Pulmonary Embolism
Pulmonary embolism: Occurs when a thrombus, fat, air, or neoplastic tissue blocked pulmonary arteries.
Signs and symptoms
Sudden onset of unexplained dyspnea accompanied by anginal and pleuritic pain, exacerbated by inspiration
Cough
Crackles
Blood-tinged sputum
Mental status changes
Anxiety
Tachypnea and tachycardia
Interventions
Acute interventions:
1. Position the patient in high Fowler’s
2. Administer oxygen as prescribed
3. Monitor vital signs, pulse oximetry, and lung sounds
4. Reassure the patient and maintain bed rest
5. Prepare intubation and mechanical ventilation for severe hypoxemia
6. Monitor ECG and ABGs
Medical interventions:
1. Administer anticoagulation therapy (heparin) intravenously as prescribed
2. Administer warfarin (Coumadin) orally as prescribed
3. Narcotics for pain relief as prescribed
Surgical therapy:
1. Pulmonary embolectomy in life threatening situation
2. Intracaval filter
3. Vein ligation
Main causes
Deep vein thrombosis (often caused by prolonged immobilization, surgery, obesity, pregnancy, and advanced age)
Long bone fractures may lead to fat emboli
Air embolism are caused by either syringe or IV inject air to a vein or arteries (e.g., dialysis, PICC)
Potential complications
Pulmonary infarction (death of lung tissue)
Pulmonary hypertension
Laboratory assessment/Diagnostic Tests
Monitor activated partial thromboplastin time (aPTT) for heparin therapy
Monitor prothrombin time (PT) and check international normalized ratio (INR) test for warfarin therapy
Education
Teach the patient who are at risk regarding prevention of DVT (e.g., mobilization, use of elastic stockings, maintaining a healthy weight) – see deep vein thrombosis
Teach the patient regarding the hazards of anticoagulant therapy including the importance of follow up for blood tests
NB: Heparin should be started immediately unless contraindicated and continued while oral anticoagulants (warfarin) are initiated because warfarin takes approximately 3-5 days to reach its therapeutic effect.
