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Notes - Pulmonary Embolism

Pulmonary Embolism
Course

Nursing Complex Health Alterations II (543-113)

7 Documents
Students shared 7 documents in this course
Academic year: 2022/2023
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Gateway Technical College

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CHA 1 - Respiratory: Pulmonary Embolism

Respiratory System  The primary purpose of the respiratory system is gas exchange (transfer of O2 and CO2) between the atmosphere and blood. Requires adequate perfusion to distribute O2 to tissue and depends on a healthy functioning respiratory system o UPPER RESPIRATORY SYSTEM TRACT (Nose, mouth, pharynx, epiglottis, larynx, and trachea) – Air enters through the nose and is moistened and warmed, and enters the pharynx  Divided into 3 parts: Nasopharynx, oropharynx, and laryngopharynx  As air enters the laryngopharynx it passes the epiglottis (Small flap behind the tongue that closes over the larynx during swallowing to prevent food and liquid from entering the lungs)  Vocal cords are in the larynx, air passes through the glottis (opening between the vocal cords and into the trachea) o THE TRACHEA is a cylindrical tube about 5” (10-12cm) long and 1” in diameter  U-shaped cartilages keep the trachea open and allow the esophagus to expand for swallowing o LOWER RESPIRATORY TRACT (Bronchi, bronchioles, alveolar ducts, and alveoli) – Once air has passed the carina it is in the lower respiratory tract Early signs of hypoxia: Restlessness and anxiety

Pulmonary Embolism  PULMONARY EMBOLISIM (PE) o Blockage of 1 or more pulmonary arteries by a thrombus (blood clot), fat, or air embolus, or tumor tissue. These clots can continue moving throughout the pulmonary system until it is lodged at a narrowed part of the circulatory system. The embolus travels with the blood flow and obstructs perfusion of the alveoli. These affect the lower lobes of the lungs the most. Most PE’s arise from deep vein thrombosis (DVT) in the legs (also called a VTE which is the pathologic condition from DVT to PE). PE’s can also originate from the right side of the heart (AFIB), pelvic veins (after surgery or childbirth), upper extremities such as central venous catheters or arterial lines  RISK FACTORS – Immobility, reduced mobility, surgery within the last 3 months (especially pelvic and lower extremity surgery), history of VTE, cancer, obesity, oral contraceptives, pregnancy, hormone therapy, cigarette smoking, prolonged air travel, heart failure (HF), atrial fibrillation (A-fib), clotting disorders, lung/bone fractures  SIGNS & SYMPTOMS/CLINICAL MANIFESTATIONS – Varied and nonspecific, making diagnosis difficult. They depend on the type, size, and extent of emboli. Small emboli may be undetected or cause vague transient symptoms. The symptoms can be sudden or slowly. Dyspnea is the most common presenting symptom in 85% of patients, mild to moderate hypoxemia, tachypnea, chest pain, crackles/wheezing, cough, hemoptysis, altered mental status (AMS), syncope, hypotension, tachycardia, fever, accentuation of pulmonic heart sound (extra heart sounds)

 A massive PE may cause a sudden change in mental status, hypotension and feelings of impending doom  COMPLICATIONS – Death occurs in 10% of patients with a massive PE within the first hour. Treatment with anticoagulants significantly reduces mortality. Other complications include:  Pulmonary Infarction (Death of lung tissue) due to occlusion of a large or medium-sized pulmonary vessel (>2mm in diameter), insufficient collateral blood flow from the bronchial circulation, or preexisting lung disease, pulmonary hypertension  Pulmonary Hypertension results from hypoxemia or from involvement of more than 50% of the area of the normal pulmonary bed. PE’s rarely causes pulmonary hypertension. Recurrent PE’s gradually reduce capillary bed blood flow and eventually cause pulmonary hypertension. Depending on the degree of the pulmonary hypertension and how quickly it develops, some patients may die within months of diagnosis while some live for decades  DIAGNOSTICS – D-dimer measures the amount of cross-linked fibrin fragments. The disadvantage of D-dimer testing is that it is not specific since other conditions can cause elevation of fibrin. Many patients with a small PE have normal results. Other tests are a spiral helical CT scan (CT angiography CTA) which is the most common test for PE’s. This is done with an IV injection of contrast media to view pulmonary blood vessels. Test allows visualization of all anatomic regions of the lungs. Patients who can’t have contrast media will have a V/Q scan performed  Other diagnostics include history and physical assessment, chest x-ray, continuous ECG monitoring, coagulation (PT, INR, PTT, platelets), ABGS (PaO2 – Low, hyperventilation; Respiratory alkalosis), cardiac markers (troponin, BNP)  ABG analysis is important but not a diagnostic. PaO2 may be low because of inadequate oxygenation from occluded pulmonary vasculature. PH is often normal unless respiratory alkalosis develops due to prolonged hyperventilation  TREATMENTS – The goal of treatment is to reduce mortality risk, treatment is started ASAP, goals are to provide adequate tissue perfusion and respiratory function, prevent further growth or extension of thrombi in lower extremities, prevent embolization from the upper or lower extremities to the pulmonary vascular system, and prevent further recurrence of PE  Medications include fibrinolytic agent, unfractionated heparin IV, low- molecular-weight heparin (enoxaparin [Lovenox]), warfarin (Coumadin) for long term therapy, analgesia o Heparin (IV)  Large PE  Antidote = Protamine Sulfate  Monitor PTT (Normal 25-35 seconds; Therapeutic 1- times value)  Above 90 seconds = Risk for bleeding  Above 100 seconds = Spontaneous bleeding o Warfarin

