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ATI Pulmonary Embolism
ATI 2010
71
Nursing
03/06/2013

Additional Nursing Flashcards

 


 

Cards

Term
___ occurs when a substance (solid, gaseous, or liquid) enters the venous circulation and forms a blockage in the pulmonary vascular
Definition
PULMONARY EMBOLISM
Term
most common cause of pulmonary embolism
Definition
emboli originating from deep vein thrombosis (DVT)
Term
Other causes that can also become emboli:
Definition
1. Tumors

2. Bone marrow

3. amniotic fluid

4. foreign matter
Term
T/F PE is a medical emergency
Definition
TRUE
Term
What can result from a large embolus?
Definition
increased hypoxia to pulmonary tissue &

impaired blood flow
Term
What is essential for a positive outcome of PE?
Definition
1. Prevention

2. Rapid recognition

3. Tx of PE
Term
Health Promotion and Disease Prevention of PE includes:
Definition
1. Smoking cessation

2. Encourage maintenance of appropriate weight for height and body frame

3. Encourage healthy diet and physical activity

4. PREVENT DVT -
Term
How can you prevent DVT?
Definition
-encourage clients to do exercises

wear compression stocktings

avoid sitting for long periods of time
Term
T/F Long term immobility is a risk factor of PE
Definition
True
Term
T/F Oral contraceptive use and estrogen therapy is NOT related to PE
Definition
FALSE. risk factor
Term
T/F
Pregnancy, Tobacco use, Obesity are risk factors to PE
Definition
True
Term
Hypercoagulability increases risk of PE
Definition
true.
(elevated platelet count)
Term
What type of surgery is a risk factor to PE?
Definition
surgeries are risk factors,

particularly, orthopedic surgery of the lower extremities or pelvis
Term
What types of cardiovascular DO are risk factors to PE?
Definition
HF and chronic atrial fib
Term
What type of anemia is a risk factor to PE?
Definition
autoimmune hemolytic anemia (sickle cell)
Term
T/F
Long bone fractures are a risk factor to PE
Definition
True
Term
Why are older adults have an increased risk of PE?
Definition
Older adults have DECREASED pulmonary reserves d/t normal lung changes

This includes:
-decreased lung elasticity and thickening alveoli

=--> older clients can decompensate more quickly
Term
What certain pathological conditions or procedures predispose clients to DVT?
Definition
* are more prevalent in older adults
-peripheral vascular disease

-HTN

-hip and knee orthoplasty
Term
Decreased physical activity levels in older adults predisposes them to _____ & ___
Definition
DVT formation and pulmonary emboli
Term
subjective data of PE
Definition
subjective data of PE

-anxiety

-P in chest

-feeling of impending doom

-pain upon INSPIRATION

-dyspnea & air hunger
Term
objective data: PE
Definition
objective data: PE

1. Pleurisy

2. Tachycardia

3. HypOtension

4. Tachypnea

5. Adventious BS (Crackles) cough

6. Heart mur murs

7. Diaphories

8. Decreased O2 sats

9. Petechiae (red dots under skin ) cynaosis

10 pleural effusion in the lungs
Term
Lab tests for PE
Definition
1. ABG

2. CBC analysis
Term
Findings of ABG
Definition
PaCo2 levels are LOW (expected range 35-45)
d/t initial hyperventilation (resp alkalosis)

--> as hypoexemia progressess --> resp acidosis occurs
Term
CBC analysis focuses on what value?
Definition
D-dimer


*elevated above expected range in response to clot formation & releases fibrin degradation products
Term
in PE ____ is elevated above expected range in response to clot formation and release fibrin degradation products
Definition
d-dimer

ref range 0.43-2.33 mcg/mL
Term
DX procedures for PE:
Definition
1. Chest x ray & CT scan

2. Ventilation and perfusion scan (VQ) scan

3. Pulmonary Angiography
Term
___ provides initial ID of a PE
Definition
Chest x ray and CT
Term
what is most commonly used to provide initial ID of PE?
Definition
CT scan
Term
A chest X ray can show:
Definition
a large PE
Term
___ images show the circulation of air and blood in the lungs and can detect a PE
Definition
ventilation and perfusion scan (V/Q scan)
Term
___ the most thorough test to detect a PE, but invasive and costly
Definition
pulmonary angiography

*catheter is inserted into the vena cava to visually see a PE
Term
Which is a higher risk procedure:
pulmonary angiography or V/Q scan
Definition
pulmonary angiography
Term
Nursing Actions for Pulmonary Angiography:
Definition
1. Verify INformed consent has been obtained

2. Monitor client status
-VS
-SaO2
-anxiety
-bleeding with angiography

*During and after procedure
Term
To relieve hypoxemia and dyspnea
Definition
1. administer oxygen therapy

2,. position client to maximize ventilation high foweler's = 90%
Term
Medications for PE:
Definition
1. anticoagulants

2. thrombolytic therapy
Term
___ used to prevent clots from getting larger or other clots from forming
Definition
anticoagulants

Enoxaparin (Lovenox)
heparin
warfarin (Coumadin)
Term
What contraindications need to be assessed for Anticoagulants:
Definition
1. Assess for contraindications
-active bleeding
-PUD
-history of stroke
-recent trauma
Term
What specific values need to be monitored for anticoagulants?
Definition
Bleeding times

1. Prothrombin (PT)& international normalized ration (INR)
--> for warfarin

2. partial thromboplastin time (aPTT)
--> for heparin

3.CBC
Term
S/E that need to be monitored for anticoagulants
Definition
1. thrombocytopenia

