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TRANSCRIPT
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Prepared by:
Kristine Joy ElizadaBSN-3D
Pulmonary Embolism
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What is Pulmonary Embolism?
An obstruction usually results from
dislodged thrombi that originate in the
leg veins. Other, less common
sources of thrombi includes pelvic
veins, renal veins, hepatic veins and
right side of the heart, and the arms.
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Risk Factors
Precipitating
factors
-lung disorders
-surgery
-diabetes mellitus
-Hx of
thromboembolism-polycythemia
-obesity,burns
-immobilization
Predisposing
factors
age
sex
hereditary
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Pathophysiology of Pulmonary Embolism
Thrombus formation
Emboli travels to the lungs
Blood flow is obstructed leading todecreased perfusion of the section
of the lung
Venous stasis, hypercoagubility, vessel wall
inflammation
Pulmonary embolism
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Clinical Manifestations
Dyspnea
Chestpain
Hypotension
Restlessness
Hemoptysis
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Diagnostic test
Chest X-rays
Lung scans
ECG
ABG
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Nursing Interventions
Give oxygen via nasal cannula or mask. Check ABG levels if new emboli develop or dyspnea worsens
Administer heparin as ordered through IV push or continuous drip.
Monitor coagulation studies daily and after changes in heparin
dosage. Maintain adequate hydration to avoid the risk
hypercoagulability.after the patient is stable, encourage him tomove about often. Monitor the temperature and the color of
patient¶s feet to check for venous stasis. Never vigorously
massage the patient¶s legs.
Report frequent pleuritic chest pain so that analgesics can be
prescribed. Evaluate the patient. His vital signs should be within normal limits
and he should show no signs of bleeding after anticoagulant
therapy.
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Cor Pulmonale
Pulmonary Heart Disease
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Cor Pulmonale
Is a condition in which hypertrophy and
dilatation of the right ventricle develop
secondary to disease affecting the
structure or function of the lungs.
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Risk Factors
Predisposing factors
-Middle aged and elderly
males
Precipitating factors
± Smoking
± COPD
± Bronchial asthma
± Pulmonary emboli
± Obesity
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Alveolar hypoxia
Hypoxic Pulmonary Vasoconstriction
Increased Pulmonary Vascular
Resistance
Pulmonary Hypertension
Increased right ventricular afterload
Right ventricular hypertrophy
Right ventricular failure
hypoxemia
acidemia
Capillary destruction
(emphysema)
polycythemia
Cor
pulmonale
Pathophysiology of cor pulmonale
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Clinical Manifestations
Chronic, productive coug
h
Exertional dyspnea
Wheezing respirations
Fatigue and weakness
Dyspnea Tachypnea
Orthopnea
Dependent edema
Distended neck veins Decreased cardiac output
Enlarged tender liver
Tachycardia
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Diagnostic Tests
Echocardiogram or angiogram
ABG analysis
ECG
Pulmonary function test
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Treatment
Cardiac glycoside (digoxin) Antibiotics if respiratory infection is present
Administration of potent pulmonary artery vasodilator
Low-salt diet, restricted fluid intake and administration
of diuretics to reduce edema Anticoagulants
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Nursing responsibilities
Prevent fluid retention by limiting t
he patient¶s fluidintake to (1-2L) per day and providing low salt diet
Monitor serum potassium levels in patient receving
diuretics
Watch for signs of digoxin toxicity.
Monitor cardiac arr hythmias.
Reposition the bedridden patient frequently to prevent
atelectasis
Periodically measure ABG levels and watch for signs of
respiratory failure.