Pulmonary Embolism Part 2

Question 1

Medical Management of Stable Pulmonary Embolism

Answer 1

*immediate anticoagulation
*Long-term anticoagulation
*Outpatient Therapy

Question 2

patients with PE who do not demonstrate any cardiopulmonary instability are

Answer 2

Normotensive
No evidence of Hypoxemia

Question 3

is indicated to prevent recurrence or extension of the thrombus and may continue for 10 days

Answer 3

immediate anticoagulation

Question 4

In patients with stable PE, the INITIAL anticoagulant selected may include an

Answer 4

*LMWH: enoxaparin
*unfractionated heparin
*direct oral anticoagulant (DOAC): direct thrombin inhibitor: dabigatran
*factor Xa inhibitor: fondaparinux, rivaroxaban, apixaban, edoxaban

Question 5

is also indicated up to 6 months following the PE and is critical in preventing recurrence of VTE. This duration may be extended indefinitely in patients who are at high risk for recurrence

Answer 5

Long-term anticoagulation

Question 6

Long-term treatment options include

Answer 6

Warfarin
DOACs
LMWH (may be selected) - SubCu

Question 6

not specific selection criteria for outpatient treatment, the patient is usually at

Answer 6

*low risk of death
*no respiratory or hemodynamic compromise
*does not require opioids for pain control
*no risk factors for bleeding
*no serious comorbid conditions
*stable baseline mental status

Question 7

Often prescribed for outpatient administration

Answer 7

DOACs

Question 8

requires regular blood draws for INR monitoring and has a higher bleeding risk, but it has long been the standard of care prior to the development of DOACs.

Answer 8

Warfarin dosing

Question 9

An antidote is available if the INR is high and there is a risk of bleeding.

Answer 9

Vitamin K

Question 10

do not require regular blood test monitoring; however, they are more costly than warfarin

Answer 10

DOACs

Question 11

Nursing Management

Answer 11

Monitoring Thrombolytic Therapy
Managing Pain
Managing Oxygen Therapy
Relieving Anxiety
Monitoring for Complications

Question 12

Monitoring Thrombolytic Therapy

Answer 12

Bed rest
Vital signs
Avoid invasive procedure
Tests for INR/aPTT performed 3-4 hrs after thrombolytic infusion is started to confirm that the fibrinolytic systems have been activated

Question 13

Managing Pain

Answer 13

semi-Fowler position
turn patients frequently
Reposition: improve V/Q
administers opioid analgesic agents

Question 14

Managing Oxygen Therapy

Answer 14

Signs of hypoxemia
Monitor pulse oximetry
Deep breathing
Incentive spirometry
Nebulizer therapy
Percussion
Postural drainage

Question 14

Relieving Anxiety

Answer 14

encourages the patient who is stabilized to talk about any fears
answers the patient’s and family’s questions concisely and accurately
explains the therapy
describes how to recognize untoward effects early

Question 14

Monitoring for Complications

Answer 14

complication of cardiogenic shock
right ventricular failure

Question 14

Providing Postoperative Nursing Care

Answer 14

*measures pulmonary arterial pressure & urinary output
*assesses the insertion site of the arterial catheter for hematoma formation and infection
*Maintaining blood pressure
*elevates the foot of the bed prevents peripheral venous stasis and edema
*encourages isometric exercises
*Use ofintermittent pneumatic compression devices, and walking
*Sitting for long periods is discouraged