Pulmonary Embolism (PE) Flashcards
What is a Pulmonary Embolism?
- The blockage of 1 or more pulmonary arteries by a thrombus, fat or air embolus, or tumor tissue.
What are emboli?
Mobile clots that generally do not stop moving until they lodge at a narrowed part of the circulatory system
- Mobile clots that generally do not stop moving until they lodge at a narrowed part of the circulatory system
Most PE’s arise from what?
DVT (deep vein thrombosis)
What are some lower limb sites of origin for emboli to form and travel to the pulmonary system?
- Femoral or iliac veins,
- Right side of the heart (atrial fibrillation), and
- Pelvic veins (especially after surgery or childbirth)
What are some reasons that may cause DVTs develop in the upper extremity?
- Presence of central venous catheters or arterial lines.
- These cases may resolve with the removal of the catheter.
Why are pulmonary emboli so difficult to diagnose?
The s/s are quite general and hard don’t point to a PE until they become serious
What are some key indicators of a massive PE?
- Sudden change in mental status
- Sudden SOB onset
- Hypotension
- Feelings of impending doom
True or false
Most PTs w/ massive PE’s die w/in the first hour
- False
- 10% die in first hour
Treatment with _____ significantly reduces PE mortality.
Anticoags
What is the main complication of PE?
Pulmonary infarction
What is pulmonary infarction?
Death of lung tissue
How does a PE cause pulmonary infarction?
When an emboli blocks a ≥ medium pulmonary vessel and there is insufficient collateral blood flow from bronchial circulation
What diagnostics are run for PE?
- D-dimer – looking for elevated fibrin fragments (not reliable for small Pes)
- CT scan – w/ contrast media
- V/Q scan if PT can’t do have contrast media
Upon dx of PE, immediate assessment should focus on the patient’s _____ _____, which can vary according to the size and location of the PE.
cardiopulmonary status
O2 should be given by mask or cannula when _____ is present.
Hypoxemia
With PE, respiratory measures, including turning, coughing, deep breathing, and incentive spirometry, are important to help prevent or treat _____.
Atelectasis
If PE manifestations of shock are present, _____ and _____ agents are given as needed to support circulation
- IV fluids
- Vasopressor
Immediate anticoagulation is required for patients with PE. Subcutaneous administration of _____ is the recommended treatment for patients with acute PE.
low-molecular-weight heparin (LMWH) (e.g., enoxaparin [Lovenox])
_____, an oral anticoagulant, should also be started at the time of diagnosis, given for at least __ months and then reevaluated.
- Warfarin (Coumadin)
- Three
Anticoagulant therapy may be contraindicated if the patient has complicating factors, involving the _____.
Liver
Prevention of PE begins with prevention of DVT. Nursing measures that can address this are…
- Compression stockings
- Early ambulation
- Anticoags
The prognosis of a patient with PE is good if _____ is started immediately.
Therapy
In caring for a PT w/ PE, the nurse should assess the patient’s cardiopulmonary status with careful monitoring of…
- vital signs,
- cardiac rhythm,
- pulse oximetry,
- ABGs, and
- lung sounds.
Monitor laboratory results to ensure therapeutic ranges of INR (for _____) and aPTT (for IV _____).
- Warfarin
- Heparin
