Unit 4 Chapter 29 Pulmonary Embolism(FAT,THROMBOSIS,AIR,AMNIOTIC FLUID)) Flashcards
What is Pulmonary Embolism?
Occlusion of an artery in the
pulmonary system
BLOCKAGE OF ARTERY IN LUNG
. (An embolism is a blood clot [thrombus] or other object [e.g., air, fat deposit]
Would you call a RAPID RESPONSE for a patient exhibiting signs of Pulmonary Embolism?
A. No
B. Yes
B. Yes
Pulmonary Embolism is a medical emergency
Mananagment of Pulmonary Embolism after Rapid Response Team.
When a patient has a sudden onset of dyspnea and chest pain, or other symptoms of respiratory impairment, immediately initiate the Rapid Response Team.
-Apply oxygen,
Connect to pulse oximeter
Assess skin color
-reassure the patient, and
elevate the head of the bed.
-Prepare for blood gas analysis
-continuing to monitor and assess for other changes.
What are the types of Pulmonary Embolism
FAT
BLOOD(thromboembolism)
AIR
AMNIOTIC FLUID
What can be a cause of pulmonary fat embolism?
fracture of long bone
-like femur
FROM MOTOR VEHICLE ACCIDENTOR BAD FALL**
Which of the following is a classical sign of Fat embolism?
A. Clubbing of the nails
B. Petechia
C. Jaundice
D. Bradypnea
B. Petechia
*Petechiae over chest and axillae (usually only associated with fat embolism syndrome [FES])
What is a complication of fat embolism?
A. Clubbing of nails
B. Jaundice
C.Acute Respiratory Disorder
D. Ventilation Associated Pneumonia
C.Acute Respiratory Disorder
Fat emboli cause injury to pulmonary vessels and cause acute respiratory distress syndrome (ARDS)
What can be the cause of Air embolism?
-removal of a central line
-diving (scuba divers
- Entry of air into the venous system above the right atrium. * 88Can occur with trauma, central line insertion, surgical procedures of head and neck.**
- Manifestations develop immediately.
*Severity depends on amount of air.
S/s for air embolism
Dyspnea
* Chest pain
Tachycardia**
**Heart murmur
* Hypotension
* * Decreased LOC
*
Circulatory shock**
**Sudden death
How to prevent air embolism when removing a central line?
To prevent venous air embolism when removing any central venous catheter (including PICCs),
Position the patient in a Trendelenburg position (Traps air in left atrium)according to agency policy. To ensure that the intrathoracic pressure is higher than atmospheric pressure,
have the patient hold his or her breath or perform a Valsalva maneuver during removal.
Be sure to keep the catheter clamped during this procedure. When a central venous catheter is removed, a tract between the skin and vein may create a conduit that could allow air to be pulled into the vein, causing a venous air embolism.
Nursing Alert Air embolism
Reduce the risk of air emboli by carefully priming all IV tubing.
Secure all connections in central lines and protect them from becoming dislodged when the client moves around.
Your patient has been on long-term Intravenous antibiotic therapy and the infection is all cleared up. You notice that the newly licensed nurse is about to remove the patient’s (PICC) line in a sims position. What complication do you suspect the patient to develop if you do not intervene?
A. Air embolism
B. Fat embolism
C. Amniotic Embolism
D. Thromboembolism
A. Air embolism
REMOVAL OF ALL CENTRAL LINES MUST BE DONE IN TRENDSDELENGURG position to prevent air embolism
What is the cause of Pulmonary amniotic fluid embolism?
Delivery of a fetus or baby
Your 36 gestation week patient has just delivered her baby through a vaginal birth 30 minutes agao. She reports dyspnea and has hypotension, and sudden sharp chest pain. After connecting the mother to the monitor , what complication do you suspect she is experiencing?
A. Air embolism
B. Myocardial Infarction
C. Amniotic Embolism
D. Thromboembolism
C. Amniotic Embolism
Signs and Symptoms of Pulmonary Embolism
Sudden onset of dyspnea**
* Sharp, stabbing chest pain
* Apprehension, restlessness
**Feeling of impending doom
Cough**
**Hemoptysis
* Diaphoresis
*Hypotension
* Increased respiratory rate(tachypnea)
* Crackles
Pleural friction rub**
* Tachycardia
* S3 or S4 heart sound
* Fever, low grade
**Petechiae over chest and axillae (usually only associated with fat embolism syndrome [FES])
*Decreased arterial oxygen saturation (SaO2)-UNDER 95
What is the Pathophysiology of Pulmonary Embolism
Air is moving, but blood flow is not
picking up the O2 to delivery, or
dropping off CO2
- Depending on size and location of
occlusion will indicate how
emergent the issue.
