NURS 418 - Pulmonary Embolism

pulmonary embolism

the blockage of one or more pulmonary arteries by a thrombus, fat or air embolus, or tumor tissue

1. deep veins of the legs (i.e., DVT/VTE)

2. right atrium in patients with a-fib

3. pelvic veins

4. upper extremities

5. long bone fractures (fat emboli)

6. bacteria vegetation on heart valves

7. amniotic fluid emboli

8. tumors

sites of origin of pulmonary embolism (8)

deep veins of the legs (i.e., DVT/VTE)

the most common site of origin of pulmonary embolism

1. dyspnea

2. hemoptysis

3. chest pain

the classic triad in 85% of patients with pulmonary embolism

pulmonary embolism

accentuation of the pulmonic heart sound (split S2) =

massive emboli

sudden collapse with shock, pallor, severe hypoxemia, crushing chest pain, altered mental status, hypotension, and feelings of impending doom

D-dimer

non-specific and not sensitive diagnostic test for pulmonary embolism

< 0.50

normal D-dimer

spiral contrast CT scan

with an elevated D-dimer, confirm diagnosis of a PE with a _____

spiral contrast CT scan

a negative venous ultrasound and positive D-dimer requires a _____ to confirm diagnosis of a PE

pulmonary angiogram

most sensitive and specific diagnostic test for pulmonary embolism

spiral contrast CT scan

diagnostic test for pulmonary embolism that has reduced the need for pulmonary angiograms

1. D-dimer

2. troponin

what labs may be elevated with a pulmonary embolism? (2)

1. IV fluids

2. pressors

3. intubation

interventions to support cardiopulmonary status in patients with a pulmonary embolism (3)

1. TCDB

2. IS

respiratory measures to prevent or treat atelectasis in patients with pulmonary embolism (2)

1. H/H

2. INR

3. PLT

what should be monitored in patients taking heparin (Warfarin) for pulmonary embolism? (3)

2-3

therapeutic INR for patients taking heparin (Warfarin) for pulmonary embolism

enoxaparin (Lovenox)

patients with a pulmonary embolism should bridge with _____ until therapeutic oral anticoagulant therapy can be initiated

3 mo

treatment time for oral anticoagulants for a pulmonary embolism is a minimum of _____ unless therapy is contraindicated

enoxaparin (Lovenox)

safer and more effective anticoagulant than unfractionated heparin

1 mg/kg BID or 1.5 mg/kg QD

therapeutic dose of enoxaparin (Lovenox)

40 mg QD or 30 mg QD with renal insufficiency

prophylactic dose of enoxaparin (Lovenox)

fibrinolytic therapy (streptokinase)

dissolves/breaks down blood clots

EKOS acoustic pulse thrombosis

a minimally invasive procedure that uses ultrasound and medication to dissolve blood clots

inferior vena cava filter (IVC filter)

a small, metal device that prevents blood clots from traveling to the lungs. indicated for high-risk patients with contraindications to anticoagulation

1. misplacement

2. migration

3. perforation

complications of IVC filters (3)

1. pulmonary infarction

2. pulmonary hypertension

complications of pulmonary embolism (2)

right-sided

pulmonary hypertension r/t pulmonary embolism leads to atrial hypertrophy and _____ heart failure

1. early ambulation

2. compression stockings (30-40 mmHg)

3. DVT prevention

4. SCDs

prevention of pulmonary embolism (4)