Pulmonary Embolism

Prepared by:
Kristine Joy Elizada
BSN-3D
 What is Pulmonary Embolism?

An obstruction usually results from

dislodged thrombi that originate in the leg
veins. Other, less common sources of
thrombi includes pelvic veins, renal veins,
hepatic veins and right side of the heart,
and the arms.
 Risk Factors
• Precipitating • Predisposing
factors factors
-lung disorders age
-surgery sex
-diabetes mellitus hereditary
-Hx of
thromboembolism
-polycythemia
-obesity,burns
-immobilization
Pathophysiology of Pulmonary Embolism
Thrombus formation

Emboli travels to the lungs

Blood flow is obstructed leading to

decreased perfusion of the section of the
lung

Venous stasis, hypercoagubility, vessel wall

inflammation

Pulmonary embolism
 Clinical Manifestations

Dyspnea
Chestpain
Hypotension
Restlessness
Hemoptysis
 Diagnostic test

• Chest X-rays
• Lung scans
• ECG
• ABG
 Nursing Interventions
• Give oxygen via nasal cannula or mask.
• Check ABG levels if new emboli develop or dyspnea worsens
• Administer heparin as ordered through IV push or continuous drip.
• Monitor coagulation studies daily and after changes in heparin
dosage. Maintain adequate hydration to avoid the risk
hypercoagulability.after the patient is stable, encourage him to
move about often. Monitor the temperature and the color of
patient’s feet to check for venous stasis. Never vigorously
massage the patient’s legs.
• Report frequent pleuritic chest pain so that analgesics can be
prescribed.
• Evaluate the patient. His vital signs should be within normal limits
and he should show no signs of bleeding after anticoagulant
therapy.
 Cor Pulmonale

•Pulmonary Heart Disease

 Cor Pulmonale

• Is a condition in which hypertrophy and

dilatation of the right ventricle develop
secondary to disease affecting the
structure or function of the lungs.
 Risk Factors

• Predisposing factors • Precipitating factors

-Middle aged and elderly – Smoking
males – COPD
– Bronchial asthma
– Pulmonary emboli
– Obesity
 Pathophysiology of cor pulmonale

Alveolar hypoxia

hypoxemia
Hypoxic Pulmonary Vasoconstriction acidemia

Increased Pulmonary Vascular Capillary destruction

Resistance (emphysema)

Pulmonary Hypertension polycythemia

Increased right ventricular afterload

Cor
Right ventricular hypertrophy pulmonale

Right ventricular failure

 Clinical Manifestations

• Chronic, productive cough

• Exertional dyspnea
• Wheezing respirations
• Fatigue and weakness
• Dyspnea
• Tachypnea
• Orthopnea
• Dependent edema
• Distended neck veins
• Decreased cardiac output
• Enlarged tender liver
• Tachycardia
 Diagnostic Tests

• Echocardiogram or angiogram
• ABG analysis
• ECG
• Pulmonary function test
 Treatment

• Cardiac glycoside (digoxin)

• Antibiotics if respiratory infection is present
• Administration of potent pulmonary artery vasodilator
• Low-salt diet, restricted fluid intake and administration
of diuretics to reduce edema
• Anticoagulants
 Nursing responsibilities

• Prevent fluid retention by limiting the patient’s fluid

intake to (1-2L) per day and providing low salt diet
• Monitor serum potassium levels in patient receving
diuretics
• Watch for signs of digoxin toxicity.
• Monitor cardiac arrhythmias.
• Reposition the bedridden patient frequently to prevent
atelectasis
• Periodically measure ABG levels and watch for signs of
respiratory failure.