DESCRIBE DISEASE PROCESS AFFECTING PATIENT

(INCLUDE PATHOPHYSIOLOGY OF DISEASE PROCESS)

Pulmonary Embolism (PE) is the blockage of one or more pulmonary arteries by a thrombus, fat or air embolus,

or tumor tissue. These clots do not stop moving until they lodge at a narrowed part of the circulatory system. A

pulmonary embolus consists of material that gain access to the venous system and then to the pulmonary

circulation. The embolus travels with blood flow through smaller blood vessels until it lodges and obstructs

perfusion of the alveoli. The lower lobes of the lungs are most commonly affected and approximately ten

percent of patients die from a massive PE within the first hour. Anticoagulants significantly reduces mortality.

Lewis, S. M., Bucher, L., Heitkemper, M. M., & Harding, M. M. Medical-surgical nursing: Assessment

and management of clinical problems. St. Louis, MO: Elsevier.

DIAGNOSTIC TESTS

(REASON FOR TEST AND

• 12-lead electrocardiogram (ECG) such as T-wave

inversion, ST-segment elevation, or the

development of an abnormal Q wave (may show

+ changes indicative of ischemia)

PATIENT INFORMATION

Vernon Watkins is a 69-

year-old male who

presented to the Emergency

ANTICIPATED PHYSICAL

FINDINGS

• Shortness of breath

• Chest pain

• Nausea

• Chest X-ray-may show infiltrates, atelectasis,

elevation of the diaphragm on the affected side, or a Department 4 days ago with • Vomiting

pleural effusion

• Spiral CT-Scan with contrast

• Arterial blood gas analysis-it may show hypoxemia

and hypocapnia (from tachypnea).

• D-dimmer test

• Prothrombin time

• International normalized ratio

complaints of nausea,

vomiting, and severe

abdominal pain and was

admitted for emergent

surgery for bowel

perforation and underwent a

hemicolectomy.

• Abdominal pain

• Anxiety

• Fever

• Tachycardia

• Apprehension

• Diaphoresis

• Hemoptysis

• Syncope

ANTICIPATED NURSING INTERVENTIONS

• Maintain oxygen saturation greater than 92%

• If SpO2 less than 92% administer oxygen therapy to relieve hypoxemia and dyspnea and position client in highFowler’s 90 degrees

• Initiate and maintain IV access.

• Administer prescribed medications

• Withhold medications that may cause respiratory depression

• Place 12 lead ECG to monitor cardiac status (dysrhythmias)

• Vital signs every 4 hours

• Monitor for signs of bleeding.

• Assess wound and IV site regularly.

• Chest X-Ray

• Spinal CT-scan with contrast

• Request need for arterial blood gas/stat labs

• Check to aPTT in six hours and then follow nurse driven IV heparin protocol