Pulmonary Embolism Overview and Prevention
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Questions and Answers

What is the most common cause of pulmonary embolism (PE)?

  • Venous thromboembolism (VTE) (correct)
  • Air emboli
  • Amniotic fluid embolism
  • Fat emboli

Which factor contributes to higher mortality rates from pulmonary embolism in young females compared to their male counterparts?

  • Increased risk of developing deep vein thrombosis
  • Greater prevalence of hormonal factors (correct)
  • Higher incidence of obesity in young females
  • Lesser access to medical care

What are effective measures for preventing deep vein thrombosis (DVT)?

  • Encouraging clients to avoid physical activity
  • Increasing sitting time during long travels
  • Promoting leg exercises and wearing compression stockings (correct)
  • Discouraging hydration

How does pulmonary embolism relate to Covid-19 compared to influenza?

<p>PE occurred more frequently in Covid-19 patients (B)</p> Signup and view all the answers

What is a significant consequence of a large pulmonary embolism?

<p>Increased hypoxia to pulmonary tissue (A)</p> Signup and view all the answers

Which of the following risk factors is NOT associated with the formation of deep vein thrombosis (DVT)?

<p>Regular exercise (D)</p> Signup and view all the answers

What physiological change contributes to older adults having decreased pulmonary reserves?

<p>Thickening of alveoli (A)</p> Signup and view all the answers

Which condition is NOT commonly associated with increased risk for DVT in older adults?

<p>Hyperactivity (D)</p> Signup and view all the answers

How does long-term immobility affect DVT risk in older adults?

<p>It promotes stasis of blood flow. (A)</p> Signup and view all the answers

What are older adults at a greater risk for due to decreased physical activity levels?

<p>DVT formation and pulmonary emboli (B)</p> Signup and view all the answers

Which of the following is a common expected finding in a patient experiencing pulmonary embolism?

<p>Feelings of impending doom (C)</p> Signup and view all the answers

What physical assessment finding is associated with pulmonary embolism and indicates pleural involvement?

<p>Pleurisy (A)</p> Signup and view all the answers

Which symptom would you expect to find in a person diagnosed with pulmonary embolism?

<p>Cough with hemoptysis (B)</p> Signup and view all the answers

Which finding in a physical assessment might suggest a complication associated with severe pulmonary embolism?

<p>Tachypnea (B)</p> Signup and view all the answers

What other sign, aside from cyanosis, would you anticipate observing in a patient with hypoxia due to pulmonary embolism?

<p>Petechiae over chest and axillae (A)</p> Signup and view all the answers

What occurs initially as a result of hyperventilation in relation to PaCO2 levels?

<p>Respiratory alkalosis (D)</p> Signup and view all the answers

In what situation does respiratory acidosis develop according to the progression of conditions discussed?

<p>As tissue hypoxia occurs (B)</p> Signup and view all the answers

What condition leads to the buildup of lactic acid from tissue hypoxia?

<p>Metabolic acidosis (D)</p> Signup and view all the answers

What is the expected reference range for D-dimer levels to be considered normal?

<p>0.4 mcg/mL (B)</p> Signup and view all the answers

What physiological change indicates elevated D-dimer levels?

<p>Clot formation and release of fibrin degradation products (D)</p> Signup and view all the answers

Which diagnostic procedure is considered the criterion standard for detecting pulmonary embolism when available?

<p>Computed tomography angiography (D)</p> Signup and view all the answers

What is the primary limitation of pulmonary angiography as a diagnostic tool for pulmonary embolism?

<p>It is invasive and expensive. (D)</p> Signup and view all the answers

When is a ventilation-perfusion (V/Q) scan particularly useful?

<p>When there is an allergy to contrast media. (D)</p> Signup and view all the answers

Which nursing action is essential to perform before conducting pulmonary angiography?

<p>Verify that informed consent has been obtained. (D)</p> Signup and view all the answers

What aspect of V/Q scan imaging helps to detect pulmonary embolism?

<p>Circulation of blood and air in the lungs. (B)</p> Signup and view all the answers

What physical finding may indicate the presence of pleural effusion in a patient with a pulmonary embolism?

<p>Elevation of the diaphragm on the affected side (D)</p> Signup and view all the answers

Which position is most appropriate for a patient experiencing dyspnea due to pulmonary embolism?

<p>High-Fowler’s position (A)</p> Signup and view all the answers

What should be monitored at least every 30 minutes in a patient suspected of having a pulmonary embolism?

