1. Pulmonary Embolism
DR / Amany lotfy

2. Pulmonary embolism (PE)
 refers to the obstruction of the
pulmonary artery or one of its
branches by a thrombus (or thrombi)
that originates somewhere in the
venous system or in the right side of
the heart

3. Causes
 1.thrombous
 2. embolism
 3.trauma
 4. surgery
 5. hypercoaguability
 6. heart failure
 7. pregnancy ( increase coaguability of BL
 8. older than 50 years
 9. atrial fibrillation

4. Pathophysiology
 -When a thrombus completely or partially
obstructs a pulmonary artery or its
branches,
 the alveolar dead space is increased . The
area, although continuing to be ventilated,
receives little or no blood flow. Thus, gas
exchange is impaired or absent in this
area.

5. Pathophysiology
 -In addition, various
substances are
released from the clot and surrounding
area, causing regional blood vessels and
bronchioles to constrict.
 This causes an increase in pulmonary
vascular resistance. This reaction
compounds (the ventilation–perfusion
imbalance.)

6. Pathophysiology
 -The hemodynamic consequences are
increased pulmonary vascular resistance
from the regional vasoconstriction and
reduced size of the pulmonary vascular
bed.
 This results in an increase in pulmonary
arterial pressure and, in turn, an increase
in right ventricular work to maintain
pulmonary blood flow. When

7. Pathophysiology
 the work requirements of the right
ventricle exceed its capacity,
 right ventricular failure occurs,
leading to a decrease in cardiac
output followed by a decrease in
systemic blood pressure and the
development of shock.

8. RISK FACTORS
 Venous Stasis (slowing of blood flow in
veins)
 -Prolonged immobilization (especially
postoperative)
 -Prolonged periods of sitting/traveling
 -Varicose veins
 -Spinal cord injury
 -Hypercoagulability (due to release of tissue
thromboplastin after injury/surgery)
 -Injury
 -Tumor (pancreatic, GI,, breast, lung)
 -Increased platelet count (polysalathemia,
splenectomy

9. RISK FACTORS

Venous Endothelial Disease
-
 -Thrombophlebitis -Vascular disease
 -Foreign bodies (IV/central venous
catheters)
 -Certain Disease States
(combination of stasis, coagulation
alterations, and venous injury)
 -Heart disease (especially heart failure)
 -Trauma (especially fracture of hip, pelvis,
vertebra, lower extremities)

10. RISK FACTORS
 -Postoperative state/postpartum period
 -Diabetes mellitus
 -Chronic obstructive pulmonary disease c
opD
 - Other Predisposing Conditions
 -Advanced age -Obesity -Pregnancy
 -Oral contraceptive use -Constrictive
clothing
 -History of previous thrombophlebitis,
pulmonary embolism

11. Clinical Manifestations
 1.Dyspnea is the most frequent symptom;
tachyapnea (very rapid respiratory rate) is
the most frequent sign . The duration and
intensity of the dyspnea depend on the
extent of embolization. Chest pain is
common and is usually sudden and
pleuritic. It may be substernal and
misdiagnosed with angina pectoris or a
myocardial infarction.
 - Other symptoms include anxiety, fever,
tachycardia, apprehension, cough,
diaphoresis, hemoptysis, and syncope.

12. Assessment and Diagnostic
Findings
 -The diagnostic workup includes a
 - ventilation–perfusion scan,
 -pulmonary angiography,
 -chest x-ray
 -, ECG,
 -peripheral vascular studies, and arterial
blood gas analysis.
 -Doppler ultrasonography and venography

13. Prevention
 prevent deep venous thrombosis.
 1. active leg exercises
 2. The intermittent pneumatic leg
compression device ( reduces venous
stasis).
 3. use of elastic compression stockings
 4. anticoagulant therapy

14. Medical Management
 • General measures to improve respiratory
and vascular status
 • Anticoagulation therapy
 • Thrombolytic therapy
 • Surgical intervention

15. GENERAL MANAGEMENT
 -Oxygen therapy is administered to correct
the hypoxemia, relieve the pulmonary
vascular vasoconstriction, and reduce the
pulmonary hypertension.
 -Using elastic compression stockings or
intermittent pneumatic leg compression
devices reduces venous stasis.

16. GENERAL MANAGEMENT
 -These measures compress the
superficial veins and increase the
vesecosity of blood in the deep
veins by redirecting the blood
through the deep veins.
 Elevating the leg (above the level
of the heart) also increases
venous flow.

17. Anticoagulation Therapy
. Anticoagulant therapy (heparin,
warfarin sodium)
 has traditionally been the primary
method for managing acute deep vein
thrombosis and PE

18. Anticoagulation Therapy
 Heparin is used to prevent recurrence of
emboli but has no effect on emboli that are
already present.
 It is administered as an intravenous bolus
of 5,000 to 10,000 units, followed by a
continuous infusion initiated at a dose of
18 U/kg per hour, not to exceed 1,600
U/hour

19. Thrombolytic Therapy
 -Thrombolytic therapy (urokinase, strepto-
kinase, alteplase, anistreplase, reteplase)
also may be used in treating
 PE, particularly in patients who are
severely compromised (eg, those who are
hypotensive and have significant
hypoxemia despite oxygen
supplementation).
-

20. Thrombolytic Therapy
 Thrombolytic therapy
 resolves the thrombi or emboli more
quickly
 restores more normal hemodynamic
functioning of the pulmonary circulation,
Reducing pulmonary hypertension
 Improving perfusion, oxygenation, and
cardiac output.

21. SURGICAL MANAGEMENT
 -Pulmonary embolectomy requires a
thoracotomy with cardiopulmonary by-
pass technique.
 -Transvenous catheter embolectomy is a
technique in which a vacuum-cupped
catheter is introduced transvenously into
the affected pulmonary artery. Suction is
applied to the end of the embolus and the
embolus is aspirated into the cup .

22. Nursing Management
 MINIMIZINGTHE RISK OF
PULMONARY EMBOLISM
 PREVENTING THROMBUS
FORMATION
 ASSESSING POTENTIAL FOR
PULMONARY EMBOLISM
 MONITORING THROMBOLYTIC
THERAPY
 MANAGING PAIN

23. Nursing management
 MANAGING OXYGEN THERAPY
 RELIEVING ANXIETY
 MONITORING FOR
COMPLICATIONS
 PROVIDING POSTOPERATIVE
NURSING CARE
 PROMOTING HOME AND
COMMUNITY-BASED CARE

24.  Mention nursing process of patient have
Pulmonary Embolism ?
 DEFINE the following?
 thrombus
 Embolism
 Pulmonary vascular resistance
-Pulmonary arterial pressure
-The intermittent pneumatic leg compression
device
-Cardiopulmonary by pass technique

25. Thank you