Week 2 - Pulmonary Emboli Flashcards
what is a pulmonary embolism
- blockage of pulmonary arteries by a thrombus, fat or air embolus, or tumour tissue
what is a pulmonary embolism commonly caused by
- DVT that travels
what effect does a pulmonary embolism have
- travels thru blood vessels until it lodges and obstructs perfusion to the alveoli
what part of the lungs are commonly affected by pulmonary emboli? why?
- lower lobes
- bc of higher blood flow
what are risk factors for pulmonary embolism (10)
- immobility
- surgery within the last 3 mo
- stroke
- paresis
- paralysis
- hx of DVT
- malignancy
- obesity in women
- heavy cigarette smoking
- HTN
what is the classic traid of a pulmonary embolism symptoms
- dyspnea
- chest pain
- hemoptysis
what are other symptoms of a pulmonary embolism (12)
- hypoxemia
- low PaCO2
- cough
- pleuritis chest pain
- hemoptysis
- crackles
- fever
- change in mental status (r/t hypoxemia)
- hypotension
- pallor
- severe dyspnea
- tachy
what are complications for a pulmonary embolus (4)
- pulmonary infarction –> alveolar necrosis –> hemorrhage
- infection of the necrotic tissue
- development of an abscess
- pulmonary HTN
what diagnostics might be used to diagnose a pulmonary embolus (5)
- spiral CT scan
- VQ scan
- D dimer
- pulmonary angiography
- ABG analysis (imp. but not diagnostic)
what does a spiral CT scan do
- injection of IV contrast media to see blood vessels
- scanner continuously rotatoes to get visualization of all anatomical regions of the lungs
- data is reconstructed to create a 3D picture
what is a d dimer test
- test that measures the amt of cross-linked fibrin fragments (which are found in the circulation after clotting events)
what does prevention of a pulmonary embolism begin w
- prevention of VTE
how can a VTE be prevented (3)
- use of compression devices
- early ambulation
- prophylactic use of anticoag meds
when is treatment of pulmonary embolism completed?
- as soon as PE is suspected
what does treatment of PE consist of (3)
- drug therapy
- surgical therapy
- supportuve therapy
what meds can be used to dissolve clots
- alteplase (tPa)
what are indications of thombolytic therapy in PE
- hemodynamic instability
- right ventricular dysfunction
what meds can be used to prevent further formation of emboli
- heparin
- warfarin
when should warfarin be initiated in treatment for PE
- in the first 24 hrs
when might surgical therapy for PE be done (2)
- if the degree of pulmonary arterial obstruction is severe
- pt does not respond to conservative therapy
what type of surgery might be done as treatment for PE
- embolectomy
what acute care can be done for a pt with PE (12)
- bed rest
- semi-fowler position for breathing
- IV line for meds & fluids
- O2 therapy as needed
- monitor VS
- cardiac dysrhythmia monitoring
- ABGs
- lung sounds
- lab results –> INR, Ptt
- assess complications of anticoag therapy
- assess for complications of PE
- interventions for immobilit & fall precautions
what complications of anticoag therapy should you monitor for (3)
- bruising
- bleeding
- hematomas
what complications of PE should you monitor for (3)
- hypoxia
- hypotension
- neuro changes
what is important to discuss during discharge teaching
- teaching regarding anticoag therapy
what teaching regarding anti coag therapy should be done (4)
- it will continue for 3-6 mo.
- if pts have recurrent emboli they will be on indefintiely
- will come in for reg. bloodwork: INR lvls are done at intervals and warfarin doses will be adjusted
- adverse effects
what is often the first sign of hypoxia
- change in mental status
what anticoag med is typically given first for PE? why?
- heparin is given first
- warfarin takes a couple days to start working, while heparin starts immediately
- use heparin until warfarin is effective
why is important to start an IV line in a pt with a PE
- bc will likely be giving them heparin
why is it important for a PT with PE to have fluids
- keep hydrated
- thin secretion
why is it important to monitor for cardiac dysrhythamis in a pt with PE
- fluids could cause electrolyte changes
when and why is it important to monitor Ptt and INR in a pt with PE
- imp. to see therpeutic lvls of heparin and warfarin
- should check baseline and throughout treatment
