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pulmonary embolism
pn 141 test 2 book: burke pg 568
| Question | Answer |
|---|---|
| what is it | the blockage of a pulmonary artery that disrupts the blood flow to the lung |
| what is the most common pulmonary emboli | a thromboemboli |
| what could cause the emboli | blood clot, tumor, bone marrow fat, amniotic fluid, foreign matter |
| what is the best Tx | prevention |
| where do most begin in the body | DVTs in the legs or pelvis |
| risk factors are same as what other disorder | DVT |
| risk factors | impaired venous blood flow, blood vessel damage, altered coagulation, prolonge imobility, childbirth, surgery, BCPills, smoking, CAD, PVD, DM |
| what happens when a clot breaks loose from the vein wall in a DVT | it treavels through vessel that become gradually larger until it reaches the right side of the heart and enters the pulmonary artery |
| what happens to the pulmonary arterioles and cappilaries is the clot goes through the pumonary system; what happens to the clot | they becomes smaller and smaller; and the clot becomes trapped |
| what happens to the blood flow when the clot it trapped | it is obstructed |
| since blood does not flow past the occlusion, what happens to gas exchange | no gas exchange takes place in that portion of the lung |
| what do the s/s of a PE depend on | the size and location of it |
| large emboli s/s are similar to what other disorder | a heart attack |
| s/s of it | abrupt onset of dyspnea, chest pain, anxiety, apprehension, cough, tachycardia, tachypnea, diaphoresis, cyanosis |
| when does a fat embolism occur after; why | a long bone fracture; it releases bone marrow fat |
| s/s: of a fat embolism | dyspnea, tachycardia, tachypnea, confusion, delirium and decreased LOC, petechiae may be seen on chest and arms |
| what are preventative measures | elastic stocking, pneumatic compression devices, anticoagulation therapy, early ambulation |
| why should one ambulate early after surgery | to prevent venous stasis |
| Tx: what is it | supportive: oxygen, analgesics, pulmonary artery and wedge pressures are monitored, |
| what heart disorder are pts monitored for | dysrhythmias |
| diagnostic tests: plasma D-dimer levels- what are they | are specific to the presence of a thrombus, elevated levels indicate formation of a blood clot |
| diagnostic tests: ventilation perfusion scan- what is it | evals blood flow in the pulmonary circulation (how well are the lungs perfusion) |
| diagnostic tests: ventilation perfusion scan- it is used when what is suspected | when a pulmonary embolism is suspected |
| diagnostic tests: pulmonary angiography: what is it | it uses contrast media to evaluate pulmonary circulation |
| diagnostic tests: why would a chest xray, or ecg be oerdered | to rule out MI |
| meds: why is a thrombolytic given | to disinigrate a large pulmonary embolus and restore pulmonary blood flow |
| meds:thrombolytic - what is an adverse effect | bleeding, particularily intracranial |
| meds: why are anticoagulants ordered | to prevent further clotting and embolism |
| meds: why is heparin given | to prevent DVTs (it is a drip) |
| meds: what lab is monitored while pt is on heparin | PTT PT |
| meds: why is Heparin continued for 5-7 days | until oral Warfarin is effective after its initiation 5-7 days earlier |
| meds: how long is pt on anticoagulant therapy | 2-3 months |
| surgery: what can be inserted into the inferior vena cava if the pt has continued PEs | an umbrella like filter |
| surgery: umbrella like filter- what does this filter do | this device traps large emboli while allowing blood to flow through the vena cava |
| Nx Dx: risk for ineffective tissue perfusion: why shouldn't pillows be used under pt knees | w/ out it promotes venous returm from legs, reduces venous stasis |
| Nx Dx- decreased cardiac output: why can right sided heart failure occur; s/s of it | because there is increased cardiac pressure; distened neck veins and peripheral edema |
| what can increase the pt risk for skin breakdown | impaired peripheral perfusion and tissue axygenation |
| how do they often start | as DVTs |
| what protein and enzyme shows up if they are at risk for clots | D-dimer (protein), factor V leiden (enzyme) |
| what are s/s of shock | cyanosis, wheezing, weak pulse and shock |
| Nx Dx: impaired gas exhchange: nursing considerations | assess resp status, skin vital, cap refill, monitor sats, administer o2, hi fowlers, bedrest, outcomes |
| prevention of pulmonary embolism | early post op ambulation, LE exercises, moving legs and ankles, stockings, SCDs, elevate LEs with bed, no pillows, aoid crossing legs, |
| what med is first administered | heparin |
| when is coumadin given | after heparin, in 5-7 days |
| why is pt still on heparin while also on coumadin | b/c it takes a while for coumadin to become therapeutic |
| why is pt at risk for injury | b/c they could hemmorhage |
| what is therapeutic INR | 2-3, norm is one to two |
| number one s/s | SOB |
| s/s are similar to what disorder | like an MI |
| when is a thrombolytic given | only if it is a big PE |
| what does heparin and coumadin do | they do not break up the clot, but it prevents it from getting larger |
| if they have an IVC filter they are always on what med | anticoagulant med |
| who is a candidate for the IVC filter | ppl with recurrent PE and ppl in automobile accidents (lots of broken bones) |
| why may pt have anxiety | b/c of SOB |
Created by:
jmkettel
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