Pulmonary Embolism (PE) Flashcards
What is a Pulmonary Embolism ?
A thrombus or blood clot, but it can be air, fat, or even amniotic fluid in the maternity client
What are causes of a Pulmonary Embolism ?
- Dehydration
- Venous stasis from prolonged immobility or surgery
- Obesity
- Birth control pills
- Clotting disorders
- Heart arrhythmias like A-fib
What is a DVT ?
Thrombosis in deep veins of the legs or the arms
What is a PE ?
Thrombosis that has broken off and lodges in a lung artery
What is a VTE ?
When you have both DVT and PE
What are signs & symptoms of a Pulmonary Embolism ?
- 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)
Pulmonary HTN affects what side of the heart ?
Right side
What are ways that Pulmonary Embolisms are Diagnosed ?
- Increased D-dimer
- Computerized tomography angiogram (CTA)
- Positive VQ scan
What does a D-dimer test tell us ?
Will tell if a clot is located anywhere in the body (not just in the lungs)
(D-dimer = increased with pulmonary embolus)
What is the most frequently used test to diagnose a PE ?
a Computerized tomography angiogram (CTA)
What do you want to check before a client undergoes a CTA and why ?
Want to check Kidney function b/c Dye Is used
How does a VQ scan work ?
Measures both airflow and blood flow to the lungs
What is a VQ scan ?
Ventilation/perfusion scan
Is Dye used with a VQ scan ?
No!
What is the most sensitive and specific test for PE’s ?
Pulmonary angiography
What is the prevention for Pulmonary Embolisms ?
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
What will not be used if a client has a suspected DVT ? and why ?
Pneumatic compression devices Because a suspected DVT could become a PE
What are the Tx’s for Pulmonary Embolisms ?
- 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)
What are three cases of Anticoagulant medications ?
- ) Vitamin K antagonists like warfarin (Coumadin)
- ) Thrombin inhibitors like heparin or more commonly used Enoxaparin (lovenox), or dabigatran
- ) Factor Xa inhibitors like rivaroxaban (Xarelto) or fondaparinux (Arixtra)
What do the Three Classes of Anticoagulant Medications do ?
- These drugs prevent a clot from getting bigger
What do you want to limit when on Warfarin ?
Limit green leafy vegetable serving to what is normally eaten
(Do not increase servings)
True or False:
It is difficult to maintain target INR if diet varies in the amount of Vitamin K ?
True
