Pulmonary Embolism

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Author:
LaurenFleming
ID:
97243
Filename:
Pulmonary Embolism
Updated:
2011-08-16 17:36:14
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N300
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  1. Pulmonary Embolism
    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
  2. Most PE arise from
    thrombi in the deep veins of the legs
  3. Lungs are an excellent area for the ______ to lodge
    thrombi to lodge because of extensive arterial and capillary network
  4. Most patients with PE from deep vein thrombosis have
    no leg symptoms at time of diagnosis
  5. Risk Factors of PE
    •Immobilization

    •Surgery in last 3 months

    •Stroke

    •History of DVT

    •Malignancy

    •Obesity,

    •smoking

    •hypertension
  6. Classic Triad of S/S for PE
    dyspnea, chest pain and hemoptysis

    —Occurs in only 20% of patients

    —Often subtle making Dx difficult
  7. PE Manifestations
    Anxiety

    —Sudden onset of dyspnea, tachycardia and tachypnea

    —Hypoxemia

    —Cough

    —Chest pain

    —Crackles

    —Sudden change in mental status

    —Massive emboli produce sudden collapse of the patient
  8. PE Diagnosis Tests
    • Ventilation perfusion scan
    • D-Dimer Testing
    • Spiral CT scan
    • Pulmonary Angiography
  9. Ventilation perfusion scan
    Assesses adequate pulmonary circulation

    —Scans distribution of gases throughout the lungs
  10. D-Dimer Testing
    —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
  11. Spiral CT scan
    —Most often used to diagnose PE

    —Done in 30 seconds with a single breath

    —Contrast is injected before scanning
  12. Pulmonary Angiography
    —Catheterization of the right side with injection of dye into PA to visualize pulmonary vessels
  13. PE Collaborative Care
    —Increase gas exchange

    —Prevent further growth of the thrombi

    —Prevent embolization into the pulmonary vascular system

    —Provide cardiopulmonary support if needed
  14. PE Conservative treatment
    —O2 as determined by pulse ox or ABG

    —Intubation and ventilation may be required

    —Bedrest

    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
  15. PE Drug Therapy
    Anticoagulants

    —Thrombolytic Agents

    —Opioids for pain relief
  16. When pt is taking Anticoagulants what lab values should be Monitored
    PTT and INR
  17. 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
  18. PE Nursing Care
    —Respiratory status

    —Monitor Pulse ox/ABG

    —Increase HOB

    —Cough and deep breathing

    —Cardiovascular status

    —Avoid crossing legs or bending knee

    —Assess lower extremities for DVT

    —Assess for bleeding

    —Assess patient’s understanding of illness and treatment

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