<p>Respiratory status (D)</p> Signup and view all the answers

Which assessment finding would NOT be relevant in evaluating cardiac status in a patient with a pulmonary embolism?

<p>Auscultation of bowel sounds (B)</p> Signup and view all the answers

When assessing a patient with suspected pulmonary embolism, which skin finding may indicate a serious condition?

<p>Petechiae (D)</p> Signup and view all the answers

Which laboratory test is primarily monitored for patients on warfarin?

<p>Prothrombin time (PT) (D)</p> Signup and view all the answers

What is a significant adverse effect that should be monitored in patients administered anticoagulants?

<p>Thrombocytopenia (D)</p> Signup and view all the answers

Which direct factor Xa inhibitor is commonly used for anticoagulation?

<p>Rivaroxaban (A)</p> Signup and view all the answers

When should anticoagulant medication be held relative to the removal of an epidural catheter?

<p>18 hours before and 6 hours after (B)</p> Signup and view all the answers

What is a primary nursing action when administering anticoagulants?

<p>Assess for active bleeding (C)</p> Signup and view all the answers

What is the mechanism of action of direct factor Xa inhibitors such as rivaroxaban and apixaban?

<p>They bind to factor Xa and inhibit thrombin production. (C)</p> Signup and view all the answers

Which nursing action is critical when managing a patient receiving direct factor Xa inhibitors?

<p>Monitor for signs of bleeding from various sites. (D)</p> Signup and view all the answers

When should direct factor Xa inhibitors be held in relation to the removal of an epidural catheter?

<p>For 18 hours before and 6 hours after removal. (B)</p> Signup and view all the answers

What type of bleeding complications can occur with the use of direct factor Xa inhibitors?

<p>Intracranial, retinal, adrenal, and gastrointestinal bleeding. (C)</p> Signup and view all the answers

Which of the following is a direct factor Xa inhibitor mentioned in the context?

<p>Fondaparinux (D)</p> Signup and view all the answers

What is the primary action of dabigatran?

<p>Directly inhibits thrombin (D)</p> Signup and view all the answers

Which nursing action is essential when administering thrombolytic therapy?

<p>Evaluate for contraindications such as active bleeding (C)</p> Signup and view all the answers

Which of the following is a common adverse effect associated with both thrombolytic therapy and anticoagulants?

<p>Thrombocytopenia (B)</p> Signup and view all the answers

During administration of thrombolytic therapy, which factors should be monitored closely?

<p>Blood pressure, heart rate, and evidence of bleeding (C)</p> Signup and view all the answers

What is a potential complication to monitor for in patients receiving dabigatran?

<p>Signs of bleeding and blood loss (B)</p> Signup and view all the answers

Which type of procedure involves the surgical removal of an embolus?

<p>Embolectomy (D)</p> Signup and view all the answers

What is the primary role of respiratory services in the management of pulmonary embolism?

<p>Providing oxygen therapy and conducting ABGs (C)</p> Signup and view all the answers

Which nursing action is crucial to be performed prior to an embolectomy?

<p>Preparing the client for NPO status and informed consent (B)</p> Signup and view all the answers

Which of the following services should be consulted for diagnostic studies to determine pulmonary embolism?

<p>Radiology (B)</p> Signup and view all the answers

What should be monitored postoperatively in a patient who underwent embolectomy for pulmonary embolism?

<p>Vital signs, SaO2, incision drainage, and pain management (C)</p> Signup and view all the answers

What is the primary purpose of inserting an inferior vena cava filter (IVCF)?

<p>To prevent emboli from reaching the pulmonary vasculature (A)</p> Signup and view all the answers

Which nursing action is essential in the postoperative monitoring of a patient who had an IVC filter placed?

<p>Monitor incision drainage closely (B)</p> Signup and view all the answers

Which of the following statements accurately reflects client education after IVC filter insertion?

<p>Use electric shavers to minimize the risk of cuts (D)</p> Signup and view all the answers

What should a patient do if experiencing severe dyspnea after the IVC filter procedure?

<p>Seek referral services for portable oxygen (D)</p> Signup and view all the answers

What is a critical recommendation for a patient on warfarin following an IVC filter placement?

<p>Do not change vitamin K consumption levels (B)</p> Signup and view all the answers

Which assessment finding indicates a decreased cardiac output that may require nursing intervention?

