Module 12 Oxygenation

Module Overview

• Module 12: Oxygenation Problems and Related Concepts

• Course: NUR 120

• Chapters: 27, 28, 29, and 30

Learning Outcomes

1. Perfusion and Ventilation: Explain their concepts and relationship to oxygenation.

2. Nursing Process Application: Apply to clients with ventilation or perfusion problems.

3. Clinical Decision-Making: Explore processes related to oxygenation or perfusion issues.

4. Nursing Interventions: Determine and implement based on oxygenation assessment findings.

5. Oxygenation Promotion: Safely implement designated nursing interventions.

6. Tracheostomies and Chest Tubes: Describe purpose, function, and nursing responsibilities.

7. Diagnostic Tests Role: Explain nurses' roles in the peri-operative environment.

8. Pharmacological Therapies: Identify indications and common adverse reactions.

The Airway

• Upper Airway: Nose, Mouth, Pharynx, Epiglottis, Larynx, Trachea

• Lower Airway: Bronchi, Bronchioles, Alveolar Ducts, Alveoli

Oxygenation and Ventilation

• Oxygenation:

  • Process of obtaining O2 from the atmosphere.

  • Measured as partial pressure of O2 in arterial blood (PaO2) and arterial O2 saturation (SaO2).

• Ventilation:

  • Involves inspiration and expiration; terms like dyspnea and the use of accessory muscles.

Manifestations of Inadequate Oxygenation

• Symptoms:

  • Unexplained Restlessness, Confusion, Lethargy

  • Nasal flaring, Retractions, Dyspnea

  • Cyanosis, Pallor, Tachycardia, Hypotension

  • Cool, Clammy skin

Nursing Assessment

• Components:

  • Health history and Vital signs interpretation.

  • Measurements: Temperature, Pulse, Respirations, Blood Pressure.

• Respiratory Patterns: Tachypnea, Orthopnea, Dyspnea, Bradypnea, Cheyne-Stokes, Biots, Kussmaul’s.

• Definitions of Respiratory Terms

  • Tachypnea: Abnormally rapid breathing, usually more than 20 breaths per minute in adults.

  • Orthopnea: Difficulty breathing when lying flat, often relieved by sitting or standing.

  • Dyspnea: Shortness of breath or difficulty in breathing; can be acute or chronic.

  • Bradypnea: Abnormally slow breathing, typically fewer than 12 breaths per minute in adults.

  • Cheyne-Stokes Respiration: A pattern of breathing characterized by a gradual increase in depth and rate followed by a decrease, leading to a temporary stop in breathing (apnea).

  • Biots: Irregular breathing pattern with periods of apnea; typically associated with neurological damage.

  • Kussmaul’s Breathing: Deep, labored breathing pattern often associated with metabolic acidosis, particularly in conditions such as diabetic ketoacidosis.

Hypoxemia and Hypoxia

• Hypoxemia:

  • Decrease in arterial oxygen in blood; may lead to hypoxia.

• Hypoxia:

  • Decrease in oxygen supply to tissues, potentially life-threatening.

Physical Assessment

• Observations of appearance: clubbing of fingers, skin color, “barrel” chest.

• Routine examination includes inspection, palpation, percussion, auscultation of respiratory structures.

Diagnostic Tests

• Tests include:

  • Pulse Oximetry, Sputum cultures, Skin tests, Lung Biopsy, CO2 monitoring, Blood gas analysis, Bronchoscopy, Pulmonary Function Tests.

Nursing Interventions to Improve Oxygenation

• Oxygen Therapy: Requires MD order, promoting adequate oxygen transport.

• Incentive Spirometer: Encourages lung inflation and alveoli expansion; requires positioning and patient education.

• Deep Breathing Exercises: Involves education on techniques like chest splinting and postural drainage.

• Suctioning: deep suction is typically done by respiratory, nurses do oral suction

• Postural drainage

• Chest Splinting

Types of Oxygen Delivery Systems

1. Nasal Cannula

   • Delivers 1 to 6 liters per minute (LPM) of oxygen.

