Nursing Care Plan for Pulmonary Embolism

Pulmonary Embolism
Pulmonary embolism (PE)

A pulmonary embolism is a sudden blockage in a lung artery. The cause is usually a blood clot in the leg called a deep vein thrombosis that breaks loose and travels through the bloodstream to the lung. Pulmonary embolism is a serious condition that can cause

  • Permanent damage to the affected lung
  • Low oxygen levels in your blood
  • Damage to other organs in your body from not getting enough oxygen
If a clot is large, or if there are many clots, pulmonary embolism can cause death.


Signs and Symptoms
  • dyspnoea - suddenly and there is at 90% of cases
  • pleuritic chest pain
  • haemoptisis
  • fainting
  • tachycardia more than 100/menit
  • tachipnoe more than 20/menit
  • fever

Threat Signs of Life:
Symptoms of Pulmonary embolism:
  • severe dyspnea
  • chest pain
  • increased venous pressure
  • there is evidence of right heart failure
  • hypotension
  • shock

Assessment for Pulmonary Embolism

Assessment of the ABCD approach

Airway
  • Assess and maintain airway
  • Perform head tilt, chin lift if necessary
  • Use this tool to the airway if necessary
  • Consider referring to the anesthesiologist to do intubation if unable to maintain airway

Breathing
  • Assess oxygen saturation using pulse oximeter, to retain more than 92% saturation.
  • Give high-flow oxygen via non re-breath mask.
  • Consider getting a breathing using bag-valve-mask ventilation
  • Make checks to assess arterial blood gas PaO2 and PaCO2
  • Assess breathing
  • Perform examination of respiratory system
  • Listen to the sound of the pleura
  • Make checks thoracic images - may be normal, but look for:
  • Evidence of a wedge shaped shadow (infarct)
  • Linear atelectasis
  • Effuse pleural
  • Hemidiaphragm increased
  • If the clinical signs show the presence of pulmonary embolism, ventilation perfusion scan done (VQ) or CT pulmonary angiogram (CTPA) in accordance with local policy

Circulation
  • Assess heart rate and rhythm, the possibility of sound gallops
  • Assess increased JVP
  • Record blood pressure
  • ECG examination may show:
  • Sinus tachycardia
  • The existence of S1 Q3 T3
  • Right bundle branch block (RBBB)
  • Right axis deviation (RAD)
  • P pulmonale
  • Perform IV access
  • Perform a complete blood

Disability
  • Assess level of consciousness by using AVPU
  • Decreased awareness of incoming patients showed early signs of extreme conditions and require immediate medical attention and requires treatment in the ICU.

Exposure
  • Always examine the possibility of using a test Pulmonary embolism, if the patient is stable and health history examinations do other physical examination.
  • Do not forget to check for signs of DVT

Risk Factors of Pulmonary embolism
  • DVT exist in 50% of patients
  • Previous surgery
  • Previous trauma
  • Immobilization for various reasons
  • Malignancy
  • Patients taking oral contraceptives
  • Patients received hormone therapy
  • Long gestation
  • Obesity
  • Patients get Estregen Selective Receptor Modulator therapy (SERM)
  • Hyperviskositas Syndrome
  • Childbed
  • Nephrotic syndrome
  • Antithrombin III deficiency
  • Deficiencies of protein C and S
  • Lupus anticoagulant

Nursing Care Plan for Pulmonary Embolism