Term
| ___ occurs when a substance (solid, gaseous, or liquid) enters the venous circulation and forms a blockage in the pulmonary vascular |
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Definition
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Term
| most common cause of pulmonary embolism |
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Definition
| emboli originating from deep vein thrombosis (DVT) |
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Term
| Other causes that can also become emboli: |
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Definition
1. Tumors
2. Bone marrow
3. amniotic fluid
4. foreign matter |
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Term
| T/F PE is a medical emergency |
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Definition
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Term
| What can result from a large embolus? |
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Definition
increased hypoxia to pulmonary tissue &
impaired blood flow |
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Term
| What is essential for a positive outcome of PE? |
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Definition
1. Prevention
2. Rapid recognition
3. Tx of PE |
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Term
| Health Promotion and Disease Prevention of PE includes: |
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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 - |
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Term
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Definition
-encourage clients to do exercises
wear compression stocktings
avoid sitting for long periods of time |
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Term
| T/F Long term immobility is a risk factor of PE |
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Definition
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Term
| T/F Oral contraceptive use and estrogen therapy is NOT related to PE |
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Definition
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Term
T/F
Pregnancy, Tobacco use, Obesity are risk factors to PE |
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Definition
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Term
| Hypercoagulability increases risk of PE |
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Definition
true.
(elevated platelet count) |
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Term
| What type of surgery is a risk factor to PE? |
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Definition
surgeries are risk factors,
particularly, orthopedic surgery of the lower extremities or pelvis |
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Term
| What types of cardiovascular DO are risk factors to PE? |
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Definition
| HF and chronic atrial fib |
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Term
| What type of anemia is a risk factor to PE? |
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Definition
| autoimmune hemolytic anemia (sickle cell) |
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Term
T/F
Long bone fractures are a risk factor to PE |
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Definition
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Term
| Why are older adults have an increased risk of PE? |
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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 |
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Term
| What certain pathological conditions or procedures predispose clients to DVT? |
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Definition
* are more prevalent in older adults
-peripheral vascular disease
-HTN
-hip and knee orthoplasty |
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Term
| Decreased physical activity levels in older adults predisposes them to _____ & ___ |
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Definition
| DVT formation and pulmonary emboli |
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Term
|
Definition
subjective data of PE
-anxiety
-P in chest
-feeling of impending doom
-pain upon INSPIRATION
-dyspnea & air hunger |
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Term
|
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 |
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Term
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Definition
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Term
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Definition
PaCo2 levels are LOW (expected range 35-45)
d/t initial hyperventilation (resp alkalosis)
--> as hypoexemia progressess --> resp acidosis occurs |
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Term
| CBC analysis focuses on what value? |
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Definition
D-dimer
*elevated above expected range in response to clot formation & releases fibrin degradation products |
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Term
| in PE ____ is elevated above expected range in response to clot formation and release fibrin degradation products |
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Definition
d-dimer
ref range 0.43-2.33 mcg/mL |
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Term
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Definition
1. Chest x ray & CT scan
2. Ventilation and perfusion scan (VQ) scan
3. Pulmonary Angiography |
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Term
| ___ provides initial ID of a PE |
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Definition
|
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Term
| what is most commonly used to provide initial ID of PE? |
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Definition
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Term
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Definition
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Term
| ___ images show the circulation of air and blood in the lungs and can detect a PE |
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Definition
| ventilation and perfusion scan (V/Q scan) |
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Term
| ___ the most thorough test to detect a PE, but invasive and costly |
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Definition
pulmonary angiography
*catheter is inserted into the vena cava to visually see a PE |
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Term
Which is a higher risk procedure:
pulmonary angiography or V/Q scan |
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Definition
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Term
| Nursing Actions for Pulmonary Angiography: |
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Definition
1. Verify INformed consent has been obtained
2. Monitor client status
-VS
-SaO2
-anxiety
-bleeding with angiography
*During and after procedure |
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Term
| To relieve hypoxemia and dyspnea |
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Definition
1. administer oxygen therapy
2,. position client to maximize ventilation high foweler's = 90% |
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Term
|
Definition
1. anticoagulants
2. thrombolytic therapy |
