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A PE is a collection of particulate matter (solids, liquids, or air) that enters venous circulation and
lodges in the pulmonary vessels. In most people with PE, a blood clot from a DVT breaks loose
from one of the veins in the legs or in the pelvis. The clot breaks off, travels through the vena
cava into the right side of the heart, and then lodges in the pulmonary artery or one or more of
its branches. Platelets collect on the embolus, triggering the release of substances that cause
blood vessel constriction. Widespread pulmonary vessel constriction and pulmonary
hypertension impair gas exchange. Deoxygenated blood is moved into the arterial circulation,
causing hypoxemia. Pg. 677

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Ê Dyspnea, sudden onset
Ê Pleuritic chest pain
Ê Apprehension, restlessness
Ê 0eeling of impending doom
Ê Gough
Ê ^emoptysis


Ê Tachypnea
Ê Grackles
Ê Pleural friction rub
Ê Tachycardia
Ê Ô or Ô heart sound
Ê Diaphoresis
Ê 0ever, low-grade
Ê Petechiae over chest and axillae
Ê Decreased Ôao2
Pg. 679

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Activated partial thromboplastin time is a test to monitor anticoagulation drugs that help with
blood coagulation. Anticoagulant drugs such as ^eparin may be used to break up existing clots
such as a PE. The aPTT is taken every  hours when therapy of heparin therapy begins, and daily
thereafter to ensure that the values remain within the therapeutic range between 1.5 and 2.5
times the control value of - seconds making it anywhere between -75 seconds.
Pg. 251, 68

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Ê Evaluate chest pain (intensity, location, radiation)

Ê Auscultate lung sounds for crackles
Ê Donitor respiratory pattern for symptoms of respiratory difficulty
Ê Donitor Ôao2, apply nasal cannula or mask
Ê Donitor for symptoms of inadequate tissue oxygenation (pallor, cyanosis, sluggish cap.
Ê Encourage good ventilation (IÔ and cough and deep breathe every 2 hours
Ê Donitor for side effects of anticoagulant medications, have antidote available
Ê Donitor vital signs, lung sounds, and cardiac and respiratory status at least every 1 to 2
hours. Document increasing dyspnea, dysrhythmias, distended neck veins, and pedal
and sacral edema
Ê Two surgical procedures can be done to manage a PE (enbolectomy and inferior vena
cava interruption)
Ê When a patient has sudden onset of dyspnea and chest pain immediately notify the
Rapid Response Team
Ê roals of management for PE are to increase gas exchange, improve lung perfusion,
reduce risk for further clot formation, and prevent complications.
Ê Priority nursing interventions include implementing oxygen therapy, administering
anticoagulation or fibrinolytic therapy, monitoring the patient͛s responses to the
interventions Pg. 68

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RRT save lives and decrease the risk for harm by providing care to patients before a respiratory
or cardiac arrest occurs. The team responds to emergency calls, usually from nurses, and they
intervene rapidly for those who are beginning to clinically decline. This emergency care reduces
medical complications and decreases the number of arrest. Pg. 2

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When a patient has a sudden onset of dyspnea and chest pain, or slow or sudden deterioration
in clinical condition (hypotension, tachycardia, and mental status changes) Pg. 68
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Drug therapy with anticoagulants may be prescribed to keep the embolus from enlarging and to
prevent the formation of new clots. ^eparin is usually used unless the PE is massive or occurs
with hemodynamic instability. A fibrinolytic drug may then be used to break up the existing clot.
^eparin therapy usually continues for 5 to 1 days. Dost patients are started on an oral
anticoagulant, such as Warfarin on the third day of heparin use until the INR of 2- is reached.
Also, lovenox is often used along with warfarin. Values must be carefully monitored, and
antidotes must be available.
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^eparin is used to begin anticoagulation to minimize growth of existing clots and to prevent the
development of additional clots. Priority nursing objectives are ensuring that appropriate
antidotes are present on the unit, and protecting the patient from situations that can lead to
bleeding, and monitoring closely the amount of bleeding that occurring. Assess at least every 2
hours for bleeding in the form of oozing, bruises that cluster, petechiae, or pupura. Examine all
stools urine, drainage, and vomitus for blood. Deasure abdominal girth every 8 hours. Avoid ID
injections, and apply firm pressure to the needle stick site for 1 minutes or until site no longer
oozes blood if it can͛t be avoided, and observe IV sites every  hours for bleeding. ^andle the
patient gently.

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