Test your knowledge on the lab values you need to know for NCLEX with these quiz questions for nursing students! Most patients who die from pulmonary embolism have not had any diagnostic workup, nor have they received any prophylaxis for the disease’’ (Feied & Handler, 2000). Prevention of deep vein thrombosis and pulmonary embolism. Small embolus in patient with healthy lung may be asymptomatic or very subtle/nonspecific, 2. Pulmonary embolism refers to the obstruction of the pulmonary artery or one of its branches by a thrombus that originates somewhere in the venous system or in the right side of the heart. Causes decreased perfusion, hypoxemia, and if large enough, right-sided heart failure. First Edition Authors: Patricia A. Lewis and Karla Mees. Age: risk progressively increases over 40; threefold increase in risk after age 70 (Caprini, Arcelus, Hasty, Tamhane, & Fabrega, 1991), b. Immobilization: bed rest, travel, sedentary work, d. Obesity: increased intra-abdominal pressure plus relative sedentary lifestyle, e. Pregnancy and postpartum state, estrogen therapy: hormonal changes affect vessel wall, a. Postsurgical or trauma patient: especially chest, abdomen, pelvic, or leg injury, c. Intravenous therapy, central venous catheters, c. Polycythemia: associated with other pulmonary conditions or congenital heart defects, d. Genetic disorders of coagulability (refer to Chapter 19, Superficial Thrombophlebitis and Deep Vein Thrombosis), k. Lupus anticoagulant/anticardiolipin antibody, l. Disseminated intravascular coagulation (DIC), m. Medications: chemotherapy, estrogen/oral contraception, 1. Internal filling defect in pulmonary artery confirms diagnosis, a. Invasive procedure using contrast material: need to note allergies, b. Pulmonary embolism. Once lytic therapy complete, do not resume heparin until aPPT <80 seconds (Walsh & Rice, 2004), 1) Hemorrhage: major bleeding occurs in approximately 20% (Erdman et al., 1997). b. Observe/record frequency of requests for pain medication, c. Observe tolerance of activity: increased pain, tachycardia, hypertension, C. Anxiety related to dyspnea, pain, and unknown treatments/diagnostics, a. amzn_assoc_region = "US"; Pulmonary embolism: High Fowler’s. b. Auscultate lung and heart sounds with each assessment and p.r.n. - Clots may break off from a larger clot in one of the deep veins and travel with venous blood to the right side of the heart. Browse our nursing jobs page to learn more about specialties, resume templates, and job-related resources. The clot is removed by withdrawal of the inflated catheter, c. Immediately followed by vena caval filter placement and anticoagulation, d. Rheolytic thrombectomy: high-velocity saline solution to create a strong Venturi effect, followed by aspiration of the clot with catheter or syringe, e. Open surgical embolectomy: used for patients with adequate systolic arterial pressure but profound right ventricular failure; beating heart bypass technique (Aklog et al., 2002; Cardin & Marinelli, 2004), A. Alteration in tissue perfusion related to pulmonary arterial obstruction as evidenced by dyspnea, tachypnea, and tachycardia, 1. Graduated compression support stocking (18 to 20 mm Hg) if patient has normal arterial examination, 3. The epidemiology of venous thromboembolism in the community. 2. Dissolution of clot via chemical lysis of fibrin component, resulting in rapid removal of intraluminal thrombus and restoration of vessel patency, a. Since then, there has been a large growth in the number of nursing schools, nursing regulatory boards, and active nurses. Thompson, B. T., & Hales, C. A. The development of the profession was largely influenced by Florence Nightingale, who felt a strong conviction that God had called to her become a nurse. Superficial thrombophlebitis (STP) generally does not lead to PE unless thrombus extends from greater saphenous vein (GSV) beyond saphenofemoral junction (SFJ) into common femoral vein, a. Displaces blood in the arterioles and capillaries, a. Displaces blood and reduces oxygen, nutrient, and waste exchange, b. Intravenous access: large bore needle if possible, 5. Urokinase: urokinase is not currently available since Abbokinase is no longer manufactured and Kinlytic is not yet FDA approved, c. Recombinant tissue plasminogen activator (rt-PA), 1) 100 mg as continuous infusion over 2 hours, 2) More rapid and complete thrombus dissolution compared to urokinase, 4) Alteplase is only FDA approved for pulmonary embolism (Jaff et al., 2011), 7. Women of childbearing age: oral contraception; planned conception (warfarin crosses placenta and causes birth defects); alcohol, tobacco, and illicit drug use; compliance; other medications such as steroid therapy; varicose veins, 3. If you find our website or videos helpful, please tell other nursing students, professors, family, and friends about us. Greenfield, L. J., & Proctor, M. C. (1996). (2000). 