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20 Cards in this Set

  • Front
  • Back
Definition of Pulmonary Embolism
The lodging of a clot usually from a DVT or other foreign matter in the pulmonary arterial vessel resulting in a pulmonary infarction and pulmonary necrosis
Causes of PE
- DVT of legs (most common)

- Emboli of the pelvic vessels

- Atrial fibrillation

- Fat emboli

- Air emboli
Risk factors for PE
- Any condition that causes:

--– Venous statsis
----- Possibly from dehydration

-- Hypercoagulability
-- Vascular wall damage
- ie. IV sticking
Conditions that put the patient at risk for PE

- Immobility

- Recent surgery esp. Gyn or ortho

- Obesity


- Recent fractures

- Estrogen therapy

- pregnancy
Pathophysiology of PE
- Emboli form and then travel through the circulatory system where they can become lodged in either a small or large portion of the pulmonary artery. The blockage of the artery prevents blood from flowing pass and therefore no gas excahnge can take place.
Signs and Symptoms of PE
- Depends on the size or number of PE

- Large pulmonary artery obstruction – pt may suddenly collapse with shock, pallor, severe dyspnea, sharp CP

- Medium obstruction – pleuritic chest pain, dyspnea, slight fever, productive cough with blood streaked sputum

- Small obstruction – may go undetected but can cause pulmonary hypertension
Goals of Therapy for PE
- Prevent further growth of thrombi

- Prevent immobilzation

- Provide cardiopulmonary support
Medications for PE
- Anticoagulants

– Heparin
-- Drug of choice
-- Inhibits coagulation/does not dissolve clots
-- IV bolus given followed by a continuous infusion
-- Monitor PTT
-- Protamine sulfate-antagonist

- Coumadin
-– Given po/IM
-- Started while patient is on Heparin
-- Monitor PT/INR
-- Vitamin K-antagonist

- Thrombolytic agents
-- Works to dissolve a clot
--Not usually used for routine PE because it does not seem to change the outcome
-- May not be used on post operative patients due to potential for bleeding
-- Examples, streptokinase, tPA
Surgical treatment of PE
- Superior Inferior vena cava filter - prevent clots from getting to the pulmonary vasculature
-- Stops the clot from entering the heart

- Embolectomy – removal of the clot surgically
Nursing care for patient with PE
- Prevention
-- Meticulously assess for positive Homan’s Sign

- Oxygenation

- Comfort

- Patient education
Definition of Aneurysm
- Points of weakness, dilation or outpouching of an artery

- Most commonly found in the aorta but can occur anywhere

- The 13th leading cause of death in US
Causes of aneurysms
- Atherosclerosis
- Congential birth defects
- Trauma
- Infections
- Connective tissue disorders
Risk factors for Aneurysms
- Smoking
- Hypertension
- Genetic predisposition
Types of aneurysms
- Fusiform-uniform dilation all around the aorta

- Saccular-saclike-narrow neck, balloon shape

- Dissecting-involves a separation or tear in between the layers of the blood vessel which can extend so that there is an accumulation of blood in this new cavity

- Ruptured-break in the blood vessel
Signs and Symptoms of aneurysms
- Asymptomatic

- Leaking or ruptured-may c/o severe pain, signs of shock, decreased RBC, increased WBC

- Abdominal-palpable mass, systolic bruit, c/o abdominal pain or back pain

- Thoracic-chest wall pain, back, flank, abdominal pain, dyspnea, cough, wheezing
Typical patient
- Male

- Over 60

- Mildly obese

- Sedetary

- Smoker

- Hypertension


- DM
Diagnostic tests for aneurysms
- History and physical exam

- X-rays
Treatment for PE
- Stop smoking

- Control BP

- Surgery
-- Usually only done if greater than 6 cm
-- Major surgical procedure
-– Diseased area is replaced with a graft
Post operative care for Aneurysms
- ICU post operatively

- T, C, and DB

- Frequent vital signs

- Pain control

- Fluid balance

- Frequent vascular checks
Diagnostic tests for PE
- Patient history
-- Ask about previous surgeries, birth control pills, recent air travel (can cause venous stasis due to sitting for long periods of time, and not as hydrated to few liquids during flight)

- EKG and Chest X-ray
-- Look to rule out MI

- V/Q perfusion scan (ventilation/perfusion scan) – will show high probability
- Pulmonary angiography - most definitive