   • Provides low-flow oxygen therapy; comfortable and often used for mild hypoxia.

2. Simple Face Mask

   • Delivers 5 to 10 LPM.

   • Suitable for moderate oxygen needs; covers the nose and mouth for improved oxygen delivery.

3. Venturi Mask

   • Delivers specific concentrations of oxygen (24% to 50%) based on flow rate.

   • Uses a color-coded system for precise oxygen delivery; ideal for patients with chronic respiratory conditions.

4. Non-Rebreather Mask

   • Delivers high concentrations of oxygen (up to 90% or more).

   • Contains a reservoir bag that allows for inhalation of oxygen without rebreathing exhaled air.

5. CPAP (Continuous Positive Airway Pressure)

   • Provides continuous oxygen and prevents airway collapse during sleep.

   • Commonly used for patients with obstructive sleep apnea.

6. BiPAP (Bilevel Positive Airway Pressure)

   • Offers two levels of pressure: one for inhalation and one for exhalation.

   • Used for patients needing ventilatory support without intubation.

7. Tracheostomy Collar

   • Provides oxygen directly to the tracheostomy site.

   • Used for patients with a tracheostomy tube requiring supplementary oxygen.

8. High-Flow Nasal Cannula (HFNC)

   • Delivers high-flow oxygen (up to 60 LPM) with the ability to humidify gas.

   • Suitable for patients with respiratory distress or requiring significant oxygenation.

Inhalation Devices

• Small, hand-held devices (MDIs) deliver measured doses of medication.

• Instructions for correct usage crucial to ensure effective drug delivery.

Mini-Nebulizer Therapy

• Indication: Difficulty clearing secretions or reduced vital capacity.

• Nursing Care: Instruct slow, deep breaths; encourage cough; monitor effectiveness.

Chest Physiotherapy

• Includes:

  • Postural drainage, Chest percussion, Vibration, Breathing retraining.

• Goals: Remove secretions, improve ventilation, support respiratory muscles.

Tracheostomy

• Procedure: Opening in trachea for ventilation. Types include cuffed and uncuffed tracheostomy tubes.

• Complications: May include air leaks, airway obstruction, and aspiration.

Methods of Ventilation

• Types:

  • Invasive (mechanical ventilation) and noninvasive methods (CPAP, BiPAP).

  • Delivered via various masks or devices.

Respiratory Problems

• Conditions in the upper include epistaxis (nose bleed, can be a big issue), cancer of larynx

• Conditions in the lower include lung cancer, pneumonia, tuberculosis, pleural effusion, pleurisy (inflamed pleura causing chest pain), and lung abscess

Epistaxis and its Management

• Epistaxis: Nosebleed, common in adults; management involves pinching the nose, use of vasoconstrictors, impregnated nasal tampon (48-72 hrs), nasal packing, balloon inflated catheter, and sometimes cauterization.

• Can be anterior or posterior

• Should hold for 5-15 minutes slightly leaning forward

• Sneeze with mouth open to decrease pressure

• No blowing nose, gentle if necessary

Head and Neck Cancer

• Symptoms: Hoarseness, persistent cough, sore throat, obstruction of airway; early detection critical for survival.

• Diagnosis of Head and Neck Cancer

  • Symptoms:

    • Hoarseness

    • Persistent cough

    • Sore throat

    • Obstruction of airway

  • Diagnostic Tests:

    • Physical examination

    • Imaging studies (CT, MRI)

    • Biopsy for histological confirmation

    • Laryngoscopy or pharyngoscopy for direct visualization

  Post-Surgery Nursing Care for Head and Neck Cancer Patients

  • Airway Management:

    • Monitor airway patency due to potential swelling or obstruction.

    • Suctioning as needed to clear secretions.

  • Wound Care:

    • Assess surgical site for signs of infection or complications.

    • Provide care as per protocol for drainage tubes if present.

