Pulmonary Embolism Comprehensive Study Notes

Disease Overview and Pathophysiology

  • Pulmonary Embolism is classified as a LIFE THREATENING condition.
  • Pathological Description:
    • Defined as the blockage of pumonary arteries by a thrombus, fat, air embolus, tumar, or tissue.
    • Pathophysiologic Process: The embolus travels with the blood flow until it lodges in the vascular bed and obstructs perfusion of the alveoli.
  • Predilection Site:
    • The lower lobes of the lung are commonly affected.

Etiology and Risk Factors

  • Thrombus Origin:
    • Commonly comes from DVT's (history of deep vein thrombosis).
  • Physical Activity and Surgical History:
    • Immobility or reduced mobility.
    • Recent surgery within the last 3 months, especially involving the lower extremety (Lesp lower extremety).
  • Underlying Medical Conditions:
    • Malignancy.
    • Obesity.
    • HF (Heart Failure).
  • Hormonal and Systemic Factors:
    • Birth Control usage.
    • Pregnancy.
  • Environmental and Lifestyle Factors:
    • Smoking.
    • Flying Travel.

Clinical Manifestations (Signs and Symptoms)

  • Respiratory Manifestations:
    • Dyspnea.
    • Cough.
    • Hemoptysis (coughing up blood).
    • Crackles.
    • Hypoxemia.
  • Pain Characteristics:
    • Chest pain.
    • Premitic Chest pain.
  • Physical and Systemic Findings:
    • Accentuation of pulmonic heart sound.
    • Sudden change in mental status.
    • Fever.

Diagnostic Tests and Laboratory Evaluation

  • Diagnostic Imaging:
    • CT scan.
  • Laboratory Studies:
    • Elevated D-Dimer: An elevated D-Dimer level indicates the presence of a clot.

Nursing Interventions and Medical Management

  • Patient Positioning and Rest:
    • Bed Rest: Position patient in Semi- Fowlers.
  • Intravenous Access and Pharmacotherapy:
    • Maintain IV: Administer meds and fluid.
    • Fibrinolytic Therapy: TKA/TPA.
    • Anticoagulant Therapy:
    • Hepanh.
    • Warfarin/coumadin.
  • Patient Monitoring and Laboratory Assessment:
    • Assess patient status continuously.
    • Monitor lab values: Check aPTT and INR.
    • Assess for lossess pleading bruising (bleeding and bruising assessment).
  • Oxygenation:
    • Administer O2.

Surgical and Interventional Procedures

  • Surgical Interventions:
    • Embolectomy.
    • Vena cava Filter insertion.

Patient Education

  • Activity and Prophylaxis Measures:
    • Increase Mobility.
    • Wear compression Stockings.
  • Safety and Medication Guidelines:
    • Reduce risk of bleeding.
    • Take Vitamin K while on warfarin.