Exam 1: Pulmonary Embolism Flashcards
What is a PE?
Blockage in a pulmonary vessel in the lungs. Can be air, liquid, or solid.
What is happening in the body while this large emboli is obstructing pulmonary blood flow? What can this lead to?
- Reduced gas exchange exchange
- Reduced oxygenation
- Pulmonary tissue hypoxia
- Decreased perfusion
- Possible death
Most often, PE’s are caused by what?
Venous thromboembolism (VTE/DVT)
Talk me through the path of DVT to a PE:
DVT → dislodges → vena cava → right atrium → right ventricle → pulmonary vessels → platelets aggregate → triggers other substances that cause vessel constriction
Which of the following increase the risk of VTE (thus increasing risk PE)?
Increased age
Hypercoagulable states
Obesity
Recent dental work
Short stature
Prolonged immobility
Central venous catheter
IV drug use
Sepsis
Recent completion of 5K
Increased age
Hypercoagulable states
Obesity
Prolonged immobility
Central venous catheter
IV drug use
Sepsis/Sepik
What is KEY with PEs?
PREVENTION!
- Prevent venous stasis
- Prevent VTE/DVT
This HUGE part of the nurse’s role in acute care!
There are 8 million things you could note in assessment that could indicate a PE. Name a few!
- Resp compromise
- Dyspnea
- Chest pain – stabbing, sharp
- Restlessness
- Agitation
- Cough
- Bloody sputum
- Abnormal breath sounds
- Tachypnea
- Tachycardia
- Diaphoresis
- Fever
- Petechiae (showering clots)
- Increased O2 demands
- Hypotension
- Abnormal heart sounds
- EKG changes
What is the big kahuna diagnostic test for a PE?
Pulmonary angiography
What are some other tests that can be used to learn more about what is happening?
- ABG
- BMP
- Troponin
- BNP
- D-Dimer
- CT-PA
- Ventilation – perfusion scan (V/Q) (there would be a mismatch)
- Chest x-ray
- US → Looking for an underlying DVT
What does a D-Dimer tell us?
All it tells us is that there is a blood clot somewhere
If you suspect your patient has a PE, what do you do?
GET HELP
You are officially suspecting a PE –> talk through what you will do (aside from getting help) and be expecting to happen:
- HOB
- Increase O2 to maintain SpO2 > 95%
- Call RR
- Reassure your patient
- Assess, assess, assess
→ Respiratory
→ Cardiac
→ Skin - Imaging
- Prescribed anticoagulants (monitor bleeding!!)
There are a bunch of anticoagulants –> name some and when to use them, fun facts, etc.
- Heparin (acute)
→ Stops working within an hour
→ Helpful if anticipating a procedure - Lovenox (acute)
→ Stops working in 12 hours - Warfarin (extended)
Other fancy ones:
Rivaroxaban, Dabigatran, Apixaban
What are two surgical interventions for PEs?
- Embolectomy
→ Going in an removing the clot - Inferior vena cava filtration
→ Filter to catch clot!
In the even of hypotension, what will you be doing?
IV fluids
IV drug therapy (Positive inotropic agents, vasopressors, vasodilators)
