Adult Heath 1- Pulmonary Embolism (PE)

Pulmonary embolism (PE)

collection of particulate matter that enters venous circulation and lodges in the pulmonary vessels

obstruction of pulmonary blood flow, result in reduced gas exchange, reduced oxygenation, pulmonary tissue hypoxia, decreased perfusion, possible death

What happens during a PE?

DVT breaks off and goes to lungs

What is the most common cause of a PE?

age (>70), prolonged immobilization, central venous catheter (tip break off), surgery (especially in last 3 months; hip, knee), pregnancy, obesity, virchows triad, genetic conditon that increase clotting, hx of thromboembolism

Risk factors for a PE?

Virchows triad, risk factor for developing blood clot

endothelial injury, venostasis, hypercoaguability

• smoking cessation, especially with HRT

• reduce weight, be more physically active

• At risk pt: anticoagulants, compression socks, IVC filter

• Travel: drink water, change position/get up from sitting Q2-3h, avoid crossing legs

Health promotion for preventing PE? For at risk patients? During travel?

Pulmonary Embolism. PE symptoms: sudden SOB, CP, hypoxemia, diaphoretic, and impending doom.

Other s/s: restless, hemoptysis, tachpnea, tachycardic, crackles

Pt. suddenly has SOB, chest pain, hypoxemia, is diaphoretic, and states, “ I feel like I am going to die.” What do you suspect?

normal to low D-Dimer: rules out PE

Elevated D-Dimer: further testing required

A D-Dimer is ran on a patient suspected of having a PE. What would a normal to low D-Dimer indicate? What would an elevated D-Dimer indicate?

CTPA (Computed Tomography Pulmonary Angiogram)- standard for diagnosing a PE

A patient shows s/s of a PE and has an elevated D-Dimer. What further testing would you expect this patient to receive?

• CTPA Contraindications: kidney failure (elevated Cre), allergic to dye

• VQ scan- tells probability of pt having a PE

What are contraindications for a CTPA? What test would the patient receive instead?

• Manage Hypoxemia

• Manage hypotension

• Control Bleeding

What are the goals for caring for a patient with a PE?

Activate a rapid response team, apply oxygen, raise HOB

You come into your patient room and they are complaining of sudden onset of SOB, stabbing chest pain, are diaphoretic and restless. What do you do?

• If pt. has sudden PE symptoms: active rapid response, apply O2, elevate HOB

• frequent monitoring (Q1-2h)- assess vitals, lung sounds

• Drug therapy: anticoagulants

Nonsurgical interventions to manage hypoxemia in PE patients?

• prevents future clot, prevent clot from growing, prevent clot from moving

• PT/PTT

What does heparin do? What labs do we run with it?

embolectomy-surgically remove clot

Percutaneous catheter directed therapy-US breaks up clot, then surgically remove

IVC filter- prevent emboli from entering lungs

Surgical interventions to manage hypoxemia

• IV Fluid- restore fluid vol, prevent shock

• Vasopressors- increase cardiac output, maintain BP

How do we manage hypotension in PE patient?

• have antidote ready

• bleeding precautions

• monitor labs for signs of bleeding (PTT)

How do we control bleeding in PE patient?

• soft tooth brush

• electric razor

• fall precautions

• no contact sport

• no unecessary needle stick

• assess for bleeding aroundgums, IV site bleeding, blood in urine/stool,

Bleeding precautions