Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
70 Cards in this Set
- Front
- Back
- 3rd side (hint)
|
Define PE
|
obstruction of blood flow in 1 or more pulmonary arteries
|
severity of problem depends on size of embolism
|
|
|
List 6 causes of PE
|
1.thrombus
2.fat globules 3.air emboli 4.tumor fragments 5. bone marrow 6.sepsis |
majority d/t thrombi in deep veins of thigh or pelvic cavity
|
|
|
What 4 conditions cause venous stasis
|
1.immobilization # 1 cause
2.leg paralysis 3.obeisity 4.SCI |
Risk factor of PE
|
|
|
what are 4 conributing factors of vessel wall injury
|
1.sx
2.hx of thrombembolism 3.multiple trauma w possible fx 4.in drug use or iv caths |
Risk factor of PE
|
|
|
what are 4 conributing factors of hypercoagulability
|
1.malignancy
2.clotting factor abnormalities 3.heparin induced thrombocytopenia |
Risk factor PE
tumors create enzymes that cause hypercoagulability heparin induced comp. can start 4-14 days after starting drip/ incre. platalets |
|
|
List 4 other diseases that contribute to PE
|
1.cardiovascular
2.trauma 3.DM 4.COPD |
arrythmias, heart failure
fx of long bones lungs are less mobile |
|
|
List 5 risk factors associated for women r/t PE
|
1.obeisity
2. smoking 3. HTN 4.oral contrac. 5.Pregnancy |
Pregnancy causes incr. vascular load,
oral contrac. cause blood clots in LE |
|
|
DEscribe the Patho of PE
|
clot breaks, R atrium, R ventricle, pulmo. artery, clot blocks the artery and produces lung that is ventilated but not perfuses
|
Clot could break off d/t stomping of foot and sitting or standing too long
|
|
|
list 3 comp. of PE
|
1. Pulm. infarction
2. pulm. HTN 3. Decreased C/O |
|
|
|
Which lobe is more frequently involved in death w/ in 2 hrs. R or L
|
R
|
|
|
|
what causes PI
|
occlusion of large vessel, insufficient blood flow, preexisting lung disease such as COPD
|
Death of lung tissue aka alveolar necrosis or abscess can follow PE causing PI
|
|
|
List 3 compl. of Pulm. HTN
|
1. compromise of pulm.d/t emboli
2.hypoxemia 3. dilation/hypertrophy of R ventricle can lead to MI |
|
|
|
List 6 comp. r/t decreased cardiac output
|
1. Myocardial ischemia
2. changes in pressure of heart 3. valvular dysfuction 4.regurgitation 5. dysrhytmias 6. R sided HF |
can lead to MI
|
|
|
How will pt present
|
anxious, sob, tacy, hypoxemic, diaphoresis, cough/hemoptysis ( pink frothy foam)
|
PE can mimic MI and if the emboli is small its hard to DX
|
|
|
list assessment findings of PE
|
1.pleuritic cx pain
2.crackles 3.thrombophelbitis 4.fever |
cx pain d/t infarcted tissue in the lung and is caused by leakage of the blood-irritation
|
|
|
Differntiate between PE and massive PE
|
Massive SXS are shock, pallor, sudden collapse, crushing cx pain, weak rapid hr,low b/p
|
may result in sudden death if emboli is large
|
|
|
list SXS of DVT
|
redness, swelling of LE pain is relieved w/ elevation of LE
|
can be sudden onset so early recognition is crucial
|
|
|
what NI should be implemented for this pt w/ possible DVT
|
Doppler US of LE
|
will also show rate of blood flow thru veins of the artery
|
|
|
Explain why B mode imaging may be necessary
|
to see if carotids are occluded
|
|
|
|
Why would this pt receive an EKG
|
to R/O MI and d/t tachycardia
|
|
|
|
what willa 2 D echo reveal
|
Enlarged R side Heart chamber and tricuspid regurgitation
|
|
|
|
Explain the reason for CXR
|
r/o pneumonia
|
initially it will be normal, but once surfactant is destroyed atelectasis and pleural effusion can occur
|
|
|
what value is considered a positive result of the D-Dimer
|
greater than 250 ml
|
reflects product of fibrogin breakdown
|
|
|
What type of CT scan is specific to PE
|
a spiral 3 dimensional view of lungs
|
|
|
|
Describe NI r/t lung scan V/Q(ventilation/perfusion radioisotope lung scan
|
Check for allergies to iv isotope
|
can be difficult if pt not cooperative. Pt must inhale radioactive gas which is distributed thru lungs and detects adequacy of pulm circulation
|
|
|
Which test is a definitive DX procedure r/t PE
|
Pulm. angiogram
|
100% certainty of obstruction and visualization of pulm vascular system as well as location of emboli
|
|
|
Who should not have this procedure
|
elderly or pt w/ coagulation/blood d/o
|
invasive procedure
|
|
|
what accounts for an abnormal finding
|
abrubt arterial cutoffs and intrluminal filling defects
|
|
|
|
what can be done to correct the embolism
|
resolution and reorganization
|
resolution restores normal vascular flow by dissolving emboli
|
|
|
explain collaborative tx r/t PE
|
pt will be on thrombolytics and anti-coag.
