Pulmonary Embolism (BALANDAN)

7/27/2019 Pulmonary Embolism (BALANDAN)

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PulmonaryEmbolism


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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.


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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.


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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


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Pathophysiology


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Clinical Manifestations

Dyspnea

Chest pain

Anxiety

Fever Tachycardia

Apprehension

Cough

Diaphoresis

Syncope

Tachypnea Most common


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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


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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


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Prevention

Active leg exercises

Early ambulation

Anti-embolism stockings

M di l M


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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


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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


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Surgical Management

Embolectomy

Transvenous catheter


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Nursing Management Minimizing the risk of pulmonary embolism

Preventing thrombus formation MAJOR NURSINGRESPONSIBILITY

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


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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


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PULMONARYEDEMA


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PULMONARY EDEMA

It is the abnormal accumulation of fluid in the

lung tissue, alveolar space or both.


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Clinical Manifestaions

Increase respiratory distress

Dyspnea

Air hunger Central cyanosis

Foamy, frothy and blood stained sputum

Tachycardia


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Assessment and Diagnostic

Findings Auscultation crackles

Chest X-ray increase interstitial markings

Pulse oximeter decrease oxygen ABG worsening hypoxemia


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Medical Management

Vasodilators

Inotropic medications

Diuretics for fluid overload Oxygen therapy for hypoxemia

Morphine to relieve pain and anxiety


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Pulmonary Embolism (BALANDAN)

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