Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Nursing 272: Final Semester > Unit 2: Pulmonary Embolism > Flashcards

Unit 2: Pulmonary Embolism Flashcards

You may prefer our related Brainscape-certified flashcards:
Nursing Pharmacology flashcards NCLEX-RN® flashcards Nursing Mental Health flashcards Nursing Fundamentals flashcards Nursing Safety & Infection flashcards Nursing Adult Health flashcards NCLEX-PN® flashcards Nursing Management of Care flashcards Nursing Pediatrics flashcards Nursing Maternity flashcards
1
Q

Pulmonary embolism (PE)

A

obstruction of one or more of the branches of the pulmonary artery by particulate matter that has a origin elsewhere in the body

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Pulmonary Embolisms (PE) are caused by?

A
  • thrombus or piece of tumor
  • amniotic fluid
  • air
  • fat
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Greatest Risk Factor for Pulmonary Embolism (PE)

A

presence of a deep vein thrombosis (DVT)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the major predisposing factor for the development of a DVT?

A

Virchow’s Triad

  • venous stasis
  • vessel wall damage
  • hypercoagulability
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Virchow’s Triad

A

predisposing factors for development of a DVT

  • venous stasis
  • vessel wall damage
  • hypercoagulability
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Most common cause of DVT

A

immobility

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Other Risk Factors for Development of a DVT

A
  • obesity
  • smoking
  • chronic heart disease
  • fracture (hip or leg)
  • hip or knee replacement
  • major surgery
  • major trauma
  • spinal cord injury
  • hx of previous thromboembolism
  • malignancy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Pathophysiology of a Pulmonary Embolism (PE)

A
  • when a blood clot or other particulate matter travels to the lungs, it lodges into the pulmonary artery and blocks blood flow
  • obstruction results in an impaired ventilation-to-perfusion ratio (V/Q); described as decreased or blocked flow or perfusion to functioning alveoli
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Ventilation-Perfusion mismatch (V/Q mismatch)

A

a decreased blood flow to functioning alveoli or areas of the lung where gas exchange can take place if perfusion is adequate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Clinical Manifestations of PE

A
  • sudden onset of intense dyspnea, pleuritic chest pain, and tachypnea
  • PE suspected in any post-op patient
  • Hypotensive and Tachycardic b/c of decreased cardiac output (CO)
  • Cerebral perfusion my become compromise; anxious, restless, and/or confused
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Common Signs and Symptoms of PE

A
  • dyspnea
  • accessory muscle use
  • pleuritic chest pain
  • tachycardia
  • tachypnea
  • crackles upon auscultation
  • cough
  • hemoptysis
  • unilateral lower extremity edema d/t presence of a DVT; pain in extremity, w/ redness and warmth
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Imaging Studies for PE

A
  • Electrocardiogram (ECG)
  • Chest x-ray
  • CT of the chest (w/ contrast)
  • Ventilation-perfusion scan (V/Q Scan)
  • Pulmonary Angiography
  • Once patient w/ acute PE is stable, lower extremity venous ultrasound is conducted to determine presence and extent of any DVT
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is the initial study for any patient present w/ chest pain?

A

Electrocardiogram (ECG/EKG)

  • to r/o MI
  • ischemic changes may be seen (ST changes [depression])
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Imaging: Chest X-ray

A

to r/o other causes of respiratory distress

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Ventilation-perfusion scan (V/Q scan)

A
  • utilized if CT scan not available
  • can identify areas of the lungs that are ventilated but not perfusing effectively; indication of obstruction of the pulmonary vasculature
  • “high probability” = perfusion mismatch
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Most Definitive Test for PE

A

Pulmonary Angiography

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Pulmonary Angiography

A

most definitive test for PE

  • allows for visualization of the pulmonary vasculature; detects any obstruction
  • only done if other studies not conclusive and patient is stable
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Laboratory Studies for PE

A
  • Plasma D-dimer
  • ABGs
  • Cardiac studies (BNP)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Plasma D-Dimer

A

level increases as the body removes clots through lysis as part of the normal clot-removal process

  • D-dimer is the fibrin left behind from that lysis
  • negative D-dimer r/o possibility of a clot
  • positive D-dimer = presence of clot but requires further testing
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

ABGs

A
  • hypoxemia (PaO2 < 80 mmHg)
  • respiratory alkalosis (PaCO2 < 35)
  • may later show metabolic acidosis d/t hypoxemia b/c body switches to anaerobic metabolism in face of hypoxemia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Laboratory Tests: Cardiac (BNP)

A
  • BNP may be elevated d/t strain on the ventricles brought on by PE
  • BNP is released by overstretched ventricles under physiological stress
  • BNP > 100 = Heart Failure (HF)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Normal BNP (Brain Natriuretic Peptide)

