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Pulmonary Embolism
Blockage of pulmonary arteries by a thrombus, fat or air embolism, or tumor tissue
•Material eventually reaches the pulmonary vessels where it lodges and obstructs perfusion
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Most PE arise from
thrombi in the deep veins of the legs
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Lungs are an excellent area for the ______ to lodge
thrombi to lodge because of extensive arterial and capillary network
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Most patients with PE from deep vein thrombosis have
no leg symptoms at time of diagnosis
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Risk Factors of PE
•Immobilization
•Surgery in last 3 months
•Stroke
•History of DVT
•Malignancy
•Obesity,
•smoking
•hypertension
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Classic Triad of S/S for PE
dyspnea, chest pain and hemoptysis
Occurs in only 20% of patients
Often subtle making Dx difficult
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PE Manifestations
Anxiety
Sudden onset of dyspnea, tachycardia and tachypnea
Hypoxemia
Cough
Chest pain
Crackles
Sudden change in mental status
Massive emboli produce sudden collapse of the patient
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PE Diagnosis Tests
- Ventilation perfusion scan
- D-Dimer Testing
- Spiral CT scan
- Pulmonary Angiography
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Ventilation perfusion scan
Assesses adequate pulmonary circulation
Scans distribution of gases throughout the lungs
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D-Dimer Testing
D-dimer is rarely found in healthy individuals
Elevated in degradation of fibrin (infection, surgery etc)
8X higher in thomboembolisms
Normal or near normal D-dimer can rule out PE
If high, other tests such as venous ultrasounds, or CT will be needed.
You see dimers done more often on pts with minor symptoms
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Spiral CT scan
Most often used to diagnose PE
Done in 30 seconds with a single breath
Contrast is injected before scanning
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Pulmonary Angiography
Catheterization of the right side with injection of dye into PA to visualize pulmonary vessels
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PE Collaborative Care
Increase gas exchange
Prevent further growth of the thrombi
Prevent embolization into the pulmonary vascular system
Provide cardiopulmonary support if needed
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PE Conservative treatment
O2 as determined by pulse ox or ABG
Intubation and ventilation may be required
Bedrest
If u sespect PE, put o2 on the pt increase head of bed keept them still don’t let them off of bedrest bc it could disoldge and they’ll have more thrombi
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PE Drug Therapy
Anticoagulants
Thrombolytic Agents
Opioids for pain relief
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When pt is taking Anticoagulants what lab values should be Monitored
PTT and INR
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What are some of the many things to do to
Prevent injury while taking Anticoagulants
- Use an electric shaver.
- Use a soft-bristled toothbrush, and do not floss.
- Avoid hard foods that would scrape the inside of your mouth.
- Eat warm, cool, or cold foods to avoid burning your mouth.
- Take a stool softener to prevent straining during a bowel movement.
- •Do not use enemas or rectal suppositories.
- Do not wear clothing or shoes that are tight or that rub.
Look at table 34-7
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PE Nursing Care
Respiratory status
Monitor Pulse ox/ABG
Increase HOB
Cough and deep breathing
Cardiovascular status
Avoid crossing legs or bending knee
Assess lower extremities for DVT
Assess for bleeding
Assess patient’s understanding of illness and treatment
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