<p>Cyanosis (B), Jugular venous distention (D)</p> Signup and view all the answers

What is the target urinary output that indicates adequate kidney perfusion in a patient with decreased blood volume?

<p>30 mL/hr or more (C)</p> Signup and view all the answers

Which of the following nursing actions is crucial for managing a patient who may experience pulmonary hypertension due to IV fluid administration?

<p>Monitoring pulmonary pressures (B)</p> Signup and view all the answers

Which of the following interventions would help in increasing myocardial contractility in a patient with heart failure?

<p>Administering inotropic agents (A)</p> Signup and view all the answers

What sign should nurses monitor for that indicates a potential cardiovascular compromise in a patient experiencing decreased cardiac output?

<p>Decreased blood pressure (B), S3 heart sound (C)</p> Signup and view all the answers

What is an essential nursing action to assess for bleeding in patients receiving anticoagulant therapy?

<p>Assess for bleeding from or bruising around injection and surgical sites at least every 2 hours. (C)</p> Signup and view all the answers

Which laboratory values should be monitored to evaluate the effectiveness of anticoagulant therapy?

<p>Complete Blood Count and bleeding times (PT, aPTT, INR). (D)</p> Signup and view all the answers

What is the purpose of administering IV fluids and blood products in patients at risk for bleeding?

<p>To maintain blood volume and stabilize circulation. (D)</p> Signup and view all the answers

What symptom might indicate internal bleeding in a patient receiving anticoagulant therapy?

<p>Abdominal girth measurement changes and abdominal or flank pain. (D)</p> Signup and view all the answers

Why is it important to have an antidote available for patients on anticoagulant therapy?

<p>To reverse excessive anticoagulation if bleeding occurs. (D)</p> Signup and view all the answers

Flashcards

Pulmonary Embolism (PE)

A blockage in the lung's blood vessels caused by a substance like a blood clot.

Cause of PE

Most often, a blood clot (venous thromboembolism or VTE) travels to the lungs.

PE Risk Factors

Older age and females assigned at birth, a history of COVID-19 versus other viral infections.

PE Severity

Potentially life-threatening, requiring immediate medical attention.

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Preventing PE

Quitting smoking, maintaining a healthy weight, diet and exercise, and avoiding prolonged sitting.

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Long-term Immobility

Staying in one position for a long time, especially in bed or a wheelchair, increases the risk of blood clots forming in the legs.

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Oral Contraceptives & Estrogen Therapy

These medications can increase the risk of blood clots forming due to their effects on blood clotting factors.

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Pregnancy

During pregnancy, the body produces more clotting factors to help with healing after childbirth, increasing the risk of blood clots.

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Tobacco Use

Smoking damages blood vessels and makes blood more prone to clotting.

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Hypercoagulability

This means your blood is overly sticky, a condition that makes blood clots more likely.

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Chest Pain with PE

Pain when breathing in and tenderness on the chest wall are common in PE.

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Shortness of Breath (PE)

Difficulty catching your breath and feeling like you're not getting enough air.

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Coughing up Blood (PE)

Rare, but can happen when a blood clot in the lung causes bleeding.

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What are the physical signs of PE?

Fast heart rate, low blood pressure, fast breathing, crackling sounds in the lungs, fever, and low oxygen levels.

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What is the cause of PE?

A blood clot (usually from the legs) travels to the lungs and blocks blood flow.

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ABG analysis in PE

Blood gas analysis reveals initial respiratory alkalosis due to hyperventilation, followed by respiratory acidosis as hypoxemia worsens. Ultimately, metabolic acidosis develops due to lactic acid build-up from tissue hypoxia.

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D-dimer in PE

D-dimer levels are elevated due to clot formation and the release of fibrin degradation products, indicating a potential blood clot.

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Hyperventilation in early PE

The body initially responds to a pulmonary embolism by increasing breathing rate (hyperventilation) to compensate for the reduced oxygen supply.

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Respiratory acidosis in PE

As hypoxemia progresses, the body's ability to remove CO2 is impaired, leading to an increase in CO2 levels and respiratory acidosis.

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Metabolic acidosis in late PE

Prolonged tissue hypoxia leads to the accumulation of lactic acid, causing metabolic acidosis.

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MDCTA for PE

Multidetector-row computed tomography angiography (MDCTA) is the preferred imaging test for detecting pulmonary embolism (PE) because it provides detailed visuals of the lung tissue.