  • Nutritional Support:

    • Assess swallowing ability; consider enteral feeding if necessary.

    • Provide nutritional supplements to meet caloric needs.

  • Pain Management:

    • Administer prescribed analgesics and monitor effectiveness.

  • Communication:

    • Facilitate communication with writing boards or speech aids if affected.

  • Psychosocial Support:

    • Provide emotional support and refer to counseling services as needed.

  • Patient Education:

    • Educate about signs of complications, feeding techniques, and follow-up care.

Lung Abscess

Definition:

• A lung abscess is a localized collection of pus in the lung tissue, usually caused by a bacterial infection.

Causes:

• Often results from pneumonia, aspiration of foreign material, or bronchial obstruction.

Symptoms:

• Common symptoms include cough, fever, and chest pain. Patients may also exhibit sputum production that can be foul-smelling and participate in hemoptysis (coughing up blood).

Diagnosis:

• Diagnosed through imaging studies, such as chest X-rays or CT scans, and confirmed with microbiological testing of sputum or bronchoalveolar lavage fluid.

Treatment:

• Treatment typically includes antibiotics for the infection and, in some cases, drainage procedures to remove the abscess.

Nursing Considerations:

• Monitor vital signs, assess lung sounds, and evaluate the effectiveness of interventions. Provide education on medication adherence and respiratory hygiene (deep breathing, splinting).

Pneumonia

• Description: Inflammation of lung tissue; significant morbidity and mortality.

• Classification: Community-acquired, Hospital-acquired, Ventilator-associated.

Types of Pneumonia

1. Community-acquired Pneumonia (CAP)

   • Occurs in individuals outside of healthcare settings.

   • Common pathogens include Streptococcus pneumoniae and Haemophilus influenzae.

2. Hospital-acquired Pneumonia (HAP)

   • Develops in patients during hospital stay, often more serious due to antibiotic-resistant bacteria.

   • Common causes include Staphylococcus aureus and Gram-negative bacilli.

3. Ventilator-associated Pneumonia (VAP)

   • A type of HAP that occurs in mechanically ventilated patients.

   • Risk factors include duration of mechanical ventilation and presence of endotracheal tube.

4. Aspiration Pneumonia

   • Results from inhalation of oropharyngeal or gastrointestinal contents.

   • Often seen in patients with swallowing difficulties or altered consciousness.

5. Fungal Pneumonia

   • Caused by fungal infections, often in immunocompromised individuals.

   • Common pathogens include Histoplasma capsulatum and Aspergillus species.

6. Mycoplasma Pneumonia

   • Atypical pneumonia caused by Mycoplasma pneumoniae, commonly seen in young adults and children.

   • Symptoms include a gradual onset of cough and low-grade fever.

7. Tuberculosis (TB) Pneumonia

   • Caused by Mycobacterium tuberculosis; can be pulmonary or extrapulmonary.

   • Often presents with chronic cough, night sweats, and hemoptysis.

Prevention of Pneumonia

• Emphasizes pneumococcal vaccination, especially for adults aged 65 and older or under 2.

• Increased risk for immunocompromised individuals

Medical Management for Pneumonia

1. Antibiotic Therapy

   • Initiate empiric antibiotics based on suspected pathogens and local resistance patterns.

   • Adjust antibiotic therapy based on culture results and patient response.

   • Vaccinations (esp. for smokers and those with lung disease)

2. Supportive Care

   • Ensure adequate hydration.

   • Use antipyretics to manage fever.

   • Provide oxygen therapy as needed to maintain adequate oxygen saturation levels.

3. Bronchodilators

   • Administer bronchodilators to alleviate bronchospasm and improve airflow if wheezing is present.

4. Corticosteroids

   • Consider corticosteroids for patients with severe pneumonia or those with significant airway inflammation.

5. Respiratory Therapy

   • Implement chest physiotherapy, incentive spirometry, and deep breathing exercises to enhance lung function and expectoration.

6. Vaccination

   • Promote pneumococcal and influenza vaccinations to prevent future infections.