2. anemia

3. hemorrhage
Term
___ used to dissolve blood clots and restore pulmonary blood flow
Definition
thrombolytic therapy
Term
medications used for thrombolytic therapy?
Definition
Alteplase (Activase)

streptokinase (Streptase)
Term
T/F
Thrombolytic agents have similar s/e and contraindications as anticoagulants
Definition
TRUE
Term
How should streptokinase be given?
Definition
SLOWLY to pregevnt hypOtension.
Term
Who should be consulted for to manage PE and tx?
Definition
cardiology and pulmonary servicves?
Term
Respiratory services should be consulted for:
Definition
1. oxygen therapy

2. breathing tx

3. ABGs
Term
Who should be consulted for dx studies to determine PE
Definition
radiology
Term
___ surgical removal of embolus
Definition
embolectomy
Term
Nursing Actions for Embolectomy
Definition
1. Informed consent & NPO status

2. Post Op
-VS
SAO2
incision
pain
Term
__ insertion of a filter in the vena cava to prevent further emboli from reaching pulmonary vasculature
Definition
vena cava filter
Term
Nursing Actions for Vena Cava Filter
Definition
1. Informed consent & NPO status

2. Post Op
-VS
SAO2
incision
pain
Term
Care after D/C of PE/DVT
Definition
1. if client homebound - set up weekly blood draws

2. referral services to supply portable oxygen for clients who have severe dyspnea
Term
If taking Warfarin, teach client to monitor intake of what foods?
Definition
foods high in Vitamin K
** reduces anticoagulant effects of warfarin
Term
Foods high in vitamin K
Definition
green, leafy, veggies
Term
Client taking wafarin needs weekly blood draws for what?
Definition
monitoring PT and INR,
Term
T/F
D/t Warfarin there is an increased risk for bruising and bleeding
Definition
true
Term
TEACH client taking wafarin
Definition
1. Avoid taking asprin

2. Check mouth and skin daily for bleeding and bruising

3. Use electric shavers and soft bristled toothbrushes

4. Instruct client to avoid blowing nose hard, if nose bleeds occur apply gentle P
Term
Complications of PE:
Definition
1. decreased CO

2. hemorrhage
Term
__ amount of blood pumped by heart is decreased
Definition
decreased CO
Term
s/s of Decresed CO
Definition
1. hypotension

2. tachycardia

3. cyanosis

4. jugular vemous distension

5. syncome
Term
What IV fluids should be administered in decreased CO
Definition
crystalloids to replace vascular vol
Term
What medications could be administerd for decreased CO
Definition
1. inotropic agents
-milrinone Primacor
-dobutamine (dobutrex)

to increase mycardial contractility
Term
What can be administered if pulmonary artery pressure is high enough that it interferes with cardiac contractility?
Definition
vasodilators
Term
Receiving anticoagulant therapy increases the risk of ___
Definition
hemorrhage/bleeding
Term
Nursing actions: Hemorrhage
Definition
1. Assess for oozing bleeding bruiting from injection or surgical sites

2. Monitor CV status
-BP
HR
rhythm

3. Monitor CBC
-hemoglobin
-hematocrit
-platelets

Bleeding times
PT
aPTT
INR

Administer IV fluids and blood pdts

Test stools, urine, vomit for occult blood

Monitor for internal bleeding (measure ab girth and ab/flank pain
Term
A nurse is caring for several clients. Which of the following clients are at risk for pulmonary embolism?
- women taking BC pills
-postmenpausal women
-fracture femor
-smokes one pipe daily
-marathon runner
-chronic a fib and HF
Definition
- women on bc
(estrogen causes hypercoagulabiilty which increases risk of blood clot)

-pt fracture femur
(fractured long bone increases risk of fat emboli)

-smokes one pipe daily
(causes hypercoagulabiilty which increases risk of blood clot)

-HF & chronic a fib
(turbulent blood flow in heart, dysrhthmia, increases risk of blood clot)
Term
A nurse caring for a middle adult female client ho is admitted to the coronary care unit with acute dyspnea and diaphroesis. Pt states she is anxious because she cannot get enough air. VS: 117/min, 38/min, 38.4C 101.2, 100/54. What is the priority action

A. obtain ABG
B. Initate heparin drip
C. administer oxygen therapy
d. Spiral CT scan
Definition
oxygen.
Term
A nurse caring for a client who has a new Rx for heparin therapy. Which of the following statemetns by a client should pose an immediate concern for the nurse?

a. allergic to morphine
b. i take antacids several times a day
c. blood clot in leg several years ago
d. it hurts to take a deep breath
Definition
b. i take antiacids several times a day (greatest risk is possibility of bleeding from PUD)
Term
improves cardaic contractility
Definition
dobutamine
Term
restores intravascular volume
Definition
crystalloids
Term
assess for thrombocytopenia
Definition
monitor platelet count
Term
A nurse is caring for a client who is to receive fibriniolytic thrombolytic therapy. Which of the following should thenurse recognize as a CONTRAINDICATION?

1. hip arhtroplasty 2 weeks ago
2. elevated sed rate
3. incident of exercise indued asthma 1 wk ago
4. elevated PLT count
Definition
hip arthroplasty 2 wks ago

- pts who undergone a major surgical procedure within the last 3 weeks should NOT receive thrombolytic therapy b.c of risk of hemmorhage for surgical site.