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Blockage of pulmonary arteries by a thrombus, fat or air embolism, or tumor tissue
•Material eventually reaches the pulmonary vessels where it lodges and obstructs perfusion
Most PE arise from
thrombi in the deep veins of the legs
Lungs are an excellent area for the ______ to lodge
thrombi to lodge because of extensive arterial and capillary network
Most patients with PE from deep vein thrombosis have
no leg symptoms at time of diagnosis
Risk Factors of PE
•Surgery in last 3 months
•History of DVT
Classic Triad of S/S for PE
dyspnea, chest pain and hemoptysis
Occurs in only 20% of patients
Often subtle making Dx difficult
Sudden onset of dyspnea, tachycardia and tachypnea
Sudden change in mental status
Massive emboli produce sudden collapse of the patient
PE Diagnosis Tests
- Ventilation perfusion scan
- D-Dimer Testing
- Spiral CT scan
- Pulmonary Angiography
Ventilation perfusion scan
Assesses adequate pulmonary circulation
Scans distribution of gases throughout the lungs
D-dimer is rarely found in healthy individuals
Elevated in degradation of fibrin (infection, surgery etc)
8X higher in thomboembolisms
Normal or near normal D-dimer can rule out PE
If high, other tests such as venous ultrasounds, or CT will be needed.
You see dimers done more often on pts with minor symptoms
Spiral CT scan
Most often used to diagnose PE
Done in 30 seconds with a single breath
Contrast is injected before scanning
Catheterization of the right side with injection of dye into PA to visualize pulmonary vessels
PE Collaborative Care
Increase gas exchange
Prevent further growth of the thrombi
Prevent embolization into the pulmonary vascular system
Provide cardiopulmonary support if needed
PE Conservative treatment
O2 as determined by pulse ox or ABG
Intubation and ventilation may be required
If u sespect PE, put o2 on the pt increase head of bed keept them still don’t let them off of bedrest bc it could disoldge and they’ll have more thrombi
PE Drug Therapy
Opioids for pain relief
When pt is taking Anticoagulants what lab values should be Monitored
PTT and INR
What are some of the many things to do to
Prevent injury while taking Anticoagulants
- Use an electric shaver.
- Use a soft-bristled toothbrush, and do not floss.
- Avoid hard foods that would scrape the inside of your mouth.
- Eat warm, cool, or cold foods to avoid burning your mouth.
- Take a stool softener to prevent straining during a bowel movement.
- •Do not use enemas or rectal suppositories.
- Do not wear clothing or shoes that are tight or that rub.
Look at table 34-7
PE Nursing Care
Monitor Pulse ox/ABG
Cough and deep breathing
Avoid crossing legs or bending knee
Assess lower extremities for DVT
Assess for bleeding
Assess patient’s understanding of illness and treatment