Pulmonary Embolism

Pulmonary Embolism
is the obstruction of the pulmonary artery or one of its branches by thrombus that originates somewhere in the venous system or in the right side of the heart. Deep vein thrombosis (DVT) is a thrombus formation in the deep veins (calf, thigh or arm) especially in patients with peripherally inserted central catheter.

Pulmonary Embolism
Combination of both DVT and Pulmonary Embolism is called venous thromboembolism. Pulmonary embolism is commonly associated with trauma, surgery, pregnancy, heart failure, 50 years old and older, hypercoagulble states and prolonged immobility.

Risk factors are as follows:

Venous stasis slowing of blood flow in veins Prolonged immobility Prolonged periods of sitting Varicose veins Spinal cord injury Hypercoagulability due to relesea of tissue thrombolplastin after injury or surgery Injury Trauma Increase platelet

Risk factors are as follows:

Venous endothelial disease Thrombophlebitis Vascular disease Foreign bodies Others Heart disease COPD Increasing age Obesity Use of oral contraceptives Constrictive clothing History of previous thrombophlebitis

Pathophysiology

Clinical Manifestations
Dyspnea Chest pain Anxiety Fever Tachycardia Apprehension Cough Diaphoresis Syncope Tachypnea Most common

Assessment and Diagnosis

Chest X-ray Shows infiltrates, atelectasis and evaluation of the diaphragm or pleural effusion ECG Shows sinus tachycardia; PR-interval depression and nonspecific T wave changes

ABG- for hypoxemia and hypocapnia

Pulmonary angiography Best method Direct visualization under fluoroscopy of the atrial obstruction and accurate assessment of the perfusion deficit

Assessment and Diagnosis

Ventilation perfusion scan Involves IV administration of contrast agent Comparisons of percentage of ventilation and perfusion in each area of the lungs Others: CT scan D-dimmer assay blood test for evidence of blood clots Pulmonary arteriogram

Prevention
Active leg exercises Early ambulation Anti-embolism stockings

Medical Management
Emergency management Oxygen via nasal canula IV infusion Perfusion scan, hemodynamic measurement and ABG If hypotension occurs, give dobutamine or dopamine ECG monitoring Digitalis glycosidase, IV diuretics and anti-arrhythmic agents Serum electrolytes, CBC and hematocit count if undesirable results, intubate and hook to mechanical ventilator Indwelling urinary catheter massive embolism and hypotension For pain and anxiety give small doses of IV morphine or sedatives

Medical Management
General management Improve respiratory and vascular status Elevate legs above the level of the heart Use of anti-embolism stockings Pharmacologic Management Anticoagulation therapy (3-6 months) Heparin Warfarin sodium Thrombolytic therapy Urokinase Streptokinase Alteplase

Surgical Management
Embolectomy Transvenous catheter

Nursing Management
Minimizing the risk of pulmonary embolism Preventing thrombus formation MAJOR NURSING RESPONSIBILITY
Encourage ambulation Encourage active and passive exercises

Assessing potential pulmonary embolism Monitor thrombolytic therapy and anticoagulation therapy
Advise bed rest Monitor vital signs every 2 hours

Nursing Management
Pain management
Semi-fowlers position Reposition to improve ventilation-perfusion ratio in the lungs Opiod for severe pain

Oxygen therapy Relieve anxiety Monitor possible complications

Cardiogenic shock

PULMONARY EDEMA

PULMONARY EDEMA
It is the abnormal accumulation of fluid in the lung tissue, alveolar space or both.

Clinical Manifestaions
Increase respiratory distress Dyspnea Air hunger Central cyanosis Foamy, frothy and blood stained sputum Tachycardia

Assessment and Diagnostic Findings

Auscultation crackles Chest X-ray increase interstitial markings Pulse oximeter decrease oxygen ABG worsening hypoxemia

Medical Management
Vasodilators Inotropic medications Diuretics for fluid overload Oxygen therapy for hypoxemia Morphine to relieve pain and anxiety