Pulmonary embolism Concept map PDF

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DETERMINANTS OF HEALTH

PRECIPITATING FACTORS

-Individuals with > 12 years of education were at lower risk for VTE. -Blue-collar workers, farmers, and non-employed individuals had higher risks for VTE; White collar workers and professionals had lower risks. -In males and/or females, risks for VTE were increased for assistant nurses; farmers; miners and quarry workers; mechanics.

Obesity, estrogen therapy, venipuncture (minimize), dehydration, infection (treat), Usually the blood clot originates from a DVT in the leg.

PREDISPOSING FACTORS Malignancy, immobility due to age or injury, congenital abnormalities, varicose veins, A.Fib and cardiac function, illness and inherited disorders, atherosclerosis

COMORBIDITIES Old age (>75 years), hypertension, previous stroke, chronic obstructive pulmonary disease (COPD), diabetes mellitus, atrial fibrillation, cancer, deep vein thrombosis (DVT) and heart failure. Immobility, Surgery within last 3 months (especially pelvic and lower extremity surgery), obesity in women, heavy cigarette smoking.

PATHOPHYSIOLOGY · · ·

Venous stasis Hyper coagulopathy Injury to endothelial layer

PULMONARY EMBOLISM MEDICATIONS AND TREATMENT General: · Oxygen- for hypoxemia · Fluids in case of circulatory shock · Avoid diuretics and vasodilators · Opiates for pain BUT be careful with hypotension Medications: 1.Anticoagulants (antithrombin):Anticoagulant medications are a type of blood thinner (given for minimum of 3 months) HEPARIN : -Un fractioned Heparin -administered IV -Low Molecular Weight Heparin – subcutaneous WARFARIN -Taken orally, takes up to 5 days to have an effect 2.Thrombolytic Therapy( break up clots) e.g. tPA (tissue plasminogen activator), alteplase, reteplase, streptokinase, tenecteplase, urokinase

POTENTIAL RISKS Postoperative states: Major abdominal/pelvic surgery, hip/knee joint replacement, post-operative intensive care Obstetrics: Late pregnancy, Caesarian section, puerperium Lower limb affections: Fractures, extensive varicosities Malignancies: Abdominal/pelvic, advanced/metastatic stage Limited mobility: Hospitalization, geriatric care Miscellaneous: History of previous venous thromboembolism

ASSESSMENT FINDINGS · Sudden Dyspnea accompanied by anginal (Sharp Chest) and pleuritic pain, exacerbated during inspiration (Hall Mark Sign) · Feeling of impending doom (Hall Mark Sign) · Apprehension and restlessness · Blood- Tinge sputum · Chest pain · Cough · Crackles and wheeze on auscultation · Cyanosis · Distended neck veins · Hypotension · Petechiae over chest and axilla · Shallow respiration · Tachypnea and tachycardia

DIAGNOSTIC TESTS AND LAB FINDING -D-Dimer -Troponin -BNP -ABGs -CT Pulmonary angiography (CT- PA) -Ventilation-perfusion scan (V/Q scan) -Pulmonary angiogram -MRI

RISK FOR BLEEDING r/t anticoagulant or thrombolytic regimen therapy · Assess for history of a high-risk bleeding condition · Monitor IV dosage and delivery system · Assess for signs and symptoms of bleeding; bleeding from catheter insertion sites; GI or GU bleeding; bleeding from the respiratory tract; bleeding from mucus membranes; decreased hemoglobin and hematocrit · Administer anticoagulant therapy as prescribed · Monitor platelet counts, coagulation test results (INR), PT, aPTT, and hemoglobin and hematocrit · Monitor platelets and the heparin-induced platelet aggregation (HIPA) status ·If the patient is HIPA positive, stop all heparin products and consult a hematologist

INEFFECTIVE BREATHING PATTERN r/t acute chest pain · Assess the respiratory rate, rhythm, and depth. Assess for any increase in the work of breathing: shortness of breath and the use of accessory muscles. · Assess characteristics of pain · Monitor ABG’s · Monitor oxygen saturation via pulse oximetry. · Position the patient in a sitting position, and change the position every 2 hours · Administer oxygen as prescribed · Assist the patient with coughing and deep breathing

PRIORITY NURSING ACTIONS Suspected Pulmonary Embolism 1. Notify the Rapid response team and health care provider (HCP) 2. Reassure the client and elevate the head of the bed. 3. Prepare oxygen administration 4. Obtain Vital Signs and check for lung sounds 5. Prepare to obtain arterial blood gas, 6. Prepare for the administration of heparin therapy or other therapies: embolectomy or placement of vena cava filter if necessary. 7. Document the event, interventions taken, and the client’s response to treatment.

DEFICIENT KNOWLEDGE r/t activities to prevent embolism and self-care after diagnosis of embolism · Ascertain level of knowledge, including anticipatory needs. · Determine client’s ability, readiness, and barriers to learning. (patient maybe physically weak and unable to participate) · Use short, simple sentences and concept. Repeat and summarize as needed. · Provide mutual goal setting and learning contracts.

PSYCHOSOCIAL ASPECTS

Group 2 

-Life-changing event -Shock/distress at uncertainty it had happened to me. Why me? It was awful not knowing what had caused it. -Loss of self -Change in focus or direction -Avoidance behaviors -PTSD - Flashbacks -Numbing of memories Hypervigilance

IMPAIRED GAS EXHANGE r/t altered blood flow to alveoli secondary to embolus · Monitor vital signs, noting any changes · Auscultate lung sounds · Assess skin color, nail beds, and mucus membranes for color changes · Monitor ABGs · Monitor oxygenation via pulse oximeter · Assess for calf tenderness, swelling, redness, and/or hardened areas · Administer oxygen as needed · Position the patient properly to facilitate ventilationperfusion matching

ANXIETY r/t fear of suffocation · Review physiological factors, i.e. Post op pts., Bed ridden pts., Pts with mobility problem, bone fractures (fat embolism) · If irrational thoughts are present provide patient with accurate information on current disease condition that contribute pt.'s anxiety. · Explain all activities, procedures, and issues that involve the client; use non-medical terms and calm slow speech....