pulmonary Embolism

Pulmonary Embolism

Is a blood clot that’s in the pulmonary artiers’s in the lungs. It can be from a clot that traveled from the legs ( DVT)

Embolus

anything that moves through the blood vessels until it reaches a vessel that is too small to let it pass ( blood, fat, air bubble, bone marrow)

Causes of Pulmonary Embolism

A blood clot that travels from the legs or other parts of the body ( DVT).

what can’t we do with PE

gas exchange

Risk factors for PE

blood not moving, vessel wall damage, prolonged immobility, trauma from bone marrow embolism , surgery, HF, obesity, advanced age, pregnancy, atrial fibrillation, estrogen therapy , birth control pills, postoperative,

Clinical manifestations for PE ( respiratory)

Dyspnea, shortness of breath, chest pain, dry cough, anxiety , hemoptysis ( coughing of blood)

Clinical manifestations for PE ( cardiac)

JVD, cyanosis , hypotension, abnormal heart sounds ( s3/s4), abnormal ecg, tachycardia, syncope ( loss of consciousness bc brain does not receive blood)

Diagnostic test

chest x- ray

ABG-

Coagulation studies (D dimer)- will tell if there is a clot

PERC (pulmonary embolism rule-out criteria),

Chest CT

Lung scans

Assessment ( physical examination)

LOC, vital signs, skin color, temperature, moisture, breath, heart sounds, O2 saturated, Neck vein distention, peripheral edema

Nursing diagnosis for PE

Gas exchange, impaired

Cardiac Output, decreased

Pain, acute

Anxiety

Ineffective tissue perfusion

Nursing interventions for PE

promote oxygenation/ gas exchange

maintain healthy blood pressure & organ function

Prevent clot formation

Monitor medications for blood clots

pain medications

Patient education for PE

weight management, increase activity, smoking cessation, anticoagulant drugs, if on warfarin no vitamin K

increase fluids

avoid injury

compression stockings that prevent blood clots

avoid long sitting/ crossing legs

Drugs for Pulmonary Embolism

Heparin

Lovenox ( enoxaparin)

Coumadin ( warfarin)

Direct oral anticoagulants ( DOACs)

Thrombolysis ( fibrinolytic therapy)

the breakdown of blood clots formed in blood vessels using medication

Embolectomy

Surgical removal of a blood clot which are blocking blood circulation.

Chest CT w / contrast

a medical imaging procedure that uses X-rays and a special dye (contrast) to create detailed images of the chest organs, including the lungs, heart, and blood vessels

lung scans

an imaging test to look at your lungs and help diagnose certain lung problems

Chest x-ray

produces images of the heart, lungs, airways, blood vessels and the bones of the spine and chest.

Arterial Blood Gas ( ABG)

Measures the balance of oxygen and carbon dioxide in your blood to see how well your lungs are working.

Coagulation studies

Laboratory tests that assess the body’s ability to form blood clots

D-dimer test

checks for the presence of tiny protein fragments that are produced when a blood clot breaks

Wells criteria

a number that estimates a patients risk of developing a blood clot in a vein or having Pulmonary embolism

Geneva score

is a decision tool that helps determine probability of pulmonary embolism

Heparin (Anticoagulants)

Prevention of blood clot formation,We monitor Aptt every 6-8 hrs, Antidote is Protamine sulfate

Enoxaparin (antithrombotics)

Prevention of blood clots formation

Warfarin ( anticoagulants)

Prevention of thromboembolic events.

Do not take with vitamin K

2-3

Direct oral anticoagulants ( DOACs)

Pradaxa, Xarelto , Eliquis , Savaysa, and Bevyxxa