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V/Q Scan for PE

A ventilation-perfusion (V/Q) scan is used to diagnose PE when a patient can't have MDCTA due to an allergy to contrast media. It shows how well air and blood are circulating in the lungs.

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Pulmonary Angiography for PE

This invasive and expensive test is the gold standard for diagnosing PE when MDCTA is unavailable. A catheter is inserted into a vein to visualize the blood clot.

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Informed Consent for Imaging

Before diagnostic procedures like MDCTA, V/Q scan, or pulmonary angiography, a patient must understand the risks and benefits and give their informed consent.

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Monitor Status During Imaging

Nurses carefully track vital signs, oxygen levels, anxiety, and any bleeding during and after diagnostic imaging procedures.

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Oxygen Therapy for PE

Administering oxygen to a patient with a pulmonary embolism (PE) helps to relieve low blood oxygen levels (hypoxemia) and shortness of breath (dyspnea).

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Positioning for PE

Placing a patient with PE in a high-Fowler's position (sitting upright at 90°) helps maximize their lung capacity and breathing ease.

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Assessing Respiratory Status

For patients with PE, regularly checking their breathing rate, rhythm, and ease of breathing is crucial to monitor their condition.

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Monitoring Cardiac Status

Closely watching a patient's blood pressure, pulse, heart rhythm, and neck veins helps detect potential complications related to PE.

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Emotional Support for PE

Providing reassurance and comfort to a patient with PE helps manage their anxiety and stress.

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Anticoagulants: What are they used for?

Anticoagulants, like heparin and warfarin, are medications used to prevent blood clots from getting larger or forming new ones.

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Heparin & Warfarin: How do they work?

Heparin and warfarin act by interfering with the clotting cascade, a series of steps that lead to blood clot formation.

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Direct Factor Xa Inhibitors: What's special about them?

Direct factor Xa inhibitors, like rivaroxaban, bind directly to the active center of factor Xa, preventing the formation of thrombin, a key enzyme in blood clotting.

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Nursing Actions for Anticoagulants: What to monitor?

Nurses monitor for bleeding, assess contraindications, and closely observe for adverse effects like thrombocytopenia, anemia, or hemorrhage.

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Direct Factor Xa Inhibitors: What's the special nursing action?

For clients taking direct factor Xa inhibitors, it's crucial to hold the medication for 18 hours before and 6 hours after removing an epidural catheter to prevent spinal hematomas.

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Direct Factor Xa Inhibitors

These medications, like rivaroxaban and apixaban, directly block factor Xa, a key enzyme in the clotting cascade, thereby preventing the formation of thrombin.

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How do Direct Factor Xa Inhibitors work?

They bind to the active site of factor Xa, preventing it from converting prothrombin into thrombin, which is necessary for blood clot formation.

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Nursing Action: Bleeding Risk

Monitor patients closely for signs of bleeding from any site, including intracranial, retinal, adrenal, and gastrointestinal bleeds.

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Nursing Action: Epidural Catheter

Hold medications for 18 hours before and 6 hours after epidural catheter removal to prevent spinal hematomas.

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Fondaparinux

This medication belongs to the group of direct factor Xa inhibitors, but it is a synthetic pentasaccharide. It is used to treat and prevent deep vein thrombosis and pulmonary embolism.

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Direct Thrombin Inhibitor

Dabigatran is a medication that directly prevents thrombin from working, slowing down blood clotting. It's like a key that blocks the lock so the clotting process can't start.

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Nursing Action: Monitor for Bleeding

When someone takes a direct thrombin inhibitor, it's essential for nurses to closely watch for any signs of bleeding, as these medications can increase the risk of bleeding.

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Thrombolytic Therapy

Alteplase, reteplase, and tenecteplase are medications used to break down blood clots, restoring blood flow. It's like using a special chemical to dissolve a blockage in a pipe.

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Nursing Action: Assess for Contraindications

Before giving thrombolytic therapy, nurses must assess if the patient has any conditions that could make the medication dangerous. These include active bleeding, recent surgery, or certain types of strokes.

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Nursing Action: Monitor for Bleeding during Thrombolytic Therapy

After administering thrombolytic therapy, nurses carefully monitor for any signs of bleeding, as this medication can increase the risk of bleeding complications.

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Interprofessional Care for PE

Multiple healthcare professionals work together to manage PE, including cardiologists, pulmonologists, respiratory therapists, and radiologists.