7. Monitoring

   • Regularly assess vital signs, oxygen saturation, and clinical response to treatment to adjust management as necessary.

Preventing Respiratory Problems

1. Aspiration Precautions

   • Positioning: Keep the head of the bed elevated at least 30-45 degrees during meals and for at least an hour afterward.

   • Thickening Agents: Use thickening agents for liquids to reduce the risk of aspiration in patients with swallowing difficulties.

   • Oral Care: Ensure proper oral hygiene to reduce the risk of aspiration pneumonia.

   • Swallowing Assessment: Conduct regular assessments of swallowing ability and consult speech therapy as needed.

2. Nursing Interventions

   • Education: Educate patients and families about the importance of following dietary modifications and safe swallowing techniques.

   • Monitoring: Regularly monitor respiratory status, including signs of aspiration (coughing, choking).

   • Encouragement: Encourage deep breathing and coughing exercises to clear secretions.

   • Use of Suctioning: Be prepared to suction as necessary to prevent aspiration and maintain airway patency.

   • Implementing Mobility: Encourage early mobilization to enhance respiratory function and decrease the risk of complications.

Pulmonary Tuberculosis

• Causes: Mycobacterium tuberculosis; symptoms include cough, fever, night sweats.

• Assessment: Involves skin tests, chest x-rays, and sputum tests.

Risk Factors for Pulmonary Tuberculosis (TB)

1. Weakened Immune System: Individuals with compromised immune systems (e.g., HIV/AIDS, organ transplant recipients, those on immunosuppressive medications) are at higher risk.

2. Close Contact: Prolonged exposure to individuals with active TB increases risk, especially in crowded living conditions.

3. Travel to Endemic Areas: Visiting or living in regions with high rates of TB increases exposure risk.

4. History of TB Infection: A previous TB infection can reactivate, especially if the immune system is weakened.

5. Substance Abuse: Alcohol and drug abuse can impair immune function, increasing susceptibility.

6. Chronic Health Conditions: Diseases such as diabetes, silicosis, or malnutrition can elevate risk due to reduced immunity.

7. Age Factors: The very young (children under 5) and elderly individuals are more vulnerable to TB infection.

8. Homelessness

9. Foreign born people

10. Living or working in long-term care facilities

11. Poor access to healthcare

Nursing Management of TB

• Goals include maintaining normal pulmonary function, adherence to treatment, and preventing spread.

Treatment for Tuberculosis (TB)

1. Antituberculous Medications:

   • A combination of antibiotics is used to effectively treat TB, typically including:

     • Isoniazid

     • Rifampin

     • Ethambutol

     • Pyrazinamide

   • Treatment usually lasts for at least 6 to 9 months.

2. Directly Observed Therapy (DOT):

   • Healthcare workers observe patients taking their medications to ensure adherence and effectiveness.

3. Supportive Care:

   • Patients may require additional support such as nutritional support, hydration, and management of any side effects from medications.

4. Monitoring:

   • Regular follow-up appointments to monitor treatment effectiveness and manage any potential adverse reactions or complications.

5. Preventive Therapy:

   • Individuals at high risk of developing TB, such as those with latent TB infection, may receive preventive treatment to reduce the risk of active disease.

6. Lifestyle Modifications:

   • Encouragement of healthy living habits, including proper nutrition and smoking cessation, to improve overall health and bolster the immune system against infection.

Nursing Management of Tuberculosis (TB)

1. Assessment:

   • Monitor vital signs frequently, focusing on respiratory status, oxygen saturation, and signs of infection.

   • Assess for symptoms of active TB, including persistent cough, fever, night sweats, and weight loss.

2. Medication Management:

   • Administer prescribed antituberculous medications and monitor for side effects.

   • Educate the patient on the importance of adherence to the medication regimen and potential interactions.

3. Preventive Measures:

   • Implement airborne precautions for patients with active TB to prevent transmission.

   • Ensure proper ventilation and use of HEPA filters in the patient's room.

