pulmonary embolism by Dr.Raafat AL-Awadhi.pptx

Nursing College

1. Pulmonary Embolism By : Dr.Raafat AL-Awadhi

2. Pulmonary Embolism Obstruction of pulmonary artery or branch by blood clot ( most common & usually arises from peripheral vein ) , air, fat, amniotic fluid, or septic thrombus Obstructed area has diminished or absent blood flow Although area is ventilated, no gas exchange occurs (dead space) Inflammatory process causes regional blood vessels, bronchioles to constrict , further increasing pulmonary vascular resistanc e, pulmonary arterial pressure , right ventricular workload Ventilation-perfusion imbalance, right ventricular failure, shock

3. Risk Factors: Venous stasis : Prolonged immobility, Hypercoagulabilty Venous endothelial disease : DVT & thrombophlebitis Certain disease states : heart disease (HF), trauma (fracture of hip), postoperative (orthopedic, abdominal) /postpartum, diabetes mellitus (DM), COPD. Other conditions :Advance age (>50 years), pregnancy, obesity, oral contraceptive use, constrictive clothing, history of PE, DVT, & thrombophlebitis

4. Clinical Manifestation: depend on the size of thrombus and the area occluded Dyspnea most frequent symptoms Tachypnea most frequent sign Chest pain (sudden, substernal, pleuritic in origin) Anxiety, fever, tachycardia, cough, apprehension, hemoptysis, diaphoresis and syncope

5. Diagnostic Finding Death occurs within one hour CXR ( show infiltrate, atelectasis, elevation of diaphragm on the affected side, pleural effusion) ECG (sinus tachycardia, PR interval depression, ABG’s ( hypoxemia, hypocapnia from tachypnea) V\Q scan : second choice, evaluate different areas in the lungs and compare the V/Q in each area after IV administration of contrast agent and scan.

6. Diagnostic Finding CT scan for the lung D-diamer assay : blood test for evidence of blood clot. ↑ indicates clotting abnormality such as (hypercoagulability) Pulmonary angiography , (first choice): injection o f dye under fluoroscopy through a catheter that goes to vena cava (right side of the heart) to discover the thrombus

7. Prevention Exercises to avoid venous stasis Early ambulation Anticoagulant therapy ( heparin , and low molecular weight heparin: Enoxaparin) Sequential compression devices (SCDs) as elastic stocking: prevent venous stasis, Review chart 23-9 p 584 . (Prevention of recurrent pulmonary embolism )

8. Medical Management: Purpose to lyse the emboli and prevent new one from forming General measures to improve respiratory and vascular status Anticoagulant therapy : (Heparin and Warfarin) Thrombolytic therapy : ( streptokinase, urokinase) Check PTT, INR, HCT, & platelets count Surgical intervention: ( embolectomy ) done for Pts who fail to improve with medications or medications were contraindicated

9. Nursing Management Minimize the risk of PE Preventing thrombus formation : - Early ambulation after surgery, - Leg exercises to avoid venous stasis , avoid dangling of legs, and feet should rest on floor. - Care of IV devices, Assessing potential of PE: risk factors Monitoring thrombolytic therapy Managing O2 therapy Relieving anxiety Providing post op care : VS, UO, elevation of legs, isometric exercise, elastic stocking, and avoid sitting to prevent hip flexion Monitoring for complications