Braga, Patricia D.

4B
NCM 118

PULMONARY EMBOLISM

- is a blockage in one of the pulmonary arteries in your lungs. In most cases, pulmonary
embolism is caused by blood clots that travel to the lungs from deep veins in the legs or, rarely,
from veins in other parts of the body (deep vein thrombosis). Because the clots block blood flow
to the lungs, pulmonary embolism can be life-threatening. Pulmonary embolism symptoms can
vary greatly, depending on how much of your lung is involved, the size of the clots, and whether
you have underlying lung or heart disease.

CASE STUDY:

A 25 years old white female reports to the Emergency Room because of sharp left sided chest
pain and shortness of breath of one day duration. The patient was in excellent health until
yesterday. She was awakened from her sleep by sharp left sided chest pain. The pain worsened
with motion and deep breathing. The pain has been progressively increasing in severity and she
now has severe left shoulder pain. She complains of shortness of breath and is very
apprehensive about dying. She denies any cough, fever, sputum production or hemoptysis.

She is married and had one normal delivery three years ago. She is currently on birth control
pills. She has never been hospitalized except for labor and delivery. Review of systems are
negative. She denies any past history of venous problems.

She reveals having a similar transitory minor episode of chest pain approximately one year ago
while she was vacationing in Michigan.

She works as a computer programmer. She smokes one pack of cigarettes a day for the past
eight years. She considers herself a social drinker.

DIAGNOSIS:

 Ineffective Breathing Pattern related to decreased lung expansion as evidenced by dyspnea

and use of accessory muscles
 Impaired Gas Exchange related to decreased lung expansion as evidenced by difficulty
breathing, abnormal pulse oximetry and reduced activity tolerance
 Anxiety related to respiratory distress secondary to pulmonary embolism as evidenced by
restlessness, pain and dyspnea

ASSESSMENT DIAGNOSIS PLANNING INTERVENTION EVALUATION
Ineffective After 4 hours Assess the Patient was able
Breathing Pattern of client’s anxiety to maintain
S: related to chest intervention, level. Anxiety effective
pain as evidenced the patient will can result in breathing
‘Nakukurian po by dyspnea and be able to rapid, shallow pattern, as
ako paghinga. use of accessory demonstrate respirations and evidenced by
Masakit gihapon muscles improved increase relaxed
it akon dughan ’ ventilation and dyspnea. It can breathing at
as verbalized by adequate be a sign of normal rate and
the patient. oxygenation decreasing depth, and the
with vital signs hypoxemia. absence of
Patient denies in normal dyspnea.
any cough, limits Assess the
fever, sputum respiratory rate,
production or rhythm, and
hemoptysis. depth. Assess
for any increase
O: in the work of
breathing:
shortness of
Blood pressure -
breath, and the
114/80 use of accessory
muscle.
Pulse - 118
Monitor arterial
Temperature - blood gasses
37.0 (oral) (ABGs). ABGs
of these clients
Respiratory rate typically exhibit
– 30 with hypoxemia and
shallow respiratory
alkalosis from a
breathing
blowing off of
carbon dioxide.
- Patient appears The
to be in development of
moderate respiratory
respiratory acidosis in this
distress. client indicates
respiratory
- No rales or failure, and
rubs. immediate
ventilator
support is
indicated.

Position the
client in a sitting
position, and
change the
position every 2
hours.

Encourage deep
breathing and
coughing
exercise.
ASSESSMENT DIAGNOSIS PLANNING INTERVENTION EVALUATION
Impaired Gas After hours of Assess the skin The patient was
Exchange intervention, the color, nail beds, able to maintain
S: related to patient will be and mucous adequate gas
decreased lung able to maintain membranes for exchange, as
Patient expansion as adequate gas color changes. evidenced by
complains with evidenced by exchange, as ABGs within the
sharp left sided difficulty evidenced by normal range,
Monitor for any
chest pain and breathing, ABGs within the oxygen
changes in vital
shortness of abnormal pulse normal range, saturation of
signs and ABGs
breath oximetry and oxygen 90% or greater,
reduced activity saturation of relaxed
tolerance 90% or greater, Assess for the breathing, and
‘The pain signs and
worsened with relaxed baseline HR for
breathing, and symptoms of the client.
motion and deep hypoxia (such as
breathing’ as baseline HR for
the client. confusion,
verbalized by The patient was
headache,
the patient also able to
diaphoresis,
Patient will be demonstrate two
restlessness,
Patient denies able to breathing
tachycardia, and
any history of demonstrate two techniques to
pale skin).
venous breathing use during
Hypoxia results
problems. techniques to dyspneic
from increased
use during episodes to help
dead space
dyspneic prevent hypoxia
(ventilation
episodes to help
without
prevent hypoxia
O: perfusion) that
reduces
Blood pressure - effective gas
114/80 exchange.

Pulse - 118 Assess for the

signs and
symptoms of
Temperature - pulmonary
37.0 (oral) infarction

Respiratory rate Maintain client

- 30 with on bed rest. May
shallow resume activity
breathing gradually as
tolerated.
Patient appears
dull Position the
client properly to
The extremities facilitate
reveal no ventilation-
evidence of perfusion
edema, cyanosis matching.
or clubbing.
Administer
Decreased chest oxygen as
expansion and
indicated.
decreased
breath sounds in
the left base.
References:
https://www.mayoclinic.org/diseases-conditions/pulmonary-embolism/symptoms-
causes/syc-20354647#:~:text=Pulmonary%20embolism%20(PE)%20occurs
%20when,deep%20vein%20thrombosis%20(DVT).
http://www.meddean.luc.edu/lumen/meded/medicine/pulmonar/mdl/emb.htm
https://nurseslabs.com/pulmonary-embolism-nursing-care-plans/