4. Nutritional Support:

   • Assess dietary needs; encourage high-calorie and protein-rich foods to support immune function and recovery.

   • Address potential medication-related side effects affecting appetite.

5. Patient Education:

   • Provide information on TB transmission, treatment duration, and the importance of completing the entire course of therapy.

   • Discuss signs of medication side effects to report and follow-up appointments.

6. Emotional Support:

   • Address psychosocial needs; provide support for anxiety and concerns about contagion or lifestyle changes.

   • Offer resources for counseling or support groups.

7. Follow-Up Care:

   • Schedule regular appointments to monitor treatment efficacy and perform sputum tests.

   • Adjust treatment based on culture results and clinical response.

Atelectasis

Definition:

• Atelectasis is a condition characterized by the partial or complete collapse of a lung or a section (lobe) of a lung, resulting in reduced or absent gas exchange.

Causes:

• Airway Obstruction: Foreign object, mucus plugs, or tumors that block the airways.

• Lung Compression: Fluid accumulation (pleural effusion), pneumothorax, or other pressures that can collapse lung tissue.

• Post-Surgical Changes: Pain and shallow breathing after surgery can restrict lung expansion.

• Prolonged Bed Rest: Lack of movement can lead to the pooling of secretions and loss of lung volume.

Symptoms:

• Shortness of breath (dyspnea)

• Cough

• Decreased breath sounds over the affected area

• Possible signs of respiratory distress

Diagnosis:

• Chest X-ray or CT scan to visualize areas of collapsed lung.

• Physical examination to assess breath sounds and respiratory effort.

Treatment:

• Positioning: Frequent repositioning to improve lung expansion.

• Deep Breathing Exercises: Techniques such as incentive spirometry to promote lung inflation.

• Chest Physiotherapy: Techniques to clear secretions.

• Treatment of Underlying Conditions: Addressing the cause, such as removing obstructions or managing fluid accumulation.

Prevention:

• Encourage mobility and early ambulation in post-operative patients.

• Educate patients on deep breathing and coughing techniques to prevent secretion buildup.

Management of Atelectasis

• Prevention through strategies like deep breathing and mobility; symptoms include decreased lung sounds.

Pleural Effusion

• Abnormal fluid collection in pleural space; management includes treating the underlying cause and may involve drainage.

Reasons for Chest Surgery

Chest surgery may be performed for various reasons including:

1. Tumors: Removal of cancerous or non-cancerous tumors from the lungs, pleura, or mediastinum.

   • Risks: Infection at the surgical site, bleeding, or damage to surrounding structures.

2. Infections: To treat severe lung infections that do not respond to medication, such as abscesses or empyema (pus in the pleural space).

   • Risks: Post-surgical pneumonia, prolonged recovery, or failure to resolve the infection.

3. Trauma: Repair of injuries to the chest, lungs, or major blood vessels resulting from accidents or penetrating injuries.

   • Risks: Anesthesia complications, respiratory failure, or complications from blood loss.

4. Pleural Effusion: Drainage of excess fluid from the pleural space.

   • Risks: Infection, reaccumulation of fluid, or lung collapse.

5. Pulmonary Conditions: Procedures to correct conditions like emphysema, lung cancer, or chronic obstructive pulmonary disease (COPD).

   • Risks: Reduced lung function, chronic pain, or need for further surgeries.

6. Non-invasive Lung Surgery: Such as video-assisted thoracoscopic surgery (VATS) which is used for both diagnostic and therapeutic purposes.

   • Risks: Potential for bleeding, lung injury, or recurrence of conditions treated.

7. Heart Surgery: Sometimes chest surgery is performed as part of procedures related to heart conditions; for instance, placing a pacemaker or coronary artery bypass surgery.

   • Risks: Anesthesia complications, heart rhythm problems, or infection.

It is essential that the risks are discussed with the patient prior to surgery, and that thorough pre-operative planning and consideration for post-operative care are made to enhance recovery and outcomes.

