ADH2 Exam 2: Pulmonary Embolism/ Anticoag Therapy

Whats a PE? And ots most common cause??

• obstx of pulmonary vessels by embolus (hypoxia)

  • d/t DVT

Risk factors of PE: (7)

1. DVT

2. Immobile

3. Recent surgery

4. Preggo

5. Obese

6. OCPs

7. Clotting disorders

List findings of PE: 

• resp (5)

• cardiac (3)

• other (3)

Respiratory:

1. dyspnea

2. crackles

3. cough

4. tachypnea

5. hemoptysis (pink frothy sputum)

Cardiac:

6. chest pain

7. tachycardia

8. syncope (faint)

Other:

9. anxiety

10. diaphoresis

11. pleural effusion

An ABG for early PE shows??

Respiratory ALKALOSIS!!

• HYPERventilate

Whats the lab test specifically used to determine PE and what does it determine?*

D-Dimer!!

• an increase suggest clot in body

Gold standard diagnostics for PE?

Whats the alternative?

CT Pulmonary Angiography

• uses contrast so note allergies!!

Use VQ scan (Ventilation/Perfusion scan) if contrast contraindicated

Whats the ranges for

• pH

• CO2

• HCO3

• pH: (a) 7.35-7.45 (b)

• CO2: (b) 35-45 (a)

• HCO3: (a) 22-26 (b)

In ABG for PE pt, what does it show in Early, Progressive, and Late/Severe stage?

• Early: Resp. ALKAlosis!!

  • Hyperventilation → blowing off CO2

• Progression: Hypoxemia develops

  • Ventilation/ Perfusion (V/Q) mismatched

    • lungs are ventilated but blood flow is BLOCKED!!

• Late/Severe: Resp. ACIDosis!!

  • fatigue

  • decreased ventilation → CO2 retention (acidic)

PE medication: (3)

Anti-coags

1. Heparin (IV)

2. Enoxaparin (SQ)

3. Warfarin (PO)

Antidotes for Heparin, Enoxaparin, Warfarin?

• Protamine Sulfate for 2

• Vitamin K for warfarin

What lab tests to monitor for Heparin and Warfarin and the values?

1. aPPT: 1.5-2.5x control

2. PT/INR: 2-3

Which of the 3 PE anticoagulants has rapid onset to prevent clot growth and should discountinue if cant control it?

IV heparin!!

Which ones considered low molecular weight heparin? 

And would u need to moniotr labs for it?

Enoxaparin!!

• more predictable, so less monitoring needed (no labs)

• SQ—abd fat, rotate site, not by navel

Nursing care for pts w/ PE

• airway/O2 (2)

• monitoring (2)

• support (1)

• Airway/ Oxygenation:

1. High fowlers

2. give O2 as prescribed

• Monitoring:

1. resp/ cardiac status

2. ABGs, labs (clotting, electrolytes)

• Support:

1. Emotional to reduce anxiety!!

Surgical Procedures for PE: (3)

• which ones for life-threatening PE?

• which is for prevention of PE?

• which is alternative to anti coagulant therapy?

1. Embolectomy:

• takes out embolus from pulmonary artery (for life-threatening PE)

2. Thrombectomy:

• takes thrombus from deep vein (DVT tx → prevents future PE)

3. IVC Filter: (basically filters bloodstream)

• device placed in Vena Cava to trap emboli and prevent PE (option if anticoag isn’t possible)

Complications of PE: (4)

1. Pulmonary HTN:

• increased pressure form blocked pulmonary circulation

2. R.S. HF (Cor pulmonale)

• RV can’t pump against high pressure!

3. Shock

• impaired O2 and CO

• bad perfusion

4. Death

• if untreated or massive embolus!

PE Pt education and Prevention (8)

• lifestyle (3)

• mobility (3)

• meds (2)

• Lifestyle

1. quit smoking

2. maintain healthy weight

3. hydrate!

• Mobility

4. regular physical activity

5. no prolonged immobility (traveling, bedrest)

6. use compression socks!

• Meds

7. adhere to anti-coagulation regimen

8. keep regular lab checks!! (INR, aPPT, etc)

PE key points!!

1. Risk (5)

2. Findings (5)

3. Labs/Diagnostics (3)

4. Tx (4)

5. Prevention (5)

1. mostly from DVT

• immobility

• surgery

• OCPs

• Obese…

2. Sudden dyspnea

• CP

• Tachypnea

• Tachycardia

• anxiety

3. D-Dimer (increased= clot)

• ABG

  • Early ALKAlosis→ HYPOxemia→ ACIDOsis

• CT Angiography (gold standard)

4. Anti-coags

• give O2

• Positioning

• possible embolectomy!

5. Keep them mobile

• hydrate!

• no smoking!

• compression socks!

• anti-coag adherence