Pulmonary Embolism (PE)

• Vascular lung disorders affect the blood vessels in the lungs, impacting blood flow and gas exchange. Pulmonary embolism (PE) is a common and serious vascular lung disorder.

Pulmonary Embolism (PE)

• PE occurs when a blood clot, usually from the deep veins of the legs (deep vein thrombosis or DVT), travels to the lungs and blocks a pulmonary artery.
• Risk factors for PE include prolonged immobility, surgery, cancer, pregnancy, oral contraceptives, smoking, obesity, and a history of DVT or PE.
• The pathophysiology of PE involves obstruction of pulmonary blood flow, leading to increased pulmonary artery pressure, right ventricular strain, and decreased oxygenation.
• Massive PE can cause sudden hemodynamic collapse and death.
• Signs and symptoms of PE include sudden onset of dyspnea, chest pain (often pleuritic), cough, hemoptysis, tachypnea, tachycardia, and signs of DVT in the extremities.
• Diagnosis of PE involves assessing clinical probability using tools like the Wells score or Geneva score, followed by diagnostic imaging such as CT pulmonary angiography (CTPA) or ventilation-perfusion (V/Q) scan.
• D-dimer testing is used to rule out PE in low-risk patients.
• The primary treatment for PE is anticoagulation to prevent further clot formation. Commonly used anticoagulants include heparin (unfractionated or low molecular weight), warfarin, direct oral anticoagulants (DOACs), and fondaparinux.
• Thrombolytic therapy (e.g., alteplase) may be used in patients with massive PE and hemodynamic instability to dissolve the clot.
• Embolectomy (surgical removal of the clot) or catheter-directed thrombolysis may be considered in patients with contraindications to thrombolysis or who fail to respond to thrombolytic therapy.
• Nursing care for patients with PE focuses on monitoring respiratory status, administering medications, preventing complications, and providing education.
• Monitor vital signs, oxygen saturation, and respiratory effort closely. Administer oxygen as needed to maintain adequate oxygenation.
• Assess for signs of bleeding or complications related to anticoagulation therapy.
• Position the patient to optimize ventilation and perfusion, such as elevating the head of the bed.
• Provide comfort measures and pain management.
• Monitor for signs of recurrent PE or complications such as pulmonary hypertension.
• Educate patients about the importance of adherence to anticoagulation therapy, signs and symptoms of bleeding, and follow-up appointments.
• Teach patients about lifestyle modifications to reduce the risk of DVT and PE, such as regular exercise, avoiding prolonged immobility, and maintaining a healthy weight.
• Pulmonary hypertension is a chronic complication of PE that can lead to right heart failure.

Nursing Assessment for Pulmonary Embolism

• Assess for risk factors for PE, such as recent surgery, immobility, history of DVT/PE, cancer, pregnancy, or use of oral contraceptives.
• Assess respiratory status:
  • Monitor respiratory rate, depth, and effort.
  • Auscultate lung sounds for abnormalities such as wheezing or crackles.
  • Assess oxygen saturation using pulse oximetry.
  • Evaluate for signs of dyspnea, such as shortness of breath, accessory muscle use, or nasal flaring.
• Assess cardiovascular status:
  • Monitor heart rate and blood pressure.
  • Assess for signs of tachycardia or hypotension.
  • Evaluate for chest pain, including location, intensity, and characteristics.
  • Assess for signs of right heart failure, such as jugular venous distension, peripheral edema, or hepatomegaly.
• Assess for pain, including location, intensity, and characteristics.
• Review medication history for anticoagulants or other medications that may affect bleeding risk.
• Assess for signs of bleeding, such as hematuria, melena, epistaxis, or bruising.
• Evaluate the patient's level of anxiety and provide emotional support.

Nursing Interventions for Pulmonary Embolism

• Administer oxygen therapy as prescribed to maintain adequate oxygen saturation.
• Elevate the head of the bed to improve ventilation and reduce dyspnea.
• Administer anticoagulants as prescribed, and monitor for therapeutic effects and adverse effects such as bleeding.
• Provide pain management as needed, using both pharmacological and non-pharmacological measures.
• Monitor vital signs, oxygen saturation, and respiratory status closely.
• Assess for signs of bleeding and implement appropriate precautions.
• Provide emotional support and education to the patient and family.
• Collaborate with other healthcare professionals, such as physicians, respiratory therapists, and pharmacists, to optimize patient care.
• Prevent complications such as further clot formation, pulmonary hypertension, or right heart failure.
• Encourage deep breathing and coughing exercises to promote lung expansion and prevent atelectasis.
• Apply sequential compression devices (SCDs) or encourage early ambulation to prevent DVT.
• Educate the patient and family about the importance of adherence to anticoagulation therapy, signs and symptoms of bleeding, and follow-up appointments.
• Provide information about lifestyle modifications to reduce the risk of DVT and PE, such as regular exercise, avoiding prolonged immobility, and maintaining a healthy weight.

Nursing Evaluation for Pulmonary Embolism

• Evaluate the patient's response to treatment, including improvement in respiratory status, pain relief, and resolution of symptoms.
• Monitor for adverse effects of medications, such as bleeding or allergic reactions.
• Assess the patient's understanding of the treatment plan and ability to adhere to medications and lifestyle modifications.
• Evaluate the patient's level of anxiety and provide ongoing emotional support as needed.
• Monitor for complications such as recurrent PE, pulmonary hypertension, or right heart failure.
• Assess the patient's ability to manage their condition at home, including medication administration, monitoring for signs of bleeding, and seeking medical attention as needed.
• Evaluate the effectiveness of patient education and make adjustments as needed to ensure understanding and adherence to the treatment plan.