Pulmonary Embolism

  • Life-Threatening Blockage of a pulmonary artery by a blood clot.

What causes venous thrombosis

Virchow’s triad:  intravascular vessel wall damage, stasis of flow, and the presence of a hypercoagulable state.

Risk Factors

Hx DVT or Untreated DVT
Immobility & Smoking
Atrial Fib/Flutter & Heart Disease
Obesity & Advanced Age
Surgery such as C-Section

Symptoms

  • Common symptom triad: Hemoptysis, dyspnea, and pleuritic chest pain
  • SOB, Dyspnea & Tachypnea
  • Apprehension and anxiety
  • Sharp chest pain worth with deep breathing (pleuritic chest pain)
  • Tachycardia, dizziness, sweating, & cool clammy skin
  • Cough, hypoxia, & hemoptysis (damage to alveoli from lung infarction).
  • Hypotension and Syncope
  • Respiratory alkalosis.  Client breathes very fast and blows off CO2.  
  • Hypoxia on the Arterial Blood Gas 

Diagnostics

  • VQ Scan
  • Pulmonary Angiogram
  • CT Angiogram
  • MRI
  • A pulmonary angiogram is the best (definitive) diagnostic test
  • Elevated D-dimer levels can indicate the presence of blood clots, but it is not specific for pulmonary embolism.

V/Q Scans

  • V= ventilation. Simple, the act of breathing, inhaling oxygen and exhaling CO2.
  • Q = perfusion. Blood flow that is necessay to bring in oxygen that is “ventilated” to the blood and to the tissues.
  • In a pulmonary embolism, a blood clot blocks perfusion.  There is ventilation, but perfusion is impaired = V/Q mismatch.
  • There are other forms of V/Q mismatches such as when there is perfusion, but no ventilation (e.g. pulmonary disease)

Nursing Interventions

ABC and Oxygen. Monitor breathing and vital signs
High Fowler's is the best position
Anticoagulation with Heparin. Follow PTT
Thrombolytics such as Streptokinase & tPA
Monitor for BLEEDING

Heparin

  • Initial treatment for a pulmonary embolism is Heparin IV, a blood thinner. 
  • Heparin places the client at risk for bleeding. The client must be on bleeding precautions. 
  • Important: Heparin does not breakdown/destroy clots. It only prevents the body from forming new ones.
  • Reversal Agent is Protamine Sulfate
  • Lab to monitor Heparin is PTT

Inferior Vena Cava Filter

Vena cava filters are often used in patients with DVT to prevent emboli from reaching the pulmonary circulation.

76-year-old client admitted to the hospital due to a fall. Client broke his left tibia and fibula. Client is now recovering in the orthopedic unit after an open reduction internal fixation (ORIF) 2 days ago. History of smoking, Atrial fibrillation, gout, and arthritis.

Welcome to your Pulmonary Embolism

Based on the case study information, what priority action should the nurse take

Based on the case study, the condition that the client is most likely experiencing is a__________________

Which of the following are the risk factors that place the client for a pulmonary embolism? Select all that apply

The nurse describes the physiologic effect of a pulmonary embolism that affects oxygenation as

The nurse teaches the client's wife about what a V/Q mismatch is. Which of the following statements by the wife demonstrates understanding?

The client suddenly develops hemoptysis. The nurse recognizes that this is due to ___________________________

Based on the client's vital signs and disease process, which of the following acid/base imbalances does the nurse expect to find in the client's arterial blood gas?

Which of the following diagnostic tests/labs does the nurse anticipate that the doctor will order? Select all that apply

Which of the following diagnostic tests will provide a definitive diagnosis?

The physician orders a Pulmonary Angiogram. What is the most important Nursing intervention?

What is the nurse's priority intervention for this client with a pulmonary embolism?

The nurse anticipates that the physician will order which of the following intravenous medications for this client with a pulmonary embolism?

The nurse anticipates that which of the following lab tests will have to be monitored once the physician orders the initial treatment?

Once the nurse initiates treatment, which precautions should the nurse also initiate?

The nurse receives a panic PTT value, which reversal agent does the nurse anticipate to administer?

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