Types of Chest Surgery Procedures and Their Risks, Complications, and Nursing Considerations

1. Thoracotomy

   • Description: Surgical incision into the chest wall.

   • Risks: Infection, bleeding, damage to surrounding organs, respiratory failure.

   • Nursing Considerations: Monitor vital signs, respiratory status, and pain management; provide postoperative care and educate on deep breathing exercises.

2. Video-assisted Thoracoscopic Surgery (VATS)

   • Description: Minimally invasive technique for diagnostic or therapeutic purposes using small incisions and a camera.

   • Risks: Bleeding, lung injury, recurrence of conditions treated, potential need for conversion to open surgery.

   • Nursing Considerations: Educate patients on recovery expectations, monitor for complications, and encourage early mobilization.

3. Thoracentesis

   • Description: Procedure to remove fluid from the pleural space.

   • Risks: Pneumothorax, bleeding, infection.

   • Nursing Considerations: Positioning the patient correctly, monitor respiratory status before and after the procedure, and assess for complications.

4. Lung Resection (Lobectomy or Pneumonectomy)

   • Description: Removal of a lobe (lobectomy) or an entire lung (pneumonectomy).

   • Risks: Respiratory failure, persistent cough, infection, bleeding.

   • Nursing Considerations: Preoperative education, postoperative respiratory care, pain management, and monitoring for signs of infection or respiratory distress.

5. Pleurodesis

   • Description: Procedure to adhere the lung to the chest wall to prevent fluid accumulation.

   • Risks: Pain, infection, pulmonary complications.

   • Nursing Considerations: Explain the procedure to the patient, manage pain, monitor respiratory function, and educate on potential signs of complications.

Pre-Operative Management for Chest Surgery

1. Patient Assessment:

   • Conduct comprehensive physical examinations and medical history review.

   • Assess respiratory function, including spirometry and oxygen saturation.

   • Evaluate nutritional status and identify any comorbid conditions.

2. Informed Consent:

   • Ensure that the patient understands the procedure, risks, benefits, and alternatives.

   • Obtain signed consent prior to the date of surgery.

3. Preoperative Education:

   • Educate the patient about what to expect during the surgery and recovery process.

   • Discuss pain management strategies and the importance of deep breathing exercises.

4. Preparation for Surgery:

   • Ensure preoperative fasting protocols are followed.

   • Administer preoperative medications as prescribed (e.g., antibiotics or sedatives).

Post-Operative Management for Chest Surgery

1. Monitoring Vital Signs:

   • Closely monitor respiratory rate, heart rate, blood pressure, and oxygen saturation.

   • Observe for any signs of respiratory distress or complications.

2. Pain Management:

   • Administer prescribed pain medications and assess their effectiveness.

   • Encourage the use of patient-controlled analgesia (PCA) if appropriate.

3. Respiratory Care:

   • Implement deep breathing exercises and incentive spirometry to promote lung expansion.

   • Educate the patient on proper coughing techniques to clear secretions.

   • Possible ventilation

4. Daily chest x-ray

5. Wound Care:

   • Assess the surgical site for signs of infection, drainage, or complications.

   • Educate on proper wound care and signs to report.

6. Nutritional Support:

   • Monitor the patient's ability to eat and tolerate fluids.

   • Provide high-protein, high-calorie diet as tolerated to promote healing.

Pneumothorax

Definition:

• Pneumothorax is the presence of air in the pleural space, leading to partial or complete collapse of the lung on the affected side.

Types:

1. Spontaneous Pneumothorax: Occurs without trauma; can be primary (with no underlying lung disease) or secondary (due to underlying lung disease).

2. Traumatic Pneumothorax: Results from blunt or penetrating trauma to the chest, causing air to enter the pleural space.

3. Tension Pneumothorax: A life-threatening condition where air enters the pleural space with each breath but cannot escape, leading to increased pressure and lung collapse. Can also be caused by a clamped chest tube. Always a medical emergency.

