Melissa Mershimer

By: Emma Toplis and Gerri Mortimore

The diagnosis and

management of
pulmonary embolism.
 JS is a 51-year-old male. He presented to the emergency department, and it
Patient was found that he had bilateral pulmonary embolisms and rhinovirus.
Patient was prescribed Xarelto and left AMA. Patient returned to
Situation emergency department a month later complaining of shortness of breath
and severe back pain. He was found to be hypoxic which his oxygen sat at
76%. Patient was placed on Bipap and was not being compliant with
keeping it in place, in return his sat kept dropping. Patient was then
intubated and sent to MICU. He was found to still have bilateral pulmonary
embolisms as well as a right heart strain and possibly a right heart
dysfunction, bilateral ground glass opacities in the lung, and a small pleural
effusion. His top 3 nursing diagnoses are impaired gas exchange related to
ventilation perfusion imbalance, ineffective airway clearance evidenced by
mechanical ventilation, and ineffective tissue perfusion evidenced to
diminished peripheral pulses.
  This article goes into depth on what pulmonary embolisms are, risk
Article factors, diagnostic tools, and treatments.

Overview  Pulmonary embolisms are obstructions of the arterial systems within

the lungs by either one or more emboli. The symptoms are different
and can be challenging to diagnose within different age groups.
 Some risk factors can include pregnancy, cancer, obesity, hx if DVTs
or PEs, varicose veins, recent surgery, or hospitalization with
bedrest. Along with hx of DVTs and PEs, a family history is a big
factor. If a patient comes into the emergency department with any
symptoms (dyspnea, pleuritic chest pain, fever, or tachycardia), the
patient should be evaluated for any of these risk factors to determine
the likelihood of a clot.
  There are many diagnostic tests they can do to determine if someone
Article has a PE. Some of these include the D-dimer test, computed
tomography pulmonary angiography (CTPA) and the VQ scan.

overview  The D-dimer test has benefits and disadvantages. The D-dimer can be
elevated within pregnancy, PVD, cancer or inflammatory diseases as
cont. well as if someone has a PE. Sometimes in older adults, the D-dimer
test is not accurate because the concentration increases with age and
the specificity for Pes decreases.
 The CPTA detects more PEs than the VQ scan. The disadvantage to
this is that since it uses contrast within the scan, it can cause
nephropathy. Before someone does this scan, they need to be sure that
the kidneys are functioning properly.
  VQ scans are another form of imaging. These are used when they
Article can’t use CPTA due to kidney function. This examines the
ventilation and perfusion of the lungs.
overview  Treatments they can use are thrombolysis and anticoagulant

cont. therapy. Thrombolysis is typically used for unstable patients with a

massive or sub-massive PE with no contraindications. Some
anticoagulants include heparin, warfarin, edoxaban, rivaroxaban,
and apixaban. Warfarin is not used as much due to to interactions
to other medications, foods, and the monitoring of labs that is
needed.
  This article helped me get a better understanding of pulmonary
Discussion embolisms and how to treat, prevent, and diagnose them.
 This article relates to my patient because my patient had bilateral
pulmonary embolisms and was not taking his prescribed medication
to help him . In return he ended up starting on heparin while in the
hospital.
 My patient's kidneys were not functioning properly so CTPA would
not work well for him because of the contrast used in the scan.
 This article will help nurses and student to have a better
understanding of what pulmonary embolisms are as well as how to
take care of a patient that they may have in the future.
Citation
Toplis, E., & Mortimore, G. (2020, January 9). The diagnosis and management of pulmonary
embolism. British Journal of Nursing.
https://www.britishjournalofnursing.com/content/clinical/the-diagnosis-and-management-of-
pulmonary-embolism/