Pulmonary

Complications
Jenneth A. Estampa RN, MN
Pulmonary
Embolism
PULMONARY EMBOLISM (PE)

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.
USUALLY RESULTS FROM A
BLOOD CLOT IN THE LEG
THAT TRAVELS TO THE
LUNG.
ORIGINS:
DEEP CALF
FEMORAL
POPLITEAL
ILIAC VEINS
 ETIOLOGIC
1. Smoking
FACTORS:
2. Venous stasis/immobility
3. Hypercoagulable states
4. Oral contraceptives
5. Surgery
6. Age older than 50 years
7. Pregnancy
8. Constrictive clothing
MECHANISM OF PULMONARY EMBOLISM:
 CLINICAL
1. Dyspnea
2. Chest pain (inspiration)
MANIFESTATIONS:
3. Anxiety/apprehension
4. Tachycardia and tachypnea
5. Leg pain or swelling
6. Back pain
7. Diaphoresis
8. Lightheadedness
9. Dizziness
10. Circum-oral/peripheral cyanosis
DIAGNOSTIC
TESTS:
1. Chest X-ray
2. ECG
3. Pulse oximetry
4. Arterial blood gas analysis
5. Multidetector-row computed
tomography angiography
(MDCTA)
6. Pulmonary angiography
7. D-Dimer assay
8. Pulmonary V/Q scan
9. Pulmonary arteriogram
 MEDICAL MANAGEMENT
1.Emergency management:

Objective: to stabilize the cardiopulmonary system.

Nasal oxygen
IV infusion lines are inserted to establish routes for
medications or fluids that will be needed.
Prompt initiation of vasopressor therapy is
recommended.
Hemodynamic measurements and evaluation for
GOAL: hypoxemia. If available, MDCTA will be performed.
To dissolve the ECG is monitored continuously for dysrhythmias and
right ventricular failure
existing emboli
Serum electrolytes, complete blood count, and
and preventing coagulation studies.
new clots from If the patient has suffered massive embolism and is
hypotensive, an indwelling urinary catheter is inserted
forming. to monitor urinary output.
Small doses of IV morphine or sedatives.
MEDICAL MANAGEMENT
3.Pharmacologic therapy
2.General management:
A. Long-term
anticoagulation
Objective: to improve
low molecular weight
respiratory and vascular
heparin
status.
new oral anticoagulants
Oxygen therapy
- direct thrombin
Anti-embolism stockings
inhibitor
or intermittent
Factor Xa inhibitor
pneumatic leg
B. Thrombolytic therapy
compression devices.
recombinant tissue
Elevating the leg above
plasminogen activator
the level of the heart.
 SURGICAL
MANAGEMENT:

Vena cava interruption (basket – like cone of

wires)
 SURGICAL
MANAGEMENT:

Pulmonary thromboendarterectomy
 NURSING
MANAGEMENT
1. Minimizing the risk of pulmonary embolism.
2. Preventing thrombus formation (major
nursing responsibility).
Encourages ambulation and active and
passive leg exercises.
Advise the patient not to sit or lie in bed
for prolonged periods, not to cross the
legs, and not to wear constrictive clothing.
Intermittent pneumatic compression (IPC)
devices.
Feet should rest on the floor or on a chair
when sitting on the edge of the bed.
IV catheters should not be left in place for
prolonged periods.
 NURSING MANAGEMENT
3. Assessing potential for pulmonary
embolism.
Careful assessment of the
patient’s health history, family
history, and medication record.
Daily basis: assess for pain or
discomfort in the extremities.
Evaluate extremities for warmth,
redness, and inflammation.
4. Monitoring thrombolytic and
anticoagulant therapy.
Bed rest, vital signs are assessed every
2 hours and invasive procedures are
avoided.
INR or PTT are performed 3 to 4 hours
after the thrombolytic infusion is
started.
Only essential arterial punctures or
venipunctures are performed.
Manual pressure is applied to any
puncture site for at least 30 minutes.
 NURSING MANAGEMENT

6.Managing oxygen therapy

5. Managing pain.
Semi-fowler’s position.
Turn patients frequently
and reposition.
Administer opioid analgesic
agents.
Assess frequently for signs of
hypoxemia and monitor the pulse
oximetry.
Deep breathing and incentive
spirometry.
Nebulizer therapy or percussion
and postural drainage.
7. Relieving anxiety.
NURSING
Encourage the stabilized patient to
talk about any fears or concerns.
MANAGEMENT
Answers the patient’s and family’s
questions concisely and accurately.
Explain the therapy, and describe
how to recognize untoward effects
early.

9.Providing postoperative nursing care.

