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Adult 3 exam 2.
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Adult 3 exam 2pulmonary embolism - ANS-blockage of one or more pulmonary arteries by thrombus
fat or air embolus, or tumor tissue
-obstructs alveolar perfusion
-most commonly affects lower lobes
Pulmonary embolism risk factors - ANS-Deep vein thrombosis
Immobility or reduced mobility
Surgery
History of DVT
Malignancy
Obesity
Oral contraceptives/ hormones
Smoking
Heart failure
Pregnancy/delivery
Clotting disorders
Atrial fibrillation
Central venous catheters
Fractured long bones
pulmonary embolism clinical manifestations - ANS--varied and nonspecific
-dyspnea most common
-tachypnea, cough, chest pain hemoptysis, crackles, wheezing, fever, tachycardia,
syncope, change in LOC
-dependent on size and extent of emboli
pulmonary infarction - ANS-Alveolar necrosis and hemorrhage
Abscess
Pleural effusion
pulmonary hypertension - ANS--Results from hypoxemia associated with massive or
recurrent emboli
-Right ventricular hypertrophy
pulmonary embolism diagnostic studies - ANS-- ABG (important but not diagnostic; low
O2 levels)
- Troponin & BNP (frequently elevated; increased mortality)
,- chest x-ray
- spiral CT (most frequently used; requires IV contrast media - caution to kidney
patients)
- VQ scan (can't have contrast media; less invasive
- D-dimer (elevated with clot degradation) - present with PE or recent fall
- Pulmonary Angiography (most sensitive but invasive - use less)
interprofessional care: Prevention - ANS--sequential compression devices
-early ambulation
-prophylactic anticoagulation
care: goals of treatment - ANS--prevent further thrombi
-prevent further embolization to pulmonary system
-provide cardiopulmonary support
care: supportive care variable - ANS--oxygen or mechanical ventilation
-pulmonary toilet
-fluids, diuretics, analgesics
pulmonary embolism drug therapy - ANS-Anticoagulation:
-Low-molecular-weight heparin (LHWH) SQ (Enoxaparin)
-Unfractionated IV heparin
-Warfarin (Coumadin) - Goal INR 2-3.0
Fibrinolytic agents:
-Tissue plasminogen activator (tPA)
-Alteplase (Activase)
pulmonary embolism surgical therapy - ANS--pulmonary embolectomy for massive PE
(if thrombolytics are contraindicated)
-percutaneous catheter embolectomy
-inferior vena cava filter to prevent migration of clots (prevents migration of clots in
pulmonary system)
nursing management of pulmonary embolism - ANS-Semi-Fowler's position
IV access
Oxygen therapy
Frequent assessments
Monitor laboratory results. (INR 2-3)
Emotional support and reassurance
, patient teaching - ANS--review long-term anticoagulation
-measures to prevent DVT
-importance of follow up exams
acute respiratory failure - ANS-results from inadequate gas exchange
-insufficient O2 transferred to blood (hypoxemia)
-inadequate CO2 removal (hypercapnia)
-hypoxemic respiratory failure (PaO2<60)
-hypercapnic respiratory failure (PaCo2>45)
Hypoxemic respiratory failure causes - ANS-alveolar hypoventilation:
-restrictive lung disease
-CNS disease
-chest wall dysfunction
-neuromuscular disease
diffusion limitation:
-severe COPD
-recurrent pulmonary emboli
-pulmonary fibrosis
-ARDS
-interstitial lung disease
-hypoxemia present during exercise
ventilation-perfusion mismatch:
-COPD
-pneumonia
-asthma
-atelectasis
-result of pain
-pulmonary embolus
Hypercapnic respiratory failure - ANS-INCREASED CO2 (greater than 45mm Hg) and
DECREASED pH (less than 7.35), Telling us it's a VENTILATION problem, pt either not
breathing enough or has an air trapping diagnosis such as asthma or COPD
hypercapnic respiratory failure - ANS-airway and alveoli abnormalities:
-asthma
-COPD
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