Pulmonary embolism Flashcards
(17 cards)
What is pulmonary embolism?
A pulmonary embolism (PE) is a blockage in one or more pulmonary arteries caused by a thrombus (blood clot), air bubbles, fat from broken bones, or tumor fragments/embolus.
What is the pathophysiology of pulmonary embolism?
A thrombus, typically from deep veins in the legs (DVT), travels through the venous system, it enters the right heart, and is pumped into the pulmonary arteries, blocking blood flow and causing impaired gas exchange, increased pulmonary vascular resistance, and strain on the right heart.
What are examples of pulmonary embolism?
Thrombotic PE from DVT, fat embolism (e.g., post long bone fracture), air embolism (e.g., central line mishandling), and amniotic fluid embolism during childbirth.
What are the risk factors for pulmonary embolism?
Prolonged immobility (e.g., post-surgery, long flights, sitting for extended periods) can slow blood flow increasing risk of clots, surgery (especially orthopedic) can increase clotting risk, trauma(e.g. fractures), medical conditions like cancer, heart failure, and obesity, pregnancy, hormonal therapy (e.g. oral contraceptives) or hormone replacement therapy, genetic clotting disorders (e.g. Factor V Leiden), and a history of DVT or PE can increase the risk of future occurrences..
What are the symptoms of pulmonary embolism?
sudden dyspnea (shortness of breath), pleuritic chest pain (worsens with deep breathing), tachypnea (rapid breathing), tachycardia, cough (possibly with hemoptysis aka bloody sputum), anxiety or sense of impending doom, and cyanosis in severe cases.
How do you detect, or clinically present pulmonary embolism in a patient?
Acute respiratory distress, Chest pain, increased heart and respiratory rate, Low oxygen saturation
How do you assess pulmonary embolism in a patient?
Respiratory status (SpO2, RR), Lung auscultation, Chest pain description, History of immobility or clotting disorders
What tests or diagnostic approaches can be made to determine pulmonary embolism?
D-dimer test: Elevated levels suggest clot formation
CT Pulmonary Angiography (CTPA): Gold standard for visualizing emboli. A special CT scan with contrast dye is used to visualize the pulmonary arteries and detect any blockages. * Provides a detailed image of the lungs and helps locate the exact site of embolism. * Quick and effective for confirming PE in emergency situations.
Ventilation-Perfusion (V/Q) scan: Measures air and blood flow in the
lungs and is used when CTPA is contraindicated.
Ultrasound of legs: To detect DVT in patients suspected of having PE.
ECG and ABG: To assess oxygenation and cardiac strain
What are the emergency responses or first aid for pulmonary embolism?
Call emergency services immediately, PE is life threatening and requires urgent intervention.
Position the patient upright
Provide high-flow oxygen
Monitor vitals, SpO2, and mental status
Prepare for anticoagulation like heparin or thrombolytic therapy to prevent further clot formation while the patient is being evaluated.
Reassure the patient and ensure airway patency
What are the pharmacological treatments of pulmonary embolism?
Anticoagulants: Heparin, warfarin, or DOACs (e.g., apixaban)
Thrombolytics (e.g., alteplase) in massive PE
What are the non pharmacological treatments of pulmonary embolism?
Oxygen therapy, IV fluids (for hypotension), Inferior vena cava (IVC) filter (in patients who cannot use anticoagulants)
What are the complications of pulmonary embolism?
Pulmonary infarction, Right-sided heart failure (acute cor pulmonale), Recurrent embolism, Hypoxemia, Sudden cardiac arrest
What diseases or organ complications can lead to pulmonary embolisms?
Diseases that can lead to pulmonary embolism(PE).
DVT
Cancer (increased coagulability)
Autoimmune disorders
Surgical recovery (esp. pelvic, orthopedic)
What nursing assessments, can be done to care/ to create a thorough care plan for a patient with pulmonary embolisms?
Monitor vital signs, such as the respiratory rate, oxygen saturation, heart rate
Assess for leg swelling, pain (DVT signs)
Monitor ABGs and ECG
What nursing interventions can be done to care/ to create a thorough care plan for a patient with pulmonary embolisms?
Administer oxygen and medications to maintain oxygen levels and reduce dsypnea.
Position in semi-Fowler’s
Prepare for diagnostic testing
Ensure IV access for emergency treatment
Manage and monitor the effects of anticoagulant therapy (e.g., warfarin or direct oral anticoagulants) and watch for signs of bleeding.
Provide reassurance and comfort to patients, as experiencing PE can be extremely frightening.
What nursing preventions can be done to care/ to create a thorough care plan for a patient with pulmonary embolisms?
Promote early ambulation for post-operative patients to prevent venous stasis.
Use of compression stockings or intermittent pneumatic compression devices to promote venous return in high-risk patients.
Administer prescribed anticoagulant prophylaxis for high-risk patients (E.g. heparin, low-molecular-weight heparin)
Describe the patient education and self-monitoring/ self-care guidelines that can be given to a patient with pulmonary embolisms?
Importance of medication adherence (especially anticoagulants)
Teach patients signs of DVT: leg pain, swelling, warmth
Avoid long periods of immobility
Use compression stockings if prescribed
Stay hydrated
Report any chest pain, shortness of breath, or sudden symptoms immediately.
