Let’s talk pulmonary embolism. The chances of you getting a question about pulmonary embolism on the actual is pretty low. However, let’s talk about it and give you the things that you need to know in case you encounter one of these questions.
First of all, let’s discuss what exactly is a pulmonary embolism. You’re going to hear pulmonary embolism as PE if you’re working in the hospital. You’re going to know it as PE, that’s what everybody’s going to call it. What is a PE? A PE, first of all it’s pulmonary, so that means lungs. Then it’s called embolism, so what’s an embolism? An embolus is a clot that breaks off and travels through the bloodstream. What’s going to happen with a pulmonary embolism is a clot is going to break off, usually a DVT, something in the lower extremities. It’s going to break off, travel through the bloodstream, into the right heart, and then into the blood supply of the lungs.
It’s going to get into the blood supply of the lungs, and eventually it’s going to get to a spot that it can no longer travel. It’s going to get into a spot that it actually clogs off the blood supply to a portion of the lungs. What’s going to happen there is you’re going to have all this blood that’s trying to get perfused. It’s going to try reach these alveolae and get perfused with oxygen and it’s going to be able to do so. That’s what a pulmonary embolism is.
Understanding what happens here and that we’re blocking off that blood flow will help us understand what some of the different symptoms are going to be. For your assessment on your patient; first of all it’s going to be anxiety. If you think about this, these patients aren’t able to perfuse their blood, and so they’re going to become very anxious. They’re going to have tachycardia, tachypnea, they’re going to breathing very fast. Plus there’ll be hypotension and a low-grade fever.
They will probably have a cough. They’ll have this dry cough, and they might have some hemoptysis, which means a little bit of blood in their cough. They got this blood clot in there, they might get a little bit of blood with it.
They’re in those altered mental status, decreased level of consciousness. These patients are no longer getting the oxygen that they need, so their neuro status is going to change. They’re going to have diaphoresis, you’re going to notice a sweating on them. This anxiety, this change in level of consciousness. You’re going to also notice VQ mismatch. Ventilation perfusion, this means Ventilation Perfusion Scan, and what that’s going to show you is basically you’re going to see VQ mismatch. That’s what you need to know with that. That’s something we can into later.
You’re going to notice an extremely low PaO2. Their partial pressure of oxygen in their blood is going to be very low, obviously they’re not getting oxygen to the blood. Pulmonary angio is going actually possibly show us the clot.
Management with this, we need to get them oxygen. We need to provide supplement oxygen, and be prepared for mechanical ventilation. If we’re unable to get their PaO2 where we need it be, then we need to offer them mechanical ventilation. We’re going to offer them anti-coags, try to decrease the coagulation in their blood, and we’re probably also going to have throw thrombolytic exactum. Possibly some TPA, or something like that to break up that clot, to bust it, and to get blood flowing how it needs to.
Obviously, we’re going to give them opioids to treat this pain that they’re going to be having, and we need to give them anti-anxieties. Or anxiolytics to help calm them, and help them feel that we’re going to be able to treat this and help them. Another thing we’re going to do is a vena cava filter. What this is, we have our inferior vena cava coming up from the lower extremities into the heart. What a vena cava filer is it’s this little tiny metal-shaped cone, triangular-shaped net, that actually sits in the inferior vena cava.
You’ll see this IVC filter, and what that does is that is going to catch any clots that break off. They’re actually going to get caught in this little net, and they will not be able to travel to the lungs, so that’s what an IVC filter is. Here’s a pulmonary angio, this is an angiogram of you can see heart here, lungs, and this is what doctors may use to be able to definitively diagnose PE.
That’s what you need to know about PE. Mainly anxiety, pain, and obviously they’re not going to be to breathe as need to, so we need to break up that clot. We need to prevent further clots. Guys, that’s what you need to know about PE. Be sure to subscribe to get more information and more two minute RN videos. If you have any questions you can e-mail me, contact at nrsng.com, or leave a comment below. Thanks a lot guys.
Date Published - Mar 17, 2015
Date Modified - Feb 25, 2016