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Pulmonary Embolism
 Krizza Anne C. Bucok, RN
CLINICAL PICTURE
The patient may have:
• Dyspnea, pleuritic chest pain,
  tachycardia
• Anxiety, diaphoresis
• Syncope, hypotension
• Wheezing
• Lower extremity edema
• Signs and symptoms of
  thrombophlebitis
IMMEDIATE INTERVENTIONS
• Administer supplemental O2
• Assess VS
• Assess respiratory rate and
  work of breathing
• Notify physician or NP
• Place on pulse oximetry and
  cardiac monitor if available
• Document patient’s
  status, phone call to physician
  or NP, physician or NP
  response
FOCUSED ASSESSMENT
• Auscultate lung fields for
  adventitious sounds and quality
  of air movement
• Assess O2 saturation, cardiac
  rhythm, VS
• Assess for chest pain, leg vein
  tenderness
• Assess for history of recent
  surgery, immobilization, recent
  DVT, malignancy
STABILIZING AND MONITORING
• Continue to assess
  VS, LOC, respiratory status
• Initiate anticoagulant therapy
  (heparin) as ordered
• Have second practicioner
  independently calculate
  dilutions and infusion pump
  programming
• Chart patient status and convey
  to physician or NP
BE PREPARED TO
• Obtain IV access
• Change or set up an O2 delivery
  system
• Administer medications or
  fluids to maintain BP
• Assist with obtaining diagnostic
  studies
   CXR, V/Q scan, spiral CT
    scan, pulmonary angiogram
• Obtain ABGs
• Obtain serial PPTs and titrate
  heparin infusion
• Transfer to ICU for high acuity
  care or thrombolytic therapy
POSSIBLE ETIOLOGIES
• Embolization of thrombi from
  deep veins of the
  femur, pelvis, and lower
  extremities from multiple
  causes:
     Venous stasis
     Hypercoagulable states
     Surgery and trauma
     Oral contraceptive and ERT
     Pregnancy
Pulmonary embolism

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Pulmonary embolism

  • 1. Pulmonary Embolism Krizza Anne C. Bucok, RN
  • 3. The patient may have: • Dyspnea, pleuritic chest pain, tachycardia • Anxiety, diaphoresis • Syncope, hypotension • Wheezing • Lower extremity edema • Signs and symptoms of thrombophlebitis
  • 5. • Administer supplemental O2 • Assess VS • Assess respiratory rate and work of breathing • Notify physician or NP • Place on pulse oximetry and cardiac monitor if available
  • 6. • Document patient’s status, phone call to physician or NP, physician or NP response
  • 8. • Auscultate lung fields for adventitious sounds and quality of air movement • Assess O2 saturation, cardiac rhythm, VS • Assess for chest pain, leg vein tenderness • Assess for history of recent surgery, immobilization, recent DVT, malignancy
  • 10. • Continue to assess VS, LOC, respiratory status • Initiate anticoagulant therapy (heparin) as ordered • Have second practicioner independently calculate dilutions and infusion pump programming • Chart patient status and convey to physician or NP
  • 12. • Obtain IV access • Change or set up an O2 delivery system • Administer medications or fluids to maintain BP • Assist with obtaining diagnostic studies  CXR, V/Q scan, spiral CT scan, pulmonary angiogram
  • 13. • Obtain ABGs • Obtain serial PPTs and titrate heparin infusion • Transfer to ICU for high acuity care or thrombolytic therapy
  • 15. • Embolization of thrombi from deep veins of the femur, pelvis, and lower extremities from multiple causes:  Venous stasis  Hypercoagulable states  Surgery and trauma  Oral contraceptive and ERT  Pregnancy