7. b and d. Helping Mr. D understand the risk factors for recurrence of PE can be life saving. Nursing assessment of clients at risk of deep vein thrombosis (DVT): The autar DVT scale. The diagnosis, risk assessment, and management of pulmonary embolism have evolved with a better understanding of efficient use of diagnostic and therapeutic options. Extensive abdominal or pelvic surgery for malignancy, 11. MRI: has been used to make diagnosis but not cost effective or safe in critically ill patients; respiratory and cardiac artifact limit imaging, b. Important to reach therapeutic level as quickly as possible to prevent reoccurrence of PE: 1.5 to 2.5 times baseline aPTT, 1) Initial bolus of 120 to 140 units/kg: 5,000 to 10,000 units, 2) Infusion of 20 units/kg/hr: usually 1,000 to 2,000 units/hr, 3) Check aPTT every 6 hours until stable, adjust heparin as necessary (Feied & Handler, 2000). This is thought to be due to improved diagnosis and treatment of DVT, with wider acceptance of prophylaxis and public education regarding prevention. Promotion of a healthy lifestyle: maintain appropriate weight, exercise/mobility, 4. 1 Most PEs arise from the legs. What signs and symptoms are suspicious for thromboembolism? Furthermore, nursing is truly one of the most diverse professions, offering many different specialties and opportunities for advancement. Autar, R. (1996). Licensed practical nurses (LPNs or LVNs): average salary of $44,030; average hourly wage of $21.17. Heparin remains the cornerstone of treatment for PE. Adjust subsequent daily dose according to the INR, with goal of 2 to 3, 3. Clinical trial results. B/P 130/70; uniform mild edema of right lower extremity from proximal thigh to ankle, radial and pedal pulses +4, Respiratory: rate 24, even and labored; chest clear bilaterally with no areas of dullness to percussion, Gastrointestinal: bowel sounds present in all four quadrants; no organomegaly, bruits, or masses, Neurologic: no deficits; alert, oriented, and appropriate but appears anxious with rapid speech and restlessness, Social history: independent ADLs; lives with his wife in a one-story home; two daughters who live close; smokes 1 pack per day for past 40 years; drinks 1 to 3 beers after work daily, Family history: mother, age 81, and two maternal uncles, both deceased, have history of DVT, ECG tachycardia with nonspecific T-wave and ST segment changes, Initial diagnosis: pulmonary embolism and right lower extremity DVT suspected. Not recommended for patients with severe renal insufficiency, low body weight, active major bleeding, bacterial endocarditis, or thrombocytopenia, b. Predisposing factors include: 4. Veins located in the pelvis, lower leg (calf), and thighs. Enter your email address below and hit "Submit" to receive free email updates and nursing tips. McCance, S. L., & Huether, S. E. (1998). Administration of oxygen and 1 mg of morphine sulfate, c. 1 L of normal saline rapidly infused over 30 minutes. Discuss methods of prevention of venous thromboembolism. Retrieved from www.trialresultscenter.org/study7632-PEGASUS.htm, accessed August 17, 2013. Potential complications (Walsh & Rice, 2004), d. Occlusion of device with bilateral venous outflow obstruction, 1. b. 2. Complete obstruction of outflow from right ventricle, c. Sudden shock with severe chest pain, tachycardia, hypotension, cyanosis, stupor, syncope, d. Death within 30 minutes before medical intervention can be initiated, A. Nursing students can access care plan examples, nursing school study tips, NCLEX review lectures and quizzes, nursing skills, and more. Berg, D. E. (1992). Thrombolytic therapy unavailable or contraindicated, c. Most patients die before they can be transported to operating room or stabilize and no longer require procedure, d. Rarely used electively for patients with chronic PE where clot did not naturally lyse, a. Balloon-tipped catheter is inserted into the pulmonary artery via incision in groin, b. Pulmonary infarction is the term used to describe a local area of necrosis in lung tissue resulting from vascular obstruction. Overlap heparin and warfarin for 5 to 7 days or until INR stable at therapeutic goal for 48 hours to allow for depletion of vitamin K-dependent clotting factors, 4. Early (within first 24 hours) achievement of a therapeutic aPPT (1.5 to 2.5 baseline) has been shown to stop progression of thrombosis and lower recurrence rate. 1. Chest: areas of dullness indicate consolidation/fluid collection, e. Cardiac: murmur, rub, arrhythmia, bruits, f. Lung sounds: rales, pleural friction rub, diminished lung sounds, g. Abdomen: bowel sounds will be diminished if in shock, a. 968–1023). Signs and symptoms variable, subtle, and nonspecific, a. She focused on improving sanitation and nutrition. Expected patient outcomes: patient will maintain end-organ perfusion, a. Deep vein thrombosis can cause leg pain or swelling, but may occur without any symptoms. Smoking cessation and use of a medication bracelet, d. Discussion of anticoagulation side effects and his work responsibilities. Patient will verbalize understanding of related tests and medical/nursing treatments, a. Administer medication as indicated for control of anxiety in acute stage of illness, b. Use the search tool below to find videos fast! 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