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Term
| ___ used to prevent clots from getting larger or other clots from forming |
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Definition
anticoagulants
Enoxaparin (Lovenox)
heparin
warfarin (Coumadin) |
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Term
| What contraindications need to be assessed for Anticoagulants: |
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Definition
1. Assess for contraindications
-active bleeding
-PUD
-history of stroke
-recent trauma |
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Term
| What specific values need to be monitored for anticoagulants? |
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Definition
Bleeding times
1. Prothrombin (PT)& international normalized ration (INR)
--> for warfarin
2. partial thromboplastin time (aPTT)
--> for heparin
3.CBC |
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Term
| S/E that need to be monitored for anticoagulants |
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Definition
1. thrombocytopenia
2. anemia
3. hemorrhage |
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Term
| ___ used to dissolve blood clots and restore pulmonary blood flow |
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Definition
|
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Term
| medications used for thrombolytic therapy? |
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Definition
Alteplase (Activase)
streptokinase (Streptase) |
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Term
T/F
Thrombolytic agents have similar s/e and contraindications as anticoagulants |
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Definition
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Term
| How should streptokinase be given? |
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Definition
| SLOWLY to pregevnt hypOtension. |
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Term
| Who should be consulted for to manage PE and tx? |
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Definition
| cardiology and pulmonary servicves? |
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Term
| Respiratory services should be consulted for: |
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Definition
1. oxygen therapy
2. breathing tx
3. ABGs |
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Term
| Who should be consulted for dx studies to determine PE |
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Definition
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Term
| ___ surgical removal of embolus |
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Definition
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Term
| Nursing Actions for Embolectomy |
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Definition
1. Informed consent & NPO status
2. Post Op
-VS
SAO2
incision
pain |
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Term
| __ insertion of a filter in the vena cava to prevent further emboli from reaching pulmonary vasculature |
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Definition
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Term
| Nursing Actions for Vena Cava Filter |
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Definition
1. Informed consent & NPO status
2. Post Op
-VS
SAO2
incision
pain |
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Term
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Definition
1. if client homebound - set up weekly blood draws
2. referral services to supply portable oxygen for clients who have severe dyspnea |
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Term
| If taking Warfarin, teach client to monitor intake of what foods? |
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Definition
foods high in Vitamin K
** reduces anticoagulant effects of warfarin |
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Term
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Definition
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Term
| Client taking wafarin needs weekly blood draws for what? |
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Definition
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Term
T/F
D/t Warfarin there is an increased risk for bruising and bleeding |
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Definition
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Term
| TEACH client taking wafarin |
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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 |
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Term
|
Definition
1. decreased CO
2. hemorrhage |
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Term
| __ amount of blood pumped by heart is decreased |
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Definition
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Term
|
Definition
1. hypotension
2. tachycardia
3. cyanosis
4. jugular vemous distension
5. syncome |
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Term
| What IV fluids should be administered in decreased CO |
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Definition
| crystalloids to replace vascular vol |
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Term
| What medications could be administerd for decreased CO |
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Definition
1. inotropic agents
-milrinone Primacor
-dobutamine (dobutrex)
to increase mycardial contractility |
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Term
| What can be administered if pulmonary artery pressure is high enough that it interferes with cardiac contractility? |
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Definition
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Term
| Receiving anticoagulant therapy increases the risk of ___ |
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Definition
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Term
| Nursing actions: Hemorrhage |
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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 |
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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) |
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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 |
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Definition
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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 |
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Definition
| b. i take antiacids several times a day (greatest risk is possibility of bleeding from PUD) |
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Term
| improves cardaic contractility |
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Definition
|
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Term
| restores intravascular volume |
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Definition
|
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Term
| assess for thrombocytopenia |
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Definition
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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 |
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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. |
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