ADH Ex2 NUR 4585 Pulmonary Embolism: Assessment and Nursing Priorities

What are the initial symptoms of pulmonary embolism as seen in Mr. Jenkins?

Sudden dyspnea, sharp chest pain with breathing, and lightheadedness.

What vital signs indicate Mr. Jenkins's condition?

RR 28/min, HR 124/min, BP 102/64 mmHg, SpO2 88% on room air.

What immediate nursing priorities should be taken for Mr. Jenkins?

Increase O2 saturation, stop physical therapy, call rapid/code blue.

What is the primary cause of pulmonary embolism?

A clot in a deep vein of the legs that breaks loose and travels to the pulmonary artery.

How does a pulmonary embolism affect oxygenation?

It blocks pulmonary blood flow, preventing efficient oxygen entry into circulation, leading to hypoxemia and dyspnea.

What is Virchow's Triad in relation to pulmonary embolism?

Venous stasis, endothelial injury, and hypercoagulability.

What are some risk factors for developing pulmonary embolism?

Prior DVT/PE, obesity, smoking, age over 65, heart failure, and severe respiratory disease.

What clinical tools can help confirm a pulmonary embolism?

Wells Criteria, Geneva Score, D-dimer, CT pulmonary angiography (CTPA), V/Q scan, echocardiography.

What are typical ABG findings in pulmonary embolism?

Normal or slightly elevated pH, low PaCO2, low PaO2, normal or slightly low HCO3-, low SaO2.

How is pulmonary embolism classified based on severity?

Low risk (submassive), intermediate risk (submassive), high risk (massive).

What are the treatment priorities for a patient with pulmonary embolism?

Anticoagulation, support oxygenation and perfusion, advanced therapies for high-risk patients.

What is the role of anticoagulation in treating pulmonary embolism?

It prevents clot growth and new clot formation.

What are the differences between unfractionated heparin (UFH) and low-molecular-weight heparin (LMWH)?

UFH is given IV, has a short half-life, and requires aPTT monitoring; LMWH is given subcutaneously and usually requires no routine monitoring.

What is Heparin-Induced Thrombocytopenia (HIT)?

An immune reaction causing thrombocytopenia and paradoxical clotting, often occurring 5 to 14 days after starting heparin.

What should be monitored for a patient suspected of having HIT?

Platelet count, signs of bleeding, and notify the provider if HIT is suspected.

What are the long-term anticoagulation recommendations for a provoked PE?

Typically requires 3 months of therapy.

What are some bleeding precautions for patients on anticoagulants?

Use a soft toothbrush, electric razor, limit alcohol, avoid high-injury-risk activities.

What are the key nursing care priorities in managing pulmonary embolism?

Early recognition, hemodynamic stability, oxygenation, safe medication management, complication prevention.

What are potential complications of pulmonary embolism?

Right-heart strain, hemodynamic instability, severe hypoxemia, chronic thromboembolic pulmonary hypertension (CTEPH).

What are the warning signs of a massive pulmonary embolism?

Sustained hypotension, shock, syncope, severe hypoxemia, mental-status changes.

What immediate actions should be taken for a patient with suspected massive PE?

Assess airway/breathing/circulation, give high-flow oxygen, monitor continuously, notify/escalate.

What is the central problem in pulmonary embolism?

Impaired perfusion, not impaired ventilation.

What does a ventilation/perfusion (V/Q) mismatch indicate?

It suggests pulmonary embolism.

What nursing actions can help prevent complications from pulmonary embolism?

Good assessment, education, and administering blood thinners.

What is the significance of Mr. Jenkins's elevated troponin levels?

It indicates possible right-heart strain and suggests an intermediate risk classification for PE.

What is the importance of maintaining SpO2 above 92% in PE patients?

It ensures adequate oxygenation and prevents hypoxemia.

What should be done if a patient with PE shows sudden deterioration?

Report immediately and escalate care as needed.

What is the role of patient education in managing pulmonary embolism?

To inform about bleeding precautions, recurrence warning signs, and risk-factor modification.