A

less than 100

-BNP is released by overstretched ventricles under physiological stress

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Treatments for a Pulmonary Embolism (PE)

A

-primarily anticoagulation
>Nonsymptomatic:
-Oral factor Xa inhibitor; require no lab monitoring for med; no hospitalization
>Symptomatic:
-w/ any type of PE: blood clot, air, fat, b/c blood clots will adhere to any of those substances making them larger and able to obstruct more blood flow
-IV Heparin w/ a bolus followed by a continuous drip

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Anticoagulation

A
  • does not reduce clots, but keeps clot from getting larger

- helps to reduce the formation of other clots

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Heparin Therapy

A

-monitored through aPTT
-prior to therapy; a aPTT is drawn and repeated q 4 to 6 hours to monitor therapy
-therapeutic goal: 1.5 to 2.5 times the normal value or 40 to 90 seconds
-if aPTT is above therapeutic level, rate of infusion is reduced
>Very high aPTT = infusion may be held before restarting to a lower rate
-If aPTT below level, an additional heparin bolus, along w/ increased rate of infusion
-once aPTT in therapeutic range for 2 consecutive iterations, it is evaluated q 12 or 24 hours
-Protamine Sulfate reversal for heparin; be readily available if active bleeding occurs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What Lab value is looked at when starting heparin therapy?

A

aPTT

27
Q

Anticoagulation after discharge

A

> Warfarin (Coumadin)

  • monitored through INR
  • Goal: INR of 2.0 to 3.0
  • takes 3 to 5 days to reach therapeutic level; that’s why heparin and warfarin used concurrently
28
Q

Thrombolytic Therapy: Alteplase

A
  • if hemodynamically compromised
  • Alteplase: responsible for lysis or removal of the clot from pulmonary artery
  • risk of bleeding
  • risk of cerebral hemorrhage in elderly
  • IV heparin usually D/C during Alteplase infusion, then restarted after infusion complete
29
Q

Contraindications to Thrombolytic Therapy

A

> Absolute:

  • hx of hemorrhagic stroke
  • active intracranial neoplasm
  • recent surgery
  • recent trauma (less than or equal to 2 months)
  • active or recent internal bleeding

> Relative:

  • severe hypertension (SBP > 200, DBP >110)
  • non-hemorrhagic stroke (within 2 months)
  • surgery in past 10 days
  • thrombocytopenia (platelets less than 100,000)
  • hx of bleeding tendencies
30
Q

Catheter-directed Thrombolysis

A
  • for patients hemodynamically unstable
  • uses low-dose hourly infusions of tissue plasminogen activator (tPA) or urokinase
  • administration of the medication directly to the clot at the site; lysis of the clot and decreases risk of bleeding complications
31
Q

Intravenous Isotonic Fluid

A
  • decreases viscosity of blood

- caution taken to prevent fluid overload

32
Q

Surgical Management

A
  • Embolectomy

- Inferior Vena Cava Filters (IVC)

33
Q

Embolectomy

A

physical removal of a clot

-catheter or surgical

34
Q

Inferior Vena Cava Filters (IVC)

A

placed to prevent recurrent PE

  • allows for blood passage
  • designed to trap any further emboli originating in lower extremities
35
Q

Indications for a Inferior Vena Cava Filter (IVC)

A
  • active bleeding that disqualifies anticoagulation therapy
  • recurrent PE despite adequate anticoagulation therapy
  • evidence that hemodynamic or respiratory dysfunction is severe enough that another PE could be fatal
36
Q

Complications of the Inferior Vena Cava Filter (IVC)

A
  • filter migration
  • erosion of the vena cava wall
  • obstruction d/t filter thrombosis
  • procedural complications
37
Q

Nursing Management: Assessment and Analysis

A
  • clinical manifestations are non-specific
  • sudden onset of pleuritic chest pain, dyspnea, and tachypnea
  • If pulmonary vascular resistance (PVR) is elevated, JVD may be seen
  • w/ a massive PE, preload to the left side of the heart may be reduced which leads to decreased CO and hypotension
  • sudden change in mental status if cerebral perfusion pressure is compromised
  • anxious or express feelings of impending doom
38
Q

Nursing Diagnoses for PE

A
  • Impaired gas exchange r/t interruption of pulmonary blood flow
  • Ineffective breathing pattern: Tachypnea r/t pain and hypoxemia
  • Decreased CO r/t increased PVR
  • Risk for bleeding r/t anticoagulant/ thrombolytic therapy
39
Q

Nursing Assessments

A
  • Airway
  • Oxygenation
  • Frequent vital signs
  • Chest Pain
  • Lab Values (ABG, Lactic Acid, Coagulation)
  • Urine output
40
Q

Assessments: Airway

A

is breathing effective to maintain oxygenation?

