Pulmonary Embolism

  1. General information
    1. Most pulmonary emboli arise as detached portions of venous thrombi formed in the deep veins of the legs, right side of the heart, or pelvic area.
    2. Distribution of emboli is related to blood flow; emboli involve the lower lobes of the lung because of higher blood flow.
    3. Embolic obstruction to blood flow increases venous pressure in the pulmonary artery and pulmonary hypertension.
    4. Risk factors: venous thrombosis, immobility, pre- and post-op states, trauma, pregnancy, CHF, use of oral contraceptives, obesity
  2. Medical management
    1. Drug therapy
      1. Anticoagulants (see Thrombophlebitis)
      2. Thrombolytics: streptokinase or urokinase
      3. Dextran 70 to decrease blood viscosity and aggregation of blood cells
      4. Narcotics for pain relief
      5. Vasopressors (in the presence of shock)
    2. Surgery: embolectomy (surgical removal of an embolus from the pulmonary arteries)
  3. Assessment findings
    1. Chest pain (pleuritic), severe dyspnea, feeling of impending doom
    2. Tachypnea, tachycardia, anxiety, hemoptysis, shock symptoms (if massive)
    3. Decreased pCO2; increased pH (due to hyperventilation)
    4. Increased temperature
    5. Intensified pulmonic S2; rales or crackles
    6. Diagnostic tests
      1. Pulmonary angiography: reveals location/extent of embolism
      2. Lung scan reveals adequacy/ inadequacy of pulmonary circulation
  4. Nursing interventions
    1. Administer medications as ordered; monitor effects and side effects.
    2. Administer oxygen therapy to correct hypoxemia.
    3. Assist with turning, coughing, deep breathing, and passive ROM exercises.
    4. Provide adequate hydration to prevent hypercoagulability.
    5. Offer support/reassurance to client/family.
    6. Elevate head of bed to relieve dyspnea
    7. Provide client teaching and discharge planning: same as for thrombophlebitis.