8. Monitoring for complications.
Cardiogenic shock or right
ventricular failure.
Surgical embolectomy: measure the
patient’s pulmonary arterial pressure
and urinary output.
Assesses the insertion site of the
arterial catheter for hematoma
formation and infection.
Elevate the foot of the bed and
encourage isometric exercises.
Pulmonary
Edema
 1.CARDIOGENIC PULMONARY EDEMA

ACUTE
PULMONARY caused as a result high pressure in
the blood vessels of the lungs as a
EDEMA: 2 result of poor functioning of the

types heart.

2.NON-CARDIOGENIC PULMONARY EDEMA

DEFINITION:
Abnormal accumulation of
fluid in the interstitial spaces occurs due to damage of the pulmonary
and alveoli in the lungs. capillary lining.
Increase pressure of the It may be due to direct injury to the lung,
pulmonary vasculature. hematogenous injury to the lung or injury
Associated with acute
plus elevated hydrostatic pressures.
decompensated heart failure
 ETIOLOGIC FACTORS:

NON-CARDIOGENIC PULMONARY
CARDIOGENIC PULMONARY EDEMA
EDEMA
Heart failure
Smoke inhalation
Coronary artery disease
Head trauma
Cardiac arrhythmias
Sepsis
Fluid overload
Hypovolemic shock
Obstructing valvular lesions
Disseminated intravascular
Myocarditis/infectious
coagulopathy
endocarditis
Kidney failure
High Altitude Pulmonary Edema
 CLINICAL
1. Dyspnea (worsens with activity/supine
position)
MANIFESTATIONS:
2. Feeling of suffocation/drowning (lying
down)
3. Dry, hacking cough (frothy sputum)
4. Cold, clammy skin
5. Anxiety; restlessness
6. Cyanosis
7. Tachycardia
8. Jugular vein distention
9. Weight gain
10. Bipedal edema
11. 1Fatigue
DIAGNOSTIC
TESTS:
1. Physical Exam
2. Echocardiogram
3. Transesophageal
echocardiogram
4. Chest X-ray/CT scan/MRI
5. Pulse oximetry
6. Arterial blood gas
7. Serum electrolytes
8. Renal function test
 MEDICAL MANAGEMENT

1. Oxygen therapy
(nonrebreathing mask)
2. Endotracheal intubation (ET)
3. Mechanical ventilation
GOALS:
4. Diuretics
Reducing fluid
overload. 5. Vasodilators (nitrates)
Improving ventricular
function.
6. Endotracheal intubation
Increasing 7. Ultrafiltration
oxygenation.
8. Intra- aortic balloon pump
nursing MANAGEMENT

1. Proper positioning of the patient to

promote circulation.
2. Monitor for signs of fluid overload.
3. Monitor vital signs and I & O.
4. Watch out for signs of electrolyte
depletion.
5. Administer oxygen inhalation as ordered.
6. Carefully record the time morphine is
given and the amount administered.
7. Reassure the patient and provide skillful
anticipatory nursing care.
 Cor
Pulmonale
COR PULMONALE
Pulmonary heart failure
Dilatation and
hypertrophy of the right
ventricle in response to

the diseases of the

pulmonary vasculature

and/or lung parenchyma.

ETIOLOGIC FACTORS:
Pulmonary hypertension – most
common
Autoimmune diseases
(scleroderma)
Cystic fibrosis
Chronic obstructive pulmonary
disease
Severe bronchiectasis
Kyphoscoliosis
Obstructive sleep apnea
 1. Dyspnea CLINICAL
2. Orthopnea MANIFESTATIONS:
3. Tachycardia
4. Elevated jugular venous pressures
5. Tussive or effort-related syncope
6. Chest discomfort, usually in the
front of the chest
7. Bipedal edema
8. Wheezing
9. Cyanosis
10. Abdominal pain
DIAGNOSTIC
TESTS:
1. 2D Echocardiogram
2. Chest X-ray
3. Computerized tomography
(CT) scan of the chest
4. Arterial blood gas
5. Pulmonary artery
catheterization
6. Ventilation/perfusion scan
7. Magnetic resonance imaging
 MEDICAL MANAGEMENT

1. Adequate oxygenation
2. Bronchodilators
3. Steroids
4. Antibiotic
5. Diuretic
PRIMARY GOAL:
6. Anticoagulants
To decrease the
pulmonary vascular 7. Beta-blockers to improve heart
resistance and relieve
function
the pressure overload
on the right ventricle. 8. Cholesterol-lowering agents to
reduce the risk of blood clots
nursing MANAGEMENT

