Nursing Management (PDF)

2/22/24, 2:04 PM Realizeit for Student Nursing Management Monitoring Thrombolytic Therapy The nurse is responsible for monitoring the patient’s response to thrombolytic and anticoagulant therapy. During the thrombolytic infusion, while the patient remains on bed rest, vital signs are frequently asse...

2/22/24, 2:04 PM Realizeit for Student Nursing Management Monitoring Thrombolytic Therapy The nurse is responsible for monitoring the patient’s response to thrombolytic and anticoagulant therapy. During the thrombolytic infusion, while the patient remains on bed rest, vital signs are frequently assessed and invasive procedures are avoided. Tests to determine INR or aPTT are performed 3 to 4 hours after the thrombolytic infusion is started to confirm that the fibrinolytic systems have been activated. Managing Pain Chest pain, if present, is usually pleuritic rather than cardiac in origin. A semi-Fowler position provides a more comfortable position for breathing. However, the nurse must continue to turn patients frequently and reposition them to improve V./Q.. The nurse administers opioid analgesic agents as prescribed for severe pain. Managing Oxygen Therapy Careful attention is given to the proper use of oxygen. The patient must understand the need for continuous oxygen therapy. The nurse assesses the patient frequently for signs of hypoxemia and monitors the pulse oximetry values to evaluate the effectiveness of the oxygen therapy. Deep breathing and incentive spirometry are indicated for all patients to minimize or prevent atelectasis and improve ventilation. Nebulizer therapy or percussion and postural drainage may be used for management of secretions. Relieving Anxiety The nurse encourages the patient who is stabilized to talk about any fears or concerns related to this frightening episode, answers the patient’s and family’s questions concisely and accurately, explains the therapy, and describes how to recognize untoward effects early. https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=lqf9HhURQ5RqpgqAkzH2zSNYYvz6N%2bxRwegtqPK%2fJ7UsPJxuq7nE1D4sTAvq22Nk5Sl… 1/5 2/22/24, 2:04 PM Realizeit for Student Monitoring for Complications When caring for a patient who has had PE, the nurse must be alert for the potential complication of cardiogenic shock or right ventricular failure subsequent to the effect of PE on the cardiovascular system. Providing Postoperative Nursing Care If the patient has undergone surgical embolectomy, the nurse measures the patient’s pulmonary arterial pressure and urinary output. The nurse also assesses the insertion site of the arterial catheter for hematoma formation and infection. Maintaining the blood pressure at a level that supports perfusion of vital organs is crucial. To prevent peripheral venous stasis and edema of the lower extremities, the nurse elevates the foot of the bed and encourages isometric exercises, the use of intermittent pneumatic compression devices, and walking when the patient is permitted out of bed. Sitting for long periods is discouraged, because hip flexion compresses the large veins in the legs. Educating Patients About Self-Care Before hospital discharge and at follow-up visits to the clinic, the nurse educates the patient about preventing recurrence and reporting signs and symptoms. Patient education instructions are intended to help prevent recurrences and side effects of treatment. Example Video: YouTube: Pulmonary Embolism | Nursing Care for PE Patient for NCLEX https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=lqf9HhURQ5RqpgqAkzH2zSNYYvz6N%2bxRwegtqPK%2fJ7UsPJxuq7nE1D4sTAvq22Nk5Sl… 2/5 2/22/24, 2:04 PM Realizeit for Student Summary PE can present with pleuritic chest pain, hemoptysis, shortness of breath and collapse, or features of DVT. Physical examination can reveal tachycardia, hypotension, tachypnea, raised jugular venous pressure and focal chest signs. There may be a loud second heart sound, crepitations or wheezing. Signs of right ventricular failure may be present, such as raised jugular venous pressure, third heart sound and possible tricuspid regurgitation. Risk factors for PE include: Heart rate >100 beats per minute Immobilization for more than three days Surgery in the previous four weeks Previous VTE Hemoptysis Malignancy. https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=lqf9HhURQ5RqpgqAkzH2zSNYYvz6N%2bxRwegtqPK%2fJ7UsPJxuq7nE1D4sTAvq22Nk5Sl… 3/5 2/22/24, 2:04 PM Realizeit for Student Possible differential diagnoses include heart failure, myocardial infarction, pneumonia, pneumothorax and COPD exacerbation. A diagnosis of PE can require an index of suspicion. For example, PE should be considered in the case of an unexplained tachycardia. Review Pulmonary embolism is a common disorder that is related to deep vein thrombosis (DVT). Pulmonary embolism refers to the obstruction of the pulmonary artery or one of its branches by a thrombus that originates somewhere in the venous system or in the right side of the heart. Most commonly, pulmonary embolism is due to a blood clot or thrombus, but there are other types of emboli: fat, air, amniotic fluid, and septic. Fat emboli - cholesterol or fatty substances that may clog the arteries when fatty foods are consumed more. Air emboli - usually come from intravenous devices. Amniotic fluid emboli - caused by amniotic fluid that has leaked towards the arteries. Septic emboli - originate from a bacterial invasion of the thrombus. Pathophysiology Obstruction. When a thrombus completely or partially obstructs the pulmonary artery or its branches, the alveolar dead space is increased. Impairment. The area receives little to no blood flow and gas exchange is impaired. Constriction. Various substances are released from the clot and surrounding area that cause constriction of the blood vessels and results in pulmonary resistance. Consequences. Increased pulmonary vascular resistance due to regional vasoconstriction leading to increase in pulmonary arterial pressure and increased right ventricle workload are the consequences that follow. Failure. When the workload of the right ventricle exceeds the limit, failure may occur. Signs and Symptoms Dyspnea - the duration and intensity of the dyspnea depend on the extent of embolization. Chest pain - occurs suddenly and is pleuritic in origin. https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=lqf9HhURQ5RqpgqAkzH2zSNYYvz6N%2bxRwegtqPK%2fJ7UsPJxuq7nE1D4sTAvq22Nk5Sl… 4/5 2/22/24, 2:04 PM Realizeit for Student Tachycardia - occurs because the right ventricle catches up with its workload. Tachypnea - the most frequent sign. Medical Management Anticoagulation therapy Thrombolytic therapy Surgical embolectomy Transvenous catheter embolectomy Interrupting the vena cava https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=lqf9HhURQ5RqpgqAkzH2zSNYYvz6N%2bxRwegtqPK%2fJ7UsPJxuq7nE1D4sTAvq22Nk5Sl… 5/5