Pulmonary Embolism (PE) Lecture Notes PDF

PULMONARY EMBOLISM Prepared By: SHERWIN GALZOTE-MAPUTOL, RN, MAN Instructor Sherwin G. Maputol, RN, MAN ST. A L E X I U S C O L L E G E 9/10/2024 1 www.stalexiuscollege.edu.ph PULMONARY...

PULMONARY EMBOLISM Prepared By: SHERWIN GALZOTE-MAPUTOL, RN, MAN Instructor Sherwin G. Maputol, RN, MAN ST. A L E X I U S C O L L E G E 9/10/2024 1 www.stalexiuscollege.edu.ph PULMONARY EMBOLISM (PE) Obstruction of the pulmonary artery or one of its branches by a thrombus, that originates somewhere in the RIGHT SIDE of the HEART. It is also be due to other types of emboli like AIR, FAT, AMNIOTIC FLUID and SEPSIS. 9/10/2024 ST. A L E X I U S C O L L E G E Sherwin G. Maputol, RN, MAN 2 www.stalexiuscollege.edu.ph  PULMONARY EMBOLISM (PE) CAUSES: ✓ Fat embolism ✓ Multiple trauma ✓ Peripheral Vascular Disorders (PVD’s) ✓ Abdominal surgery ✓ Immobility ✓ Hypercoagulopathy 9/10/2024 ST. A L E X I U S C O L L E G E Sherwin G. Maputol, RN, MAN 3 www.stalexiuscollege.edu.ph  PULMONARY EMBOLISM (PE) Pathophysiology: Thrombus formation results from vascular wall damage, venous stasis, or blood hypercoagulability Trauma, clot dissolution, sudden muscle spasm, intravascular pressure changes/peripheral bld flow changes 9/10/2024 ST. A L E X I U S C O L L E G E Sherwin G. Maputol, RN, MAN 4 www.stalexiuscollege.edu.ph  PULMONARY EMBOLISM (PE) Pathophysiology: Loosened or fragmented thrombus Embolus floats to the heart's right side Enters the lung through P.A. and may dissolve, continuing to fragmentize or grow 9/10/2024 ST. A L E X I U S C O L L E G E Sherwin G. Maputol, RN, MAN 5 www.stalexiuscollege.edu.ph  PULMONARY EMBOLISM (PE) Pathophysiology: Lodge/occluding P.A. Prevent production of surfactant Develop alveoli collapse and atelectasis 9/10/2024 ST. A L E X I U S C O L L E G E Sherwin G. Maputol, RN, MAN 6 www.stalexiuscollege.edu.ph  PULMONARY EMBOLISM (PE) Pathophysiology: Large embolus occlude most of pulmonary vessels Death 9/10/2024 ST. A L E X I U S C O L L E G E Sherwin G. Maputol, RN, MAN 7 www.stalexiuscollege.edu.ph  PULMONARY EMBOLISM (PE) Assessment: ✓ Restlessness ✓ SOB Dyspnea, tachypnea ✓ Stabbing chest pain ✓ Cyanosis ✓ Dilated pupils ✓ Apprehension/fear 9/10/2024 ST. A L E X I U S C O L L E G E Sherwin G. Maputol, RN, MAN 8 www.stalexiuscollege.edu.ph PULMONARY EMBOLISM (PE) Assessment: ✓ Diaphoresis ✓ Dysrhythmias ✓ Hypotension ✓ Fever ✓ Hemoptysis ✓ Syncope 9/10/2024 ST. A L E X I U S C O L L E G E Sherwin G. Maputol, RN, MAN 9 www.stalexiuscollege.edu.ph PULMONARY EMBOLISM (PE) Complications: ✓ Pulmonary infarction ✓ Pulmonary hypertension ✓ Embolic extension ✓ Hepatic congestion & necrosis ✓ Pulmonary abscess ✓ Shock 9/10/2024 ST. A L E X I U S C O L L E G E Sherwin G. Maputol, RN, MAN 10 www.stalexiuscollege.edu.ph PULMONARY EMBOLISM (PE) Complications: ✓ ARDS ✓ Massive atelectasis ✓ Right-sided heart failure ✓ Ventilation-perfusion mismatch ✓ Death 9/10/2024 ST. A L E X I U S C O L L E G E Sherwin G. Maputol, RN, MAN 11 www.stalexiuscollege.edu.ph  PULMONARY EMBOLISM (PE) Diagnostic tests: ✓ Chest x-ray ✓ Lung scan ✓ Pulmonary angiography ✓ ECG ✓ ABG measurements ✓ Thoracentesis ✓ Plasma D-dimer test 9/10/2024 ST. A L E X I U S C O L L E G E Sherwin G. Maputol, RN, MAN 12 www.stalexiuscollege.edu.ph  PULMONARY EMBOLISM (PE) Collaborative Management: ✓ Oxygen therapy STAT ✓ Early ambulation postoperative. ✓ Monitor obese patients. ✓ Do not massage legs. ✓ Relieve pain. ✓ Elevate head of the bead. 9/10/2024 ST. A L E X I U S C O L L E G E Sherwin G. Maputol, RN, MAN 13 www.stalexiuscollege.edu.ph PULMONARY EMBOLISM (PE) Collaborative Management: ✓ Heparin (2 weeks) then Coumadin (3-6 months) as prescribed. ✓ Thrombolytic therapy as prescribed. ✓ Surgery: Pulmonary Embolectomy ✓ Perfusion scan, hemodynamic measurements 9/10/2024 ST. A L E X I U S C O L L E G E Sherwin G. Maputol, RN, MAN 14 www.stalexiuscollege.edu.ph  PULMONARY EMBOLISM (PE) Collaborative Management: ✓ Surgery: vena cava filter A small metal device placed in the vena cava (the large blood vessel that returns blood from the body to the heart) may be used to keep clots from traveling to the lungs. 