Unit 4 Chapter 29 Pulmonary Embolism(FAT,THROMBOSIS,AIR,AMNIOTIC FLUID))

Question 1

What is Pulmonary Embolism?

Answer 1

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]

Question 2

Would you call a RAPID RESPONSE for a patient exhibiting signs of Pulmonary Embolism?

A. No
B. Yes

Answer 2

B. Yes

Pulmonary Embolism is a medical emergency

Question 3

Mananagment of Pulmonary Embolism after Rapid Response Team.

Answer 3

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.

Question 4

What are the types of Pulmonary Embolism

Answer 4

FAT
BLOOD(thromboembolism)
AIR
AMNIOTIC FLUID

Question 5

What can be a cause of pulmonary fat embolism?

Answer 5

fracture of long bone
-like femur
FROM MOTOR VEHICLE ACCIDENTOR BAD FALL**

Question 6

Which of the following is a classical sign of Fat embolism?
A. Clubbing of the nails
B. Petechia
C. Jaundice
D. Bradypnea

Answer 6

B. Petechia

*Petechiae over chest and axillae (usually only associated with fat embolism syndrome [FES])

Question 7

What is a complication of fat embolism?
A. Clubbing of nails
B. Jaundice
C.Acute Respiratory Disorder
D. Ventilation Associated Pneumonia

Answer 7

C.Acute Respiratory Disorder

Fat emboli cause injury to pulmonary vessels and cause acute respiratory distress syndrome (ARDS)

Question 8

What can be the cause of Air embolism?

Answer 8

-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.

Question 9

S/s for air embolism

Answer 9

Dyspnea
* Chest pain
Tachycardia**
**Heart murmur
* Hypotension
* * Decreased LOC
*
Circulatory shock**
**Sudden death

Question 10

How to prevent air embolism when removing a central line?

Answer 10

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.

Question 11

Nursing Alert Air embolism

Answer 11

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.

Question 12

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

Answer 12

A. Air embolism

REMOVAL OF ALL CENTRAL LINES MUST BE DONE IN TRENDSDELENGURG position to prevent air embolism

Question 13

What is the cause of Pulmonary amniotic fluid embolism?

Answer 13

Delivery of a fetus or baby

Question 14

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

Answer 14

C. Amniotic Embolism

Question 15

Signs and Symptoms of Pulmonary Embolism

Answer 15

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

Question 16

What is the Pathophysiology of Pulmonary Embolism

Answer 16

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

Question 17

Which of the following can cause Pulmonary Thromboembolism?
A. Sinus Normal Rhythm
B. Deep Vein Thrombosis
C. Rheumatoid arthritis
D. Glaucoma

Answer 17

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.

Question 18

What are risk factors for VTE OR DVT

Answer 18

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

Question 19

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

Answer 19

B. Pulmonary Embolism

Patients with Pulmonary embolism report of having IMPENDING DOOM

Question 20

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

Answer 20

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.

Question 21

WHt is the diagnostic tool of choice for Pulmonary Embolism

Answer 21

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.

Question 22

What is the primary prevention of Pulmonary Embolism Post surgical procedure>

Answer 22

*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)

Question 23

Management of Pulmonary Embolism

Answer 23

• 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.

Question 24

What is the treatment for Pulmonary Thromboembolism?

Answer 24

-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

Question 25

Patient teaching for warfarin

Answer 25

-maintain consistency with green leafy vegetables
-use an electric razor
-avoid flossing
-monitor INR; 2-3 with use
-draw labs consistently
-monitor for bleeding and bruising
-monitor PT 13.5-31.25 with use

Question 26

Patient teaching for Heparin

Answer 26

-monitor for bleeding and bruising
-Monior APTT AND PTT
-LONGTERM USE MONITOR FOR HIT

Question 27

Drugs used for PE

Answer 27

• Heparin
• Lovenox (enoxaparin)
  Coumadin (warfarin- NOT SAFE FOR PREGNANT WOMEN)
• Arixtra (fondaparinux)
  Xarelto (rivaroxaban); NO LAB DRAWS **
  ** Alteplase(no invasive procedures bleeding precautions initiated