery

Clotting disorders

Atrial fibrillation

Central venous catheters

Fractured long bones

Question 3

Clinical Manifestations

Answer 3

Variable

Dyspnea most common

Tachypnea, cough, chest pain, hemoptysis, crackles, wheezing, fever, tachycardia, syncope, change in LOC

Dependent on size and extent of emboli

Question 4

Clinical Manifestations

Answer 4

Pulmonary infarction

Alveolar necrosis and hemorrhage

Abscess

Pleural effusion

Pulmonary hypertension

Results from hypoxemia associated with massive or recurrent emboli

Right ventricular hypertrophy

Question 5

Diagnostic Studies

Answer 5

Arterial blood gases

Chest x-ray

Electrocardiogram

Troponin levels

B-type natriuretic peptide

D-Dimer

• Elevated with any clot degradation
• False negatives with small PE

Spiral (helical) CT scan

• Most frequently used dx test
• Requires IV contrast media

Ventilation-perfusion (V/Q) scan

• Used if patient cannot have contrast
• Two components
• Perfusion scanning
• Ventilation scanning

Pulmonary angiography.

-Most sensitive but invasive

Arterial blood gases (ABGs)

Question 6

Collaborative Care

Answer 6

Prevention—the key!

• Sequential compression devices
• Early ambulation
• Prophylactic anticoagulation

Question 7

Goals of TX

Answer 7

Prevent further thrombi

Prevent further embolization to pulmonary system

Provide cardiopulmonary support

Question 8

Supportive care variable

Answer 8

Oxygen → mechanical ventilation

Fluids, diuretics, analgesics

Question 9

Drug Therapy

Answer 9

Anticoagulation

• Low-molecular-weight heparin (LHWH)
• Unfractionated IV heparin- aPPT level-Prevents clots –dissolve them

Warfarin (Coumadin)-PT/INR

Fibrinolytic agents

• Tissue plasminogen activator (tPA)
• Alteplase (Activase)

Question 10

Surgical Therapy

Answer 10

Pulmonary embolectomy for massive PE

Inferior vena cava (IVC) filter

• Prevents migration of clots in pulmonary system

Question 11

Nursing Management

Answer 11

Semi-Fowler’s position

IV access

Oxygen therapy

Frequent assessments

Monitor laboratory results.

Emotional support and reassurance

May have to give bot hydration and diuretics if a CHF patient

Question 12

Patient Teaching

Answer 12

Regarding long-term anticoagulant therapy

Measures to prevent DVT

Importance of follow-up exams

Question 13

Evaluation

Answer 13

•Expected Outcomes

Adequate tissue perfusion and respiratory function

Adequate cardiac output

Increased level of comfort

No recurrence of PE