9/10/2024 ST. A L E X I U S C O L L E G E Sherwin G. Maputol, RN, MAN 15 www.stalexiuscollege.edu.ph PULMONARY EMBOLISM (PE) Collaborative Management: ✓ Perfusion scan, hemodynamic measurements ❖ Hemodynamic Basics for Nursing Students - Bing video ❖ Lung Perfusion - Bing video 9/10/2024 ST. A L E X I U S C O L L E G E Sherwin G. Maputol, RN, MAN 16 www.stalexiuscollege.edu.ph  PULMONARY EMBOLISM (PE) Collaborative Management: ✓ ABG’s, pulmonary angiography, serum electrolytes, cbc, hematocrit ✓ Slow infusion of Dobutamine as prescribed. ✓ Slow dose of Morphine 9/10/2024 ST. A L E X I U S C O L L E G E Sherwin G. Maputol, RN, MAN 17 www.stalexiuscollege.edu.ph PULMONARY EMBOLISM (PE) Nursing Interventions ✓ Give prescribed drugs; avoid IM injections ✓ Avoid massage of the lower legs; early postoperative ambulation. ✓ Encourage use of incentive spirometry. 9/10/2024 ST. A L E X I U S C O L L E G E Sherwin G. Maputol, RN, MAN 18 www.stalexiuscollege.edu.ph PULMONARY EMBOLISM (PE) Nursing Interventions ✓ Monitor the following: VS, intake and output Respiratory status; O2sat Signs of DVT Coagulation study results Abnormal bleeding; stools for occult blood 9/10/2024 ST. A L E X I U S C O L L E G E Sherwin G. Maputol, RN, MAN 19 www.stalexiuscollege.edu.ph PULMONARY EMBOLISM (PE) Patient Teaching: ❖ DO’s ✓ Observe for bleeding ✓ Use soft toothbrush, electric razor ✓ Evaluate use of contraceptives ✓ Use antiembolism stockings. 9/10/2024 ST. A L E X I U S C O L L E G E Sherwin G. Maputol, RN, MAN 20 www.stalexiuscollege.edu.ph PULMONARY EMBOLISM (PE) Patient Teaching: ❖ DONT’s ✓ Take ASA with Coumadin ✓ Restrictive clothing's on legs ✓ Prolonged sitting/standing ✓ Smoking ✓ Bruises, constipation, contact sports 9/10/2024 ST. A L E X I U S C O L L E G E Sherwin G. Maputol, RN, MAN 21 www.stalexiuscollege.edu.ph KEY POINTS: PULMONARY EMBOLISMS PULMONARY EMBOLISM (PE) is a blood clot that develops in a blood vessel elsewhere in the body (often the leg), travels to an artery in the lung, and suddenly forms a blockage of the artery. Abnormal blood clots can form due to problems such as "sluggish" blood flow through the veins, an abnormality in clot forming factors, and/or an injury to the blood vessel wall. A wide variety of conditions and risk factors have been linked to PEs. Sudden shortness of breath is the most common symptom of a PE. 9/10/2024 ST. A L E X I U S C O L L E G E Sherwin G. Maputol, RN, MAN 22 www.stalexiuscollege.edu.ph  KEY POINTS: PULMONARY EMBOLISMS PULMONARY EMBOLISM (PE) difficult to diagnose because the signs and symptoms of PE are a lot like those of many other conditions and diseases. Imaging tests and blood tests are used to look for a PE. An important aspect of treating a PE is preventing additional clots. Medicines, filters to keep clots from getting to the lungs, and surgery are used to treat PEs. A PE, particularly a large PE or many clots, can quickly cause serious life-threatening consequences and death. 9/10/2024 ST. A L E X I U S C O L L E G E Sherwin G. Maputol, RN, MAN 23 www.stalexiuscollege.edu.ph  KEY POINTS: PULMONARY EMBOLISMS PULMONARY EMBOLISM (PE) 9/10/2024 ST. A L E X I U S C O L L E G E Sherwin G. Maputol, RN, MAN 24 www.stalexiuscollege.edu.ph