POLMUNARY EMBOLISM

refers to lodgement in one or more polmunary arteries of a thrombus or thrombi from venous system or in the heart presence of thrombus will interrupt blood supply so, it may cause infarction of lung tissue

SIGNS AND SYMPTOMS: of Polmunary emboli

sudden substernal pain dyspnea (difficulty of breathing) rapid and weak pulse shock syncope sudden death

SIGNS of Polmunary arteries are obstructed:

dyspnea (difficulty of breathing) mild substernal pain weakness tachycardia ( abnormal rapid pulse rate) fever cough hemoptysis (presence of blood in the sputum)

PREDISPOSING CAUSES: Immobilization- produces slowing of blood flow can produce a thrombus . Thus polmunary embolism is always a danger in :

patient after surgery obstetrical delivery prolonged bedrest aged individual who are inactive patient with congestive heart failure or with atrial fibrillation

MANAGEMENT: 1. prevent venous stagnation

patient on bed should be encourage an early ambulation or ambulate if possible according to his condition passive leg exercises deep breathing exercises

2. If large obstructing embolus should always ready for emergency therapy to combat shock, hypoxia and heart failure 3. patient be guarded for symptoms of cardiac arrest Nursing Interventions for Pulmonary Embolism Nursing goal is to prevent the development of DVT Early ambulation Use of Pneumatic stockings or boots/ support hose Passive ROM exercises are performed Signs and symptoms of DVT are monitored in the lower extremities( pain on dosiflexion of foot {Homans sign}) Provide O2 therapy and patient is asked to cough hours Signs and symptoms of worsening pulmonary ABG analysis and Pulse Oximetry is monitored Distraction is provided during periods of bedrest Pillows placed under patients knees in an return attempt to improve venous and deep breathe every 2

Patient is positioned for comfort and optimal oxygenation status is assessed

Signs and symptoms of bleeding are monitored when anticoagulant or thrombolytic therapy is in progress ( blood in stool or urine, pale mucous membranes, complaints of back or flank pain) Assess skin puncture sites for leakage, Anticoagulant laboratory values (CBC) are Administer medications to decrease anxiety (Pt. Education) Provide Patient education on definition of PE , symptoms. If Pt. is on anticoagulant therapy, explain the bleeding. Teach on proper use of antiembolic leg hose . how it develops, signs and signs and symptoms of and to avoid crossing of legs hemorrhage and hematoma monitored for any abnormalities and pain

Teach patient on the importance of adequate hydration

Treatments and drugs

Prompt treatment of pulmonary embolism is essential to prevent serious complications or death. Medications

Anticoagulants. Heparin works quickly and is usually delivered with a needle. Warfarin (Coumadin) comes in pill form. Both prevent new clots from forming, but it takes a few days before warfarin begins to work. Risks include bleeding gums and easy bruising. Clot dissolvers (thrombolytics). While clots usually dissolve on their own, there are medications that can dissolve clots quickly. Because these clot-busting drugs can cause sudden and severe bleeding, they usually are reserved for lifethreatening situations. 02 therapy

Surgical and other procedures

Clot removal. If you have a very large clot in your lung, your doctor may suggest removing it via a thin flexible tube (catheter) threaded through your blood vessels. Vein filter. A catheter can also be used to position a filter in the main vein called the inferior vena cava that leads from your legs to the right side of your heart. This filter can block clots from being carried into your lungs. This procedure is typically reserved for people who can't take anticoagulant drugs or when anticoagulant drugs don't work well enough.