Causes:

• Ruptured alveoli, trauma (fractured ribs, stab wounds), or iatrogenic causes (e.g., from medical procedures like thoracentesis).

Symptoms:

• Sudden sharp chest pain, dyspnea (shortness of breath), tachycardia, decreased breath sounds on the affected side, and potentially cyanosis.

Diagnosis:

• Physical examination, chest X-ray, or CT scan to confirm the presence of air in the pleural space.

Treatment:

• Observation: For small pneumothoraces that are asymptomatic.

• Needle Decompression: For tension pneumothorax to relieve pressure.

• Chest Tube Insertion: To drain air and allow the lung to re-expand.

• Surgery: In cases of recurrent pneumothoraces or when conservative measures fail.

Nursing Considerations:

• Monitor respiratory status, vital signs, and pain levels.

• Provide education on activity limitations and signs of complications (e.g., increased dyspnea, chest pain).

Chest Tubes

Purpose:

• Chest tubes are used to remove air (pneumothorax) or fluid (pleural effusion, hemothorax) from the pleural space, allowing the lung to re-expand and function properly.

Indications:

• Pneumothorax: To relieve pressure and allow lung re-expansion.

• Pleural Effusion: To drain excess fluid accumulation in the pleural space.

• Hemothorax: To remove blood from the pleural cavity post-surgery or due to trauma.

Procedure:

• Insertion is typically done by a physician or trained healthcare professional under sterile conditions.

• Local anesthesia is administered, and the tube is inserted between the ribs into the pleural space.

• The other end of the tube is connected to a drainage system, which may include a water-seal chamber.

Management:

• Monitor vital signs and respiratory status frequently.

• Assess drainage output and characteristics (color, consistency).

• Maintain proper placement and function of the drainage system, ensuring no kinks or blockage.

• Educate the patient on the importance of deep breathing and coughing exercises to promote lung expansion.

• Provide emotional support, as the presence of a chest tube can be distressing.

• Bubbling constantly in collection chambers can mean there is an air leak

• Only clamp chest tube before removal

Pulmonary Embolism

• Definition: Obstruction (blood clot, fat, or air) of pulmonary artery, often from DVT.

• Symptoms include dyspnea, cough, chest pain, tachycardia

• Treatment includes anticoagulants.

• Moving helps clot prevention

• If susceptible to clots a filter can be placed to stop them

• Risk: heart failure, surgery, immobility, pregnancy, prone to excessive clotting , trauma

Drug Therapy for PE

• Involves fibrinolytic agents, low-molecular-weight and normal heparin or warfarin; monitoring of lab values is crucial.

Diagnosis of Pulmonary Embolism

Clinical Presentation:

• Common symptoms include:

  • Dyspnea (shortness of breath)

  • Chest pain (may be pleuritic)

  • Cough (may be associated with hemoptysis)

  • Tachypnea (rapid breathing)

Diagnostic Tests:

1. D-dimer Test:

   • Elevated levels may indicate the presence of an abnormal blood clot, though not specific to PE.

2. Chest X-ray:

   • May show signs of pleural effusion or atelectasis but is often normal in PE.

3. CT Pulmonary Angiography (CTPA):

   • Preferred imaging modality for confirming the presence of a PE.

   • Provides visualization of the pulmonary arteries to locate clots.

4. Ventilation-Perfusion (V/Q) Scan:

   • Used in patients unable to undergo CT scan; assesses blood flow versus ventilation in the lungs.

5. Ultrasound of the Legs:

   • May be performed to detect deep vein thrombosis (DVT), which can indicate a source for the embolism.

6. Pulmonary Angiogram:

   • Invasive procedure used less frequently; provides direct visualization of pulmonary arteries.

Risk Assessment:

• Utilize clinical scoring systems (e.g., Wells Score) to assess the likelihood of PE based on patient history and presenting symptoms.

Conclusion:

• Diagnosis of pulmonary embolism requires a combination of clinical evaluation, imaging studies, and laboratory testing to confirm the presence and assess the extent of the embolism.