1. Proper positioning of the patient to

promote circulation.
2. Monitor for signs of fluid overload.
3. Monitor vital signs and I & O.
4. Watch out for signs of electrolyte
depletion.
5. Administer oxygen inhalation as ordered.
6. Carefully record the time morphine is
given and the amount administered.
7. Reassure the patient and provide skillful
anticipatory nursing care.
 Acute
Respiratory
Failure
ACUTE RESPIRATORY FAILURE
Defined as a decrease in arterial oxygen
tension (PaO2) to less than 60 mm Hg and an
increase in arterial carbon dioxide tension
(PaCO2) to greater than 50 mm Hg, with an
arterial pH of less than 7.35.
ETIOLOGIC FACTORS:
1. Ventilatory failure mechanisms
Impaired function of the central nervous system
Neuromuscular dysfunction
Musculoskeletal dysfunction
Pulmonary dysfunction
2. Oxygenation failure mechanisms
Pneumonia
Acute respiratory distress syndrome (ARDS)
Heart failure
COPD
Pulmonary embolism
Restrictive lung diseases
3. Post-operative period
4. Pain
 1. Restlessness
CLINICAL
2. Fatigue MANIFESTATIONS:
3. Headache
4. Dyspnea
5. Tachycardia
6. Increased blood pressure
7. Confusion
8. Lethargy
9. Circumoral cyanosis
10. Diaphoresis
11. Use of accessory muscles
12. Decreased breath sounds
 MEDICAL MANAGEMENT

1. Endotracheal intubation
Objectives: 2. Mechanical ventilation
To correct the
underlying cause and
to restore adequate
gas exchange in the
lung.
nursing MANAGEMENT

1. Assisting with intubation and maintaining

mechanical ventilation.
2. Assess the patient’s respiratory status:
monitoring the level of responsiveness
arterial blood gases
pulse oximetry
vital signs
3. Changing position
4. Oral care
5. Skin care
6. Range of motion of extremities
Pneumothorax
 PNEUMOTHORAX

PNEUMOTHORAX IS
THE ACCUMULATION
OF AIR IN THE PLEURAL
SPACE, WHICH
RESULTS IN PARTIAL
OR COMPLETE LUNG
COLLAPSE.
TYPES OF
PNEUMOTHORAX:
1. OPEN PNEUMOTHORAX
2. CLOSED
PNEUMOTHORAX
3. TENSION
PNEUMOTHORAX
ETIOLOGIC FACTORS:
1. Tension pneumothorax results from
unknown causes.
2. Secondary pneumothorax
crushing injuries (chest wall)
stab wounds
gunshot wounds
3. Spontaneous pneumothorax
ruptured bleb (smokers)
 1. Pleuritic pain
2. Tachypnea CLINICAL
3. Dyspnea
4. Visible asymmetry of the chest (rib fracture)
MANIFESTATIONS:
5. Hyper-resonant lung sounds
6. Decreased breath sounds over the area of
pneumothorax
7. Trachea deviating to the injured side
8. Neck vain distention
9. Palpable subcutaneous emphysema
10. Shifting of mediastinal structures to
unaffected side of the chest (caused by large
pneumothorax)
11. Hypoxemia (seen on ABG)
12. Signs of shock
DIAGNOSTIC
TESTS:
1. Diminished or absent

breath sounds on the

affected side.

2. Chest x-ray

3. Arterial blood gas

 MEDICAL MANAGEMENT

1. Small chest tube (28 Fr) insertion (2nd ICS)

connected to water-seal drainage.
2. If with hemothorax: large-diameter chest tube (32
Fr or greater) insertion (4th or 5th ICS midaxillary
line) connected to water-seal drainage.
3. Autotransfusion
4. Thoracentesis
5. Thoracotomy - if more than 1,500 mL of blood is
Goal: aspirated initially by thoracentesis or if chest tube
output continues at greater than 200 mL per hour.
To evacuate the
6. High concentration of supplemental oxygen (tension
air or blood from pneumothorax).
the pleural space. 7. Emergency: anything may be used that is large
enough to fill the chest wound—a towel, a
handkerchief, or the heel of the hand.
8. Analgesics and antimicrobial.
CHEST TUBE INSERTION
 nursing MANAGEMENT
1. Monitor vital signs and signs of shock.
2. Put in a semi-fowler’s position.
3. Administer oxygen as ordered.
4. For a patient with chest tubes:
Maintain sterile dressing at chest tube insertion
site.
Maintain patency and integrity of the closed chest
drainage system and suction as ordered.
Evaluate amount of fluid and breath sounds to
determine progress of closed chest drainage.
Assess for sign and symptoms of wound infection.
Assess for fear and anxiety and institute
appropriate measures for alleviation and relief.
Thank You!
Any Questions?