Hi tnedokushev,
Please kindly make this concept map revision.
This is adult health 2 ( med-surge )
PULMONARY EMBOLISM
Pathophysiology
Pulmonary embolism is the blockage of
one, or more, of arteries of pulmonary
circulation. When a foreign material for
example blood clot blocks one of the
lung arteries, the part of the lung supplied
by that particular artery experience an
imbalance between ventilation and blood
supply. This leads to impaired diffusion
of oxygen to blood and carbon dioxide
from blood to alveoli (Swaroop &
Tarbox, 2013)
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Medical diagnosis
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Diagnostic tests
Chest X-ray, MRI and CT Scan
for visualization of the lungs and
heart.
Pulmonary angiography to
visualize lung blood vessels.
Venography to see the leg veins.
Lab tests
Check the levels of:
• Glucose
• BUN
• Creatinine
• Sodium
• Potassium
• Chloride
• CO
• Calcium
Typical treatment
Thrombolytic agent such as intravenous streptokinase 250000 IU (bolus) followed by 100000 IU infusion per
hour for the next 24 hours. Striptokinase work by dissolving the thrombi within the pulmonary arteries. Its side
effects include increased risk for bleeding, fever, and hypotension
Anticoagulant i.e. intravenous heparin 80 units/Kg bolus followed by 18 units/Kg/hour continuous infusion.
Heparin prevents further formation of blood clots intravascularly. Anticipated side effects are risk for
hemorrhage, thrombocytopenia and allergic reaction.
Administer oxygen and titrate to achieve SPO2 of >96%, PaO2 >80% and PaCO2 of 35-45%. Oxygen therapy
will increase oxygen available for perfusion and reduce respiratory rate, which will in turn lead to normalization
of PaCO2.
Clinical presentation
Signs and symptoms
Chest pain, dyspnea,
tachypnea, dry cough;
occasionally bloody
productive, dizziness,
anxiety, tachycardia,
cyanosis (Swaroop &
Tarbox, 2013)
Case study
Mr. K, a 86 year old client with history of deep venous thrombosis present to the outpatient facility with
complains of chest pain, palpitations, cough, anxiety and gasping for breath. His vital signs shows that
BP 142/83, respiratory rate 18, temperature 97.4, pulse 81 and Sp02 96%. Lab results indicates glucose
104, BUN 21.0, creatinine 0.7, sodium 138, potassium 3.9, chloride 103, CO2 26, calcium 9.1.
PULMONARY EMBOLISM
Objective data
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Subjective data
Chest pain
Palpitations
Cough
Anxiety
Gasping for breath
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Vital signs
BP 142/83
RR 18
Temp 97.4
Pulse 81
Sp02 96%
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Lab results
Glucose 104
BUN 21.0
Creatinine 0.7
Sodium 138
Potassium 3.9
Chloride 103
CO2 26
Calcium 9.1
Nursing Diagnosis
Nursing diagnosis 1
Nursing Diagnosis 2
Nursing diagnosis 3
Patient results
Normal ranges
Rationale for the test
To detect any abnormalities and intervene by repla
electrolytes
138
9.1
3.9
103
135-146 mmol/L
8.6-10.3 mmol/L
3.5-5.5 mmol/L
95-105 mmol/L
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96%, PaO2
>80% and PaCO2 of 35-45%.
Oxygen therapy will increase oxygen available for perfusion
and reduce respiratory rate, which will in turn lead to
normalization of PaCO2.
Nursing diagnosis 1
➢ Impaired gaseous exchange related to pulmonary artery obstruction by an embolus as evidenced by patient gasping for
breath.
Outcome identification:
➢ After a period of 2-3 hours, the patient will have better gaseous exchange that will be evidenced by normal arterial blood
gases and reduced pain and chest pain.
Planning and implementation of care and their rationales:
➢ Check lung sounds and the rate of respiration. Unclear or absent lung sounds and higher than 24 or lower than 14
respiratory rate indicates that the patient is distressed.
➢ Check skin color for cyanosis. This indicates poor oxygenation.
➢ Monitor pulse oximetry. Less than 90% indicates poor oxygen supply to body tissues.
➢ Administer Oxygen therapy at 2 L/minute. This aids in increasing oxygen concentration in blood.
➢ Perform patient on high Fowler’s position. This aids in oxygen delivery to the tissues (Morici, 2014).
Nursing diagnosis 2
➢Acute pain related to tissue hypoxia as evidenced by reports of chest pain
Outcome identification:
➢After a period of between 45 minutes to 1 hour, the patient will be able to
breath in deeply and comfortably.
Planning and implementation of care and their rationales:
➢Administer analgesic: analgesics will help relieve the pain
➢Administer oxygen: this will help counter the effects of hypoxia on
tissues(Morici, 2014).
Nursing diagnosis 3
• Risk for injury bleeding/coagulopathies related to the use of anticoagulants.
Outcome identification:
• Throughout the period on using anticoagulants, the patient will be free from bleeding.
Planning and implementation of care and their rationales:
• Daily check on coagulation studies. This provides a basis of making any necessary
adjustments on the dose and type of anticoagulants.
• Give instructions to the patient to report any bleeding. This allows timely administration
of antidote or adjustment of dose of anticoagulants
• Teach the patient on measures like using soft tooth brushes. This reduce the chances of
injury and bleeding.
• Avoid use of intramuscular route of drug administration. This can potentially lead to
formation of hematoma (Pineo & Hull, 2012).
References
• References
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Morici, B. (2014). Diagnosis and management of acute pulmonary
embolism. Journal of the American Academy of Physician Assistants, 27(4),
18–22. https://doi.org/10.1097/01.jaa.0000444729.09046.09
• Pineo, G. F., & Hull, R. D. (2012). Adverse Effects of Coumarin
Anticoagulants. Drug Safety, 9(4), 263–271.
https://doi.org/10.2165/00002018-199309040-00004
• Sharon Mantik Lewis. (2017). Medical-surgical nursing : assessment and
management of clinical problems (10th ed.). Elsevier.
• Swaroop, M., & Tarbox, A. (2013). Pulmonary embolism. International
Journal of Critical Illness and Injury Science, 3(1), 69.
https://doi.org/10.4103/2229-5151.109427
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Date for the Lab test was 10/24/2020
Head to toe assessment
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Patient is alert and oriented x4
Pt has no hearing aide
Pt pupil is round, equal, and reactive to light
No lumps in her neck
No redness in her nose
Good gag reflux
Normal bowel sound
Nose is symmetric, no discharge or flaring, no tenderness and lesions
Skin is intact
No loose teeth, and does not use dentures
Face is symmetrical
Her skull is round, no masses
Hair is evenly distributed
Please kindly add any additional assessment that can be used for pulmonary embolism patient.
Thank you
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Graded on
Wednesday, 2 December 2020, 9:25 AM
Graded by
Picture of Deborah WirwiczDeborah Wirwicz
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You did not include your head-to-toe assessment.
You did not include the date of your lab/tests.
LIpid profile: your rationale is incorrect…
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