  • pt breathing comfortably or in respiratory distress?
  • mechanical ventilation may be required
41
Q

Assessment: Oxygenation

A

-pulse oximetry reading decreases from baseline as a result of increased dead-space ventilation; blood is not properly oxygenated in the lungs

42
Q

Assessment: Frequent Vital Signs

A
  • pulse increases b/c of hypoxemia
  • BP decreases in cases of massive PE b/c of decreased left heart preload
  • tachypnea d/t decreased oxygenation and pain
  • fever b/c of inflammatory response
43
Q

Assessment: Chest Pain

A

-sudden onset (pleuritic) pain w/ dyspnea and tachycardia = first sign of acute PE
>resulting from release of inflammatory markers

44
Q

Lab Values: Arterial Blood Gases (ABGs) [Onset]

A
  • tachypnea causes respiratory alkalosis

- PaO2 reduced b/c increased dead-space ventilation

45
Q

Lab Values: Arterial Blood Gases (ABGs) [as disease progresses]

A

-metabolic acidosis results from hypoxia and subsequent transition to anaerobic metabolism

46
Q

Lab Values: Lactic Acid Level

A

increase confirms anaerobic metabolism

47
Q

Lab Values: Coagulation studies

A
  • aPTT monitored if on Heparin

- PT/INR if on warfarin

48
Q

Assessment: Urine Output

A

less than 0.5 mL/kg/hr = early sign of shock

49
Q

Nursing Actions

A
  • Elevate HOB
  • Administer IV fluids
  • Anticoagulation Meds
  • Thrombolytic Meds
  • Inotropic agents
  • Norepinephrine or Vasopressin as ordered
  • Bleeding Precautions
  • Be prepared for Intubation and resuscitation
50
Q

Actions: Elevate HOB

A
  • allows diaphragm to drop

- facilitates less work of breathing and better oxygenation

51
Q

Actions: Administer IV fluids

A
  • decrease viscosity of blood

- caution used in cases of right ventricular overload

52
Q

Actions: Anticoagulation Meds

A
  • Heparin infusions, warfarin, and factor Xa inhibitors limit growth of PE and DVT
  • decreases formation of new clots
53
Q

Actions: Thrombolytic Meds

A
  • degrades the clot

- if not contraindicated, used when hemodynamically compromised

54
Q

Actions: Inotropic Agents

A

increased cardiac contractility to augment cardiac output if patient is hemodynamically unstable

55
Q

Actions: Norepinephrine or Vasopressin as ordered

A

vasoconstrictive meds given, if necessary, to maintain systolic BP of at least 80 mmHg

56
Q

Actions: Bleeding Precautions

A
  • use of anticoagulants and/or thrombolytics can result in bleeding
  • minimize venipunctures
  • watch for blood in urine, stool, sputum
  • watch for unusual bruising
57
Q

Actions: Be prepared for intubation and resuscitation

A

massive PE may result in cardiogenic shock and sudden death

58
Q

Nurse Teachings

A
  • Disease Process/ lifestyle Modifications
  • Medications
  • Bleeding Precautions
  • Diet
  • S/S of recurrent PE/DVT
59
Q

Teachings: Disease Process/Lifestyle Modifications

A
  • understand risks of PE
  • how to avoid future occurrences
  • smoking cessation

> Exercise Regimen:
-aerobic exercise strengthens heart + cardiovascular system, improves venous return to the heart, assists in loss of weight

> Cardiac-prudent diet that minimizes saturated fats:
-heart-healthy diet to reduce damage to vasculature

> Adequate fluid intake:
-8oz glasses of water 8x spread across the day; maintains hydration; decreases blood viscosity

> Medications: teach mechanism of action of anticoagulants + thrombolytics; follow-up lab samples drawn if on warfarin (PT/INR) to determine effective dosing of outpatient anticoagulant

60
Q

Teaching For Bleeding Precautions

A
  • use of electric razor
  • soft toothbrush
  • no flossing
  • avoid activities w/ a risk of bleeding
61
Q

Teaching: Diet

A

limit foods high in vitamin K; interfere w/ efficacy of warfarin

62
Q

Teaching: Signs of recurrent PE/DVT

A
  • unilateral lower extremity edema and pain, w/ redness and warmth d/t presence of DVT
  • pleuritic chest pain and dyspnea = recurrent PE
62
Q

Evaluating Care Outcomes

A
  • if had PE, there is increased incidence of recurrent PE
  • adhering to medication regimen
  • improving diet
  • beginning exercise program
  • staying adequately hydrated
  • quit smoking
62
Q 
Connection Check: After oxygen has been administered the next PRIORITY intervention the nurse would initiate for a patient with a pulmonary embolus is the administration of which of these therapies?
A. Normal Saline IV Fluid
B. IV Heparin
C. Platelet administration
D. Antibiotics for inflammatory fever
A

B. IV Heparin

Nursing 272: Final Semester (79 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions