The Etiology of pulmonary Embolism is due to blood clot from a deep venous thrombosis (DVT )breaks loose from one of the veins in the lower extremities or from the Pelvis to the pulmonary artery. That is blood clot that travel from the legs or other parts of the body.
Examples of these are:
foreign objects like:
broken intravenous catheters.
Infected fibrin clots or pus.
Fat.
Air.
Amniotic fluid.
Tumor cells.
Injected particles.
The thrombus will detach itself travels through the vena cava and right side of the heart and then lodges into the bifurcation or in a Capillary of the pulmonary artery – Platelets will then accumulate the embolus which leads to Vasoconstriction.
Pulmonary constriction will develop due to high pressure in the lung,resulting in Hypertension, impaired ventilation and perfusion.
ASSESSMENT OF PATIENT.
Assess patient for risk of DVT.
Gathering background information.
Previous history of thromboembolism.
Surgery.
Obesity.
Major trauma.
Advanced age.
Prolonged immobilization.
Smoking.
Estrogen therapy.
Hypercoagulability.
WHAT ARE THE CLINICAL MANIFESTATIONS?.
Dyspnea.
Diaphoresis.
Pleuritic chest pain.
Substernal chest pain.
Crackles in some patients with Pulmonary Embolism and decreased breath sounds. Tachycardia.
Tachypnea.
Hemoptysis.
Dry cough.
Apprehension.
Low grade fever.
DIAGNOSTIC TESTS:
ABG :
That is Arterial Blood Gas.
ABG will show respiratory alkalosis > respiratory acidosis-> Metabolic acidosis.
Lung Scan if inconclusive then Pulmonary Angiography .
Electrocardiogram.
Nursing Responsibilities.
Provide patient with pain medication as ordered.
Educate patient and family members on the disease because patient and family lack knowledge regarding conditions due to lack of exposure.
There will be alteration in tissue perfusion related to vascular Obstruction due to emboli.
DISCHARGE GOALS.
Coagulation studies within normal range.( Prothrombin time ,Partial Prothrombin time)
Prothrombin time(International normalized ratio,PT,PTT ) test for rapid blood clotting.INR: Medical and Surgical thromboembolic states =2.0 to 3.0 is effective therapeutic range.
Artificial heart valves and recurrent embolism =3.0 to 4.5.
IV site is intact no redness.
PAO2 is within normal range : 80 to 100mmHg.
PaCO2 is : 35 to 45mmHg.
PH : 7.35 to 7.45.
Patient verbalized and demonsticated signs and Symptoms of pulmonary embolism.
Verbalized and demonstrate the reasons for coagulation therapy, prescribed doses and time of administration of medication.
And also plan to follow up care including going for laboratory tests on coagulation therapy. Adminster Oxygen due to hypoxemia that occurs.
Prophylactic is used for high risk patients such as :heparin 5000units subQ Q12hours preoperatively.
And every 8to 12hours postoperatively until patient is ambulatory.
Coumadin 5 to 10mg daily x3days.
Then maintenance dose on the basis of Prothrombin time.
Must Check Laboratory for Coagulation. TREATMENT :
Heparin approximately 5000units to 15,000units IV bolus then continuous infusion approximately 1000units every hour or 2500 to 5000units every 4hours.
Long term treatment with 5mg to 10mg of Warfarin daily.
The administration of prescribed thrombolytic therapy can promote immediately dissolution of the embolus with prompt return of pulmonary function.
Example Streptokinase or Urokinase.
Thrombolytic therapy is delivered either systematically or directly into the pulmonary artery through the selective catheterization though systemic therapy is much better. Follow doctor orders.
Patient is prepared for pulmonary embolectomy.Follow doctor orders.
Provide your patient with antiembolism stockings.
Do not massage the legs.
Elevate lower extremities with pillows.
Assess lower extremities for adequate pulses.
Provide teaching regarding common signs and Symptoms of pulmonary embolism such as Coughing, dyspnea,substernal chest pain,hemoptysis,chest palpations and apprehension.
No smoking .
No constrictive clothing.
No sitting or standing for a prolonged period of time.
Follow your doctor orders and your facility policy and procedures.
Nurses You Move Me 