Scc Nursing Med Surg Ii - Pulmonary Embolism

The lodging of a clot usually from a DVT or other foreign matter in the pulmonary arterial vessel resulting in a pulmonary infarction and pulmonary necrosis

- DVT of legs (most common)

- Emboli of the pelvic vessels

- Atrial fibrillation

- Fat emboli

- Air emboli

- Any condition that causes:

--– Venous statsis
----- Possibly from dehydration

-- Hypercoagulability
-- Vascular wall damage
- ie. IV sticking

- DVT

- Immobility

- Recent surgery esp. Gyn or ortho

- Obesity

- CHF/MI

- Recent fractures

- Estrogen therapy

- pregnancy

- Emboli form and then travel through the circulatory system where they can become lodged in either a small or large portion of the pulmonary artery. The blockage of the artery prevents blood from flowing pass and therefore no gas excahnge can take place.

- Depends on the size or number of PE

- Large pulmonary artery obstruction – pt may suddenly collapse with shock, pallor, severe dyspnea, sharp CP

- Medium obstruction – pleuritic chest pain, dyspnea, slight fever, productive cough with blood streaked sputum

- Small obstruction – may go undetected but can cause pulmonary hypertension

- Prevent further growth of thrombi

- Prevent immobilzation

- Provide cardiopulmonary support

- Anticoagulants

– Heparin
-- Drug of choice
-- Inhibits coagulation/does not dissolve clots
-- IV bolus given followed by a continuous infusion
-- Monitor PTT
-- Protamine sulfate-antagonist

- Coumadin
-– Given po/IM
-- Started while patient is on Heparin
-- Monitor PT/INR
-- Vitamin K-antagonist

- Thrombolytic agents
-- Works to dissolve a clot
--Not usually used for routine PE because it does not seem to change the outcome
-- May not be used on post operative patients due to potential for bleeding
-- Examples, streptokinase, tPA

- Superior Inferior vena cava filter - prevent clots from getting to the pulmonary vasculature
-- Stops the clot from entering the heart

- Embolectomy – removal of the clot surgically

- Prevention
-- Meticulously assess for positive Homan’s Sign

- Oxygenation

- Comfort

- Patient education

- Points of weakness, dilation or outpouching of an artery

- Most commonly found in the aorta but can occur anywhere

- The 13th leading cause of death in US

- Atherosclerosis
- Congential birth defects
- Trauma
- Infections
- Connective tissue disorders

- Smoking
- Hypertension
- Genetic predisposition

- Fusiform-uniform dilation all around the aorta

- Saccular-saclike-narrow neck, balloon shape

- Dissecting-involves a separation or tear in between the layers of the blood vessel which can extend so that there is an accumulation of blood in this new cavity

- Ruptured-break in the blood vessel

- Asymptomatic

- Leaking or ruptured-may c/o severe pain, signs of shock, decreased RBC, increased WBC

- Abdominal-palpable mass, systolic bruit, c/o abdominal pain or back pain

- Thoracic-chest wall pain, back, flank, abdominal pain, dyspnea, cough, wheezing

- Male

- Over 60

- Mildly obese

- Sedetary

- Smoker

- Hypertension

- CAD

- DM

- History and physical exam

- X-rays

- Stop smoking

- Control BP

- Surgery
-- Usually only done if greater than 6 cm
-- Major surgical procedure
-– Diseased area is replaced with a graft

- ICU post operatively

- T, C, and DB

- Frequent vital signs

- Pain control

- Fluid balance

- Frequent vascular checks

- Patient history
-- Ask about previous surgeries, birth control pills, recent air travel (can cause venous stasis due to sitting for long periods of time, and not as hydrated to few liquids during flight)

- EKG and Chest X-ray
-- Look to rule out MI

- V/Q perfusion scan (ventilation/perfusion scan) – will show high probability
- Pulmonary angiography - most definitive