Term
| What causes a Pulmonary Embolism? |
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Definition
| A clot lodges in a branch of the pulmonary artery, disrupting flow of blood to an area of the lungs. |
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Term
| Most thrombotic emboli start as a ___ in the iliac, femoral, or popliteal venis. |
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Definition
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Term
| A blood clot may also form in the RV, become an embolus and travel to the __ __. |
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Definition
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Term
| What are the 3 predisposing factors that put a person at risk for development of a PE? |
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Definition
| Hypercoagulability (Thick blood, or patient's not well hydrated), injury to vascular endothelium, and venous stasis (patient isn't moving, causing blood to pool and form clots) |
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Term
| Occlusion of more than __ of the pulmonary vascular bed (Massive PE) has both pulmonary and hemodynamic consequences. |
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Definition
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Term
| What are the pulmonary and hemodynamic consequences of a Massive PE? |
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Definition
| Increased dead space: O2 is coming in but no blood flow to pick it up. Bronchoconstriction: Wheezing. Compensatory shunting: Blood shunts off somewhere else to pick up O2. Pulmonary HTN: pressure within the PA is very high (around 16-19). |
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Term
| What are some s/s of a PE? |
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Definition
| Tachycardia, tachypnea, dyspnea, apprehension, fever, pleuritic chest pain, cough, hemoptysis (bloody sputum), presence of a DVT, crackles in lungs, RVF, and syncope. |
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Term
| What is the main test done to check for Pulmonary Embolism? |
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Definition
| V/Q Scan, if 0.8 or greater there is a PE. Normal is 0.8 or (4:5). |
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Term
| What levels of an ABG indicate presence of a PE? |
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Definition
| Low PaO2, Low PaCO2, elevated D-Dimer |
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Term
| Why is it important to monitor ECG in patients with high risk for PE? |
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Definition
| Want to watch for new onset A-Fib nad RBBB. This is bad because the heart is used to pumping at a regular rate, when it becomes irregular not all of the blood is pumped out causing it to pool in the heart and cause clots, which can release to the brain! |
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Term
| How is a pulmonary angiogram performed in patients with PE? |
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Definition
| Catheter inserted, and dye is released throughout the PA to look for clot. |
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Term
| For patients at high-risk of developing a PE, what is the priority medical management? |
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Definition
| Prevention strategies: anticoagulation meds, SCDs, TEDs, etc. |
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Term
| Once a patient has a PE, what are some treatment strategies for that patient? |
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Definition
| prevention of recurrence, clot dissolution, reverse pulmonary HTN, promote gas exchange, and prevent complications. |
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Term
| What may be ordered to dissolve the clot in PE patients and what lab needs to monitored? |
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Definition
| Heparin. Monitor the PTT value, its value should be 1.5-2 times the normal value. |
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Term
| How can we reverse Pulmonary HTN in PE patients? |
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Definition
| Reverse by giving positive inotropes: Dobutamine, Dig. It makes the heart pump really hard to increase CO to get the stagnant blood out the heart. |
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Term
| What is a major complication of patients with PE? |
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Definition
| Respiratory Failure. Always oxygenate patient first, then start an IV line. |
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Term
| As nurses, what does our assessment include for PE patients? |
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Definition
| Vital signs, ABGs(monitors if pt is getting worse), lab values (PTT, INR), and ausculatation of breath sounds (they may have developed crackles), and continuous assessment of lower extremtities for DVT. |
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Term
| What are 3 main nursing diagnoses for PE patients? |
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Definition
| Impaired gas exchange r/t V/Q mismatching or intrapulmonary shunting and Acute pain. If patient is not in pain, the next diagnosis would be Risk for fluid volume deficit r/t bleeding. |
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Term
| What is a nurse's priority intervention? |
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Definition
| Prevention! Prevent DVT from occurring by passive & active ROM exercises, SCDs, TEDs, adequate hydration. Teach to not sit/stand for long periods of time, don't cross legs, don't wear constrictive clothing, and increase fluids. |
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Term
| What are some medications administered to patients with PE? |
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Definition
| Thrombolytics (streptokinase, Activase), Heparin, Coumadin, Lovenox, Inotropic Agents, and analgesics. |
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Term
| After assessing our patient, what is an important intervention to implement before leaving the room? |
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Definition
| Give the patient the call bell. patient may become anxious if someone is not in the room and something happens. |
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Term
| What are some other important nursing interventions for PE patients? |
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Definition
| Optimize adequate oxygentaion & ventilation-manage ventilator, positioning, promote secretion clearance, and prevent desaturation. Manage IV fluids, Monitor Lab Values (PTT, INR, CBC, ABG), and provide comfort and emotional support. |
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Term
| Hemodynamic monitoring for PE patients include, ___, ____, and ____. |
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Definition
| Central Venous Catheter pressure, Pulmonary Artery Catheter pressur, adn Cardiac Output. |
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Term
| What can we teach our client with PE? |
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Definition
| How to prevent DVT, s/s of DVT, How to decrease risk factors, and prevention of bleeding if patient is on anticoagulants. |
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