VQmismatch
- ventilation and perfusion mismtach
Which of the following can cause Pulmonary Thromboembolism?
A. Sinus Normal Rhythm
B. Deep Vein Thrombosis
C. Rheumatoid arthritis
D. Glaucoma
B. Deep Vein Thrombosis
Most often, a PE occurs when inappropriate blood clott ing forms a venous thromboembolism (VTE) (or deep vein thrombosis [DVT]) in a vein in the legs or the pelvis and a clot breaks off and travels to the right side of the heart.
Doppler ultrasound may be used to document the presence of VTE.
What are risk factors for VTE OR DVT
Major risk factors for VTE leading to PE are:
* Prolonged immobility
* Central venous catheters
* Surgery
* Pregnancy
* Use of oral contraceptive
* Obesity
* Advancing age
* General and genetic conditions that increase blood clo tting * History of thromboembolism
Your patient who is coming out of a post-operative abdominal surgery reports impending doom. You have placed him on a sequential compression device and he denies chest pain and reports having a nagging cough. What complication would you suspect this patient to have?
A. Myocardial Infarction
B. Pulmonary Embolism
C. Deep Vein thrombosis
D. Pneumonia
B. Pulmonary Embolism
Patients with Pulmonary embolism report of having IMPENDING DOOM
Your patient who has been diagnosed with Pulmonary Embolism has been hyperventilating. What ABG results would you suspect based on the following pH; 7.60 PACO2; 18 SaO2; 85 HCO3; 24.
A. Respiratory Alkalosis
B. Respiratory Acidosis
C. Metabolic Acidosis
D. Metabolic Alkalosis
A. Respiratory Alkalosis
INTIALLY THE ABG FOR PE IS RESPIRATORY ALKALOSIS
The hyperventilation triggered by hypoxia and pain first leads to respiratory alkalosis, indicated by low partial pressure of arterial carbon dioxide (PaCO 2) on arterial blood gas (ABG) analysis.
WHt is the diagnostic tool of choice for Pulmonary Embolism
d-dimer: checks for blood clots
A D-dimer test is a global marker of coagulation activation and measures fibrin degradation products produced from fibrinolysis (clot breakdown)
Computed tomography pulmonary angiography (CTPA) or helical CT may be used for diagnosis.
What is the primary prevention of Pulmonary Embolism Post surgical procedure>
*EARLY AMBULATION
SCD’S
ENOXAPARIN
- Passive & Active ROM for all postop and immobilized patients
- Post op ambulation as soon as ordered
- SCD’s or Plexipulse compression
- Patient repositioning Q2h
- Low dose anticoagulant and antiplatelet meds (ENOXAPARIN)
- Smoking cessation (esp. in females on birth control pills)
Management of Pulmonary Embolism
- Apply oxygen by nasal cannula or mask.
- Reassure patient that the correct measures are being taken.
- Place patient in high-Fowler position.
- Apply telemetry monitoring equipment.
- Obtain venous access.
- Assess oxygenation continuously with pulse oximetry.
- Assess respiratory status at least every 30 minutes by:
- Listening to lung sounds
- Measuring the rate, rhythm, and ease of respirations
*Checking skin color and capillary refill - Checking position of trachea
- Assess cardiac status by:
- Comparing blood pressures in right and left arms * Checking pulse quality
- Checking cardiac monitor for dysrhythmias
- Checking for distention of neck veins
- Ensure that prescribed chest imaging and laboratory tests are obtained immediately (may include complete blood count [CBC] with differential, platelet count, prothrombin time, partial thromboplastin time, D-dimer level, arterial blood gases).
- Examine the chest for presence of petechiae.
- Give prescribed anticoagulants.
- Assess for bleeding.
- Handle patient gently.
*Institute Bleeding Precautions.
What is the treatment for Pulmonary Thromboembolism?
-Drug therapy begins immediately with anticoagulants to prevent embolus enlargement and more clott ing
Anticoagulants
* Heparin – Obtain IV access/monitor heparin drip/institute bleeding
precautions * Institute bleeding precautions when on medications that affect clotting * Fibrinolytics