|
|
|
|
moa of thrombolytic
|
breaks up/dissolves the clot
|
typically used for stoke Pt's
|
|
|
what thrombolytic is a plasminogen activator that will help dissolve clot in 24 hr
|
TPA
|
SE is bleeding so its not DOC
|
|
|
moa of anti-coags
|
PX. formation of clot by prolonging clotting time
|
does not dissolve clot
|
|
|
list #1 NI r/t heparin therapy
|
get baseline aptt to determine therapeutic levels based on their weight
|
|
|
|
how many units is the standard iv loading dose of heparin and which route is it given
|
5000-10,000 units and its given bolus iv push
|
|
|
|
What is the standard iv infusion concentration of heparin
|
25,000 units in 250ml
|
its 100 units/1 ml
|
|
|
how many units of heparin is that an hour
|
1000-1600 units/hr
|
|
|
|
can heparin share an iv line w/ another med
|
no
|
|
|
|
how often are aptt drawn once therapeutic level reached
|
every day
|
|
|
|
when is aptt drawn following the initial bolus
|
6hrs later
|
if hep started at 0700 the next aptt draw would be 1300
|
|
|
following a dose change d/t aptt results when will the next aptt be drawn
|
6 hrs after med change
|
|
|
|
what is therapeutic level of heparin
|
1.5-2.5
x's their baseline |
typically between 46-70 seconds
|
|
|
what would happen if Pt's aptt was 35 at 1200
|
re bolus of 5000-1000 units ivp and increase units and hour
|
next aptt draw 1800
|
|
|
what if the aptt was 85 at 0900
|
decrease the units an hour
|
next aptt draw is 1500
|
|
|
what if aptt was 110
|
d/c infusion and call MD
|
|
|
|
list 4 teaching points r/t heparin Th.
|
1.bleeding precautions
2.advise all MD of med not recommended for pregenant or lactating women 3.maintain routine checks on coag. studies |
SE include hemorrhagic tendencies, bleeding gums, hematuria, frank hemorrhage
|
|
|
can heparin be given po
|
no
|
only iv or sq
|
|
|
what is the onset of heparin
|
immediately
|
|
|
|
what is duration of heparin
|
short
|
|
|
|
what is the antidote to heparin
|
protamine sulfate
|
|
|
|
if pt starts hep drip at 0700 when will pt be put on coumadin
|
24 hrs later
|
d/t to therapeutic effect taking 1-3 days
|
|
|
classification of coumadin
|
oral anti-coag
|
same pt teaching as heparin in regards to basic precautions
|
|
|
antidote to coumadin
|
vitamin K
|
additional teaching about avoiding green leafy veggies high in vit k
|
|
|
what extra pt teaching should occur in addition to basic anti-coag precautions when teaching about coumadin
|
1. long term therapy
2. check when taking any other meds 3.oral contr. decrease its effect 4.have INR and PT levels checked routinely 5. take at the same time everyday |
|
|
|
what is normal INR for coumadin
|
2.0-3.0
|
|
|
|
what is normal initial dose of coumadin
|
5-10 mg every day
|
progress to 2.5-7.5 mg every day
|
|
|
List 2 filters placed surgically to tx PE
|
greenfield
umbrella |
inserted percutaneously in the femoral vein and permits filtration of clots w/o impeding blood flow
|
|
|
name 1 high risk procedure r/t massive PE
|
pulmonary embolectomy
|
|
|
|
how long will pt be on br after initial heparin dose
|
until therapeutic levels are reached
|
|
|
|
list NI r/t PE
|
1.o2, mechanical vent., c & DB, semi-fowlers positioning, assess lung sounds, abg's and v/S
|
|
|
|
list 3 meds used to tx PE other than anti-coags
|
1.vasopressors
2.diuretics 3.opioids |
vasopressors have dopamine and support systemic circulation and maintain hypoten
diuretics used to get rid of excess fluid in the lungs monitor for respiratory depression r/t narcotics |
|
|
Three main interventions drive nursing care of the PE pt. What are they
|
1.0BR
2. reduction of anxiety 3. safety d/t their anxious state potentiallt causing confusion |
|
|
|
Re. anti-coags, what is the biggest concern
|
bleeding, hematomas, bruising
|
watch for INR above 5, pt maybe bleeding internally and may express " feeling funny" and look pale
|
|
|
At home teaching r/t anti-coags focuses on
|
bleeding
|
use electric razors, soft toothbrush, no ASA, no contact sports, no getting pregnant so use barrier methods as contr.
|
|
|
what should the pt know about coumadin and their urine color
|
it makes urine orange
|
|
|
|
pt on anti-coags should avoid what
|
etoh, herbal supp, caffeine
|
also tell pt about hair loss
|
|
|
when should pt on anti-coags call the MD
|
1. black tarry stools, coffee ground emesis, nosebleeds, back/abd. pain that doesn't go away
|
all could signify internal bleeding
|
|
|
list 4 PC r/t PE
|
1. hemorrhage
2. resp failure 3.dysrhymias 4. cva |
|
|
|
list 4 nandas r/t PE
|
1. ineffective tissue perfusion
2. decreased c/o 3.imapired gas exchange 4.anxiety |
|
|
|
list 5 pt outcomes r/t PE
|
1.adequate tissue perfusion
2. adequate resp func. 3.adequate c/o 4. incraesed level of comfort 5. no reoccurance of PE |
|
