Pulmonary Embolism (PE) Flashcards
what is a PE?
p. 1210
obstruction of blood flow in part of PULMONARY VASCULAR SYSTEM by an E M B O L U S (aggregate of blood, fat, or an air bubble)
THROMBOEMBOLI = emboli created by a blood clot
- -develop in the venous system/deep vein or R-side of <3
- -MOST FREQ. CAUSE OF PE
- -vasoconstriction = incr. pulmonary vascular resistance»_space; can lead to PULMONARY HTN & R-ventricular HF
–may develop systemic HYPOTENSION & decr CO
respiratory effects of PE
INFARCT OF LUNG TISSUE
perfusion AND ventilation effected by obstruction of pulmonary blood flow
–obstruction created DEAD SPACE in the lungs
(areas that are ventilated (breathing in) but NOT PERFUSED); increases as clot obstructs blood flow
1st: resp. ALKALOSIS
2nd: resp. ACIDOSIS
**tissues are HYPOXIC»_space; **
s/s: CP, dyspnea, cyanosis, tachypnea/cardia, accessory muscles to breathe, resp. acidosis
tx:
-reposition to decr. work of breathing
-give O2
-prep. for possible ventilation or intubation
-anticoagulant therapy
-low stimulus environment (decr. O2 demands)
alveolar collapse»_space;
s/s: productive cough, CP, hypoxia, dyspnea
tx: incentive spirometer, reposition, give O2
arterioles in lungs rupture d/t congestion»
s/s: cough w/ or w/o blood, dyspnea, coarse crackles
tx: give O2; maintain PATENT AIRWAY
PE risk factors
trauma surgery pregnant (pressure on great vessels) heart disease (HF, MI, CHF) = static blood prolonged immobility increasing age estrogen use cancer coagulation disorders obesity smoking
PE manifestations
**SUDDEN pleuritic CP w/ INSPIRATION
**dyspnea & SOB
tachycardia
tachypnea
anxiety/impending doom
cough
crackles (rales)
low-grade fever
diaphoresis hemoptysis syncope cyanosis s3/s4 gallop
Virchows triad
1) endothelial damage
2) hypercoagulability
3) stasis
hemodynamic response to PE
- Pulmonary Vascular Resistance increases
- R-ventricle fails when workload exceeds capacity
- CO decreases
- systemic blood pressure decreases
- shock
diagnostic tests for PE
- CHEST CT SCAN + CONTRAST*
- ekg
- chest xray
- ABGs (show hypoxia)
- d-dimer (clots & lysis)
- lung scans
- pulmonary angiography (dye)
- coagulation studies (look for hypercoagulability)
- ETCO2
pharm. for PE: ANTICOAGULANTS
inhibit clotting mechanisms & prevent clot formation
1) enoxaparin (Lovenox)–LMW heparin
- -SQ injection
- -*monitor for HIT
2) warfarin (Coumadin)
–PO med
–regularly check PT/INR
(normal INR = 1.5 - 2 // THERAPEUTIC INR = 2 - 3)
–reversal agent: VITAMIN K
3) heparin
–check PTT (normal PTT = 25 - 35 sec)
–reversal agent: PROTAMINE SULFATE
–* monitor for s/s of bleeding
–use BLEEDING PRECAUTIONS
– monitor for HIT
(rec’d heparin w/i 3 mos or for 5-15 days)
pharm. for PE: THROMBOLYTICS
breakdown thrombus/clot
1) streptokinase
2) tPA (tissue plasminogen activator)
3) urokinase
treatment GOALS:
1) restore V/Q : intubation + PEEP
2) stabilize hemodynamically
- -assess VS
- -increase CO
- -decrease Pulm. Vasc. Resist. AND R-vent workload
3) assess & decrease anxiety
(may be from impaired gas exchange)
4) surgery
* *IVC filter (UMBRELLA FILTER)
* *pumonary embolectomy
* *transvenous catheter embolectomy
nursing interventions
1) impaired gas exchange
- -freq. resp. assessments
- -HIGH FOWLERS
- -monitor ABGs
- -maintain bedrest
2) decreased CO
- -auscultate heart sounds q2-4 h
- -assess skin color & temp
- -monitor cardiac rhythm
- -admin. VASOPRESSORS
- -monitor PAP, JVD, & peripheral edema
- -maintain IV, arterial access, & central lines
3) ineffective protection
- -assess freq. for s/s of bleeding
- -coagulation studies
- -keep reversal agents nearby
- -bleeding precautions»_space;
- -avoid invasive procedures/injections/puntures
- -firm pressure on injection sites
- -adequate fluid intake; use stool softeners (hemorrhoids)
4) relive anxiety
- -remain with pt
- -explain procedures
- -reduce environmental stimuli
- -give morphine sulfate (DOC for air hunger)
