 Patho

o Collection of particulate matter (solids, liquids, or air) that enters venous

circulation & lodges in the pulmonary vessels

o Lg emboli obstruct pulmonary blood flow = reduced gas exchange, reduced

oxygenation, pulmonary tissue hypoxia, decreased perfusion, possibly death

o Most often occus when inappropriate clotting forms a VTE in a vein in legs/pelvis

& a clot breaks off & travels into R side of heart

o Clot then lodges in pulmonary artery

o Platelets collect on the embolus = release of substances that cause blood vessel

constriction

o Widespread pulmonary vessel constriction x pulmonary hypertension = impaired

gas exchange & tissue perfusion

o Deoxy blood moves into arterial circulation = hypoxemia

o Some patients may not have hypoxemia

o Major Risk Factors for VTE leading to PE

 Prolonged immobility, central venous catheters, sx, obesity, advancing

age, conditions that increase blood clotting, hx of thromboembolism

o Increased Risk

 Smoking, pregnancy, estrogen therapy, HF, stroke, cancer (lung or

prostate), trauma

o Fat, oil, air, tumor cells, amniotic fluid & fetal debris, foreign objects, injected

particles, and infected clots can enter a vein & cause PE

o Fat emboli from fracture & oil emboli from dx procedures injure blood vessels &

cause acute ARDS

o Septic clots often arise from a pelvic abscess, infected IV catheter, & injections of

illegal drugs

o Prevention

 Passive & active ROM exercises

 Ambulate pt soon after sx

 Use antiembolism & pneumatic compression stockings & devices after sx

 Evaluate pt for criteria indicating need for anticoag therapy

 Avoid use of tight garters, girdles & clothing

 Prevent pressure under popliteal space by placing pillow under knee

 Perform a comprehensive assessment of peripheral circulation

 Elevate affected limb 20 degrees or more above level of heart

 Change position every 2h

 Prevent injury to vessel lumen by preventing local pressure, trauma,

infection, or sepsis

 Refrain from massaging legs

 Do not cross legs

 Administer px’d drugs

 Teach pt to avoid activities resulting in Valsalva maneuver (holding breath,

bearing down, cough)