Pulmonary Embolism (PE)

Question 1

What is a Pulmonary Embolism ?

Answer 1

A thrombus or blood clot, but it can be air, fat, or even amniotic fluid in the maternity client

Question 2

What are causes of a Pulmonary Embolism ?

Answer 2

• Dehydration
• Venous stasis from prolonged immobility or surgery
• Obesity
• Birth control pills
• Clotting disorders
• Heart arrhythmias like A-fib

Question 3

What is a DVT ?

Answer 3

Thrombosis in deep veins of the legs or the arms

Question 4

What is a PE ?

Answer 4

Thrombosis that has broken off and lodges in a lung artery

Question 5

What is a VTE ?

Answer 5

When you have both DVT and PE

Question 6

What are signs & symptoms of a Pulmonary Embolism ?

Answer 6

• Hypoxemia = #1
• PaO2 = Decreased (O2 can’t get passed the clot)
• SOB
• Cough
• Increased RR
• Restlessness
• Apprehension
• Petechiae over chest
• Cyanosis
• Hemoptysis (coughing up blood)
• Increase pulse (b/c of hypoxia)
• Chest pain (sharp, stabbing)
• Atelectasis (on chest x-ray)
• BP in lungs increases (which is pulmonary HTN)

Question 7

Pulmonary HTN affects what side of the heart ?

Answer 7

Right side

Question 8

What are ways that Pulmonary Embolisms are Diagnosed ?

Answer 8

• Increased D-dimer
• Computerized tomography angiogram (CTA)
• Positive VQ scan

Question 9

What does a D-dimer test tell us ?

Answer 9

Will tell if a clot is located anywhere in the body (not just in the lungs)

(D-dimer = increased with pulmonary embolus)

Question 10

What is the most frequently used test to diagnose a PE ?

Answer 10

a Computerized tomography angiogram (CTA)

Question 11

What do you want to check before a client undergoes a CTA and why ?

Answer 11

Want to check Kidney function b/c Dye Is used

Question 12

How does a VQ scan work ?

Answer 12

Measures both airflow and blood flow to the lungs

Question 13

What is a VQ scan ?

Answer 13

Ventilation/perfusion scan

Question 14

Is Dye used with a VQ scan ?

Answer 14

No!

Question 15

What is the most sensitive and specific test for PE’s ?

Answer 15

Pulmonary angiography

Question 16

What is the prevention for Pulmonary Embolisms ?

Answer 16

Early mobilization:

• change positions every 2 hours
• Prevent stasis (by flexing & extending feet, knees, & hips every 2 to 4 hours)
• Need to walk 4 to 6 times a day
• TED hose
• Hydrate! by forcing fluids

Question 17

What will not be used if a client has a suspected DVT ? and why ?

Answer 17

Pneumatic compression devices Because a suspected DVT could become a PE

Question 18

What are the Tx’s for Pulmonary Embolisms ?

Answer 18

• Bedrest/ affected leg may be elevated above the heart to promote blood flow and prevent stasis
• Oxygen according to ABG’s
• Decrease pain
• Administer anticoagulants
• Bleeding precautions
• Fibrinolytic agents like tPA or alteplase help dissolve the embolus
• Pulmonary embolectomy (if not candidate for fibrinolytic)
• Inferior vena cava filtration device may be inserted
  (prevents clots from getting into pulmonary circulation)

Question 19

What are three cases of Anticoagulant medications ?

Answer 19

1. ) Vitamin K antagonists like warfarin (Coumadin)
2. ) Thrombin inhibitors like heparin or more commonly used Enoxaparin (lovenox), or dabigatran
3. ) Factor Xa inhibitors like rivaroxaban (Xarelto) or fondaparinux (Arixtra)

Question 20

What do the Three Classes of Anticoagulant Medications do ?

Answer 20

• These drugs prevent a clot from getting bigger

Question 21

What do you want to limit when on Warfarin ?

Answer 21

Limit green leafy vegetable serving to what is normally eaten

(Do not increase servings)

Question 22

True or False:

It is difficult to maintain target INR if diet varies in the amount of Vitamin K ?

Answer 22

True