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Embolectomy

Surgical removal of a blood clot (embolus) from a blood vessel.

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Nursing Actions for Embolectomy

Nurses prepare the patient for surgery by ensuring they are NPO (nothing by mouth) and have informed consent. Post-operatively, they monitor vital signs, oxygen saturation, incision drainage, and pain management.

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Radiology Consultation for PE

Radiologists are consulted to perform diagnostic imaging studies, such as MDCTA or V/Q scans, to confirm the diagnosis of PE.

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ICVF Purpose

An Inferior Vena Cava Filter (ICVF) prevents blood clots from traveling to the lungs in patients who can't take blood thinners.

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ICVF Nursing Actions

Before the procedure, prepare the client by ensuring they are NPO (nothing by mouth) and have provided informed consent. After ICVF placement, closely monitor vital signs, oxygen levels, incision site, and pain.

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ICVF Home Care

For clients who are homebound, arrange for weekly blood draws and consider setting up home health services for additional support.

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ICVF Travel Safety

When traveling, take precautions to prevent pulmonary embolism by getting up and walking for 5 minutes every hour, wearing compression stockings, staying hydrated, and doing ankle pump exercises.

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ICVF: Vitamin K

If the client is taking warfarin, advise them to maintain a consistent intake of vitamin K foods (green leafy vegetables) because vitamin K can decrease the effectiveness of warfarin.

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Decreased Cardiac Output (Complications of PE)

Pulmonary embolism (PE) can cause a decrease in cardiac output due to the blockage of blood flow in the lungs, leading to an increased workload on the heart.

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Monitor Hypotension

Nurses monitor for hypotension, a drop in blood pressure, as a sign of decreased cardiac output in patients with pulmonary embolism (PE).

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Assess for S3 or S4 Heart Sounds

Nurses assess heart sounds to look for S3 or S4, abnormal heart sounds indicating a problem with the heart's pumping ability, which can occur in pulmonary embolism (PE).

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Administer IV Fluids (Crystalloids)

Nurses administer IV fluids to help restore blood volume and improve cardiac output in patients with pulmonary embolism (PE), particularly those with hypotension.

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Inotropic Agents (Milrinone, Dobutamine)

Inotropic agents like milrinone or dobutamine are used to increase myocardial contractility, the strength of the heart's contractions, to improve cardiac output in pulmonary embolism (PE).

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Anticoagulant Therapy & Bleeding Risk

Anticoagulant medications, like heparin and warfarin, decrease blood clotting, increasing the risk of bleeding.

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Monitoring for Bleeding

Nurses must constantly assess for signs of bleeding in patients on anticoagulants. This includes sites like injection points, surgical wounds, and stool.

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CBC & Coagulation Tests

Blood tests like CBC and PT/INR are crucial for monitoring the effectiveness of anticoagulants and for detecting bleeding.

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Antidote Availability

It's essential to have the antidote for anticoagulants readily available in case of excessive bleeding.

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Monitoring for Internal Bleeding

Nurses check for abdominal pain and measure abdominal girth to detect potential internal bleeding, a serious complication of anticoagulant therapy.

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Study Notes

Pulmonary Embolism (PE)

  • A PE occurs when a substance (solid, liquid, or gas) blocks the pulmonary blood vessels.
  • The most common cause is emboli from venous thromboembolism (VTE).
  • Other causes include fat, air, septic (bacterial), and amniotic fluid.
  • Large emboli impair blood flow, causing hypoxia to the lungs.
  • A PE is a medical emergency.

PE Mortality and Risk Factors

  • PE mortality is higher in older adults.
  • Young females assigned at birth are more likely to die from a PE than males assigned at birth, in the same age group.
  • PEs occur more often in COVID-19 patients compared to influenza patients.
  • Mortality is significantly higher in COVID-19 related PEs compared to the general population.

Prevention of PE

  • Promote smoking cessation.
  • Encourage healthy body weight maintenance.
  • Advocate for a healthy diet and physical activity.
  • Prevent deep vein thrombosis (DVT) by advising clients to perform leg exercises, wear compression stockings, and avoid long periods of sitting.

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Description

This quiz covers the crucial aspects of Pulmonary Embolism (PE), including its causes, mortality rates, and risk factors. It emphasizes the importance of prevention strategies and outlines how lifestyle choices can mitigate these risks. Understand the critical information related to PE to enhance your knowledge in this medical emergency.

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