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Notes - Pulmonary Embolism

Course: Nursing Complex Health Alterations II (543-113)

7 Documents
Students shared 7 documents in this course

University: Gateway Technical College

Was this document helpful?
CHA 1 - Respiratory: Pulmonary Embolism
Respiratory System
The primary purpose of the respiratory system is gas exchange (transfer of O2 and CO2) between
the atmosphere and blood. Requires adequate perfusion to distribute O2 to tissue and depends
on a healthy functioning respiratory system
oUPPER RESPIRATORY SYSTEM TRACT (Nose, mouth, pharynx, epiglottis, larynx, and
trachea) – Air enters through the nose and is moistened and warmed, and enters the
pharynx
Divided into 3 parts: Nasopharynx, oropharynx, and laryngopharynx
As air enters the laryngopharynx it passes the epiglottis (Small flap
behind the tongue that closes over the larynx during swallowing to
prevent food and liquid from entering the lungs)
Vocal cords are in the larynx, air passes through the glottis (opening
between the vocal cords and into the trachea)
oTHE TRACHEA is a cylindrical tube about 5” (10-12cm) long and 1” in diameter
U-shaped cartilages keep the trachea open and allow the esophagus to expand
for swallowing
oLOWER RESPIRATORY TRACT (Bronchi, bronchioles, alveolar ducts, and alveoli) – Once
air has passed the carina it is in the lower respiratory tract
***Early signs of hypoxia: Restlessness and anxiety***
Pulmonary Embolism
PULMONARY EMBOLISIM (PE)
oBlockage of 1 or more pulmonary arteries by a thrombus (blood clot), fat, or air
embolus, or tumor tissue. These clots can continue moving throughout the pulmonary
system until it is lodged at a narrowed part of the circulatory system. The embolus
travels with the blood flow and obstructs perfusion of the alveoli. These affect the lower
lobes of the lungs the most. Most PE’s arise from deep vein thrombosis (DVT) in the legs
(also called a VTE which is the pathologic condition from DVT to PE). PE’s can also
originate from the right side of the heart (AFIB), pelvic veins (after surgery or childbirth),
upper extremities such as central venous catheters or arterial lines
RISK FACTORS – Immobility, reduced mobility, surgery within the last 3 months
(especially pelvic and lower extremity surgery), history of VTE, cancer, obesity,
oral contraceptives, pregnancy, hormone therapy, cigarette smoking, prolonged
air travel, heart failure (HF), atrial fibrillation (A-fib), clotting disorders,
lung/bone fractures
SIGNS & SYMPTOMS/CLINICAL MANIFESTATIONS – Varied and nonspecific,
making diagnosis difficult. They depend on the type, size, and extent of emboli.
Small emboli may be undetected or cause vague transient symptoms. The
symptoms can be sudden or slowly. Dyspnea is the most common presenting
symptom in 85% of patients, mild to moderate hypoxemia, tachypnea, chest
pain, crackles/wheezing, cough, hemoptysis, altered mental status (AMS),
syncope, hypotension, tachycardia, fever, accentuation of pulmonic heart sound
(extra heart sounds)

Students also viewed

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