Exemplar 16.1: Pulmonary Embolism

You are tasked with teaching a fellow nursing student about pulmonary embolisms as part of an in class activity. Select the information that is correct.

You are taking care of a 40-year-old female patient following a knee replacement. She is complaining of chest pain, coughing, nervousness, and inability to breathe. You are incredibly concerned because her MAR shows that her first dose of enoxaparin was not administered. What might you be looking for when you assess this patient?

Which of the following is NOT an intervention for a patient experiencing hypoxia due to blockage of alveoli by thrombus?

Select the interventions that would be appropriate for a patient whose small arterioles are rupturing due to arterial congestion.

You have a patient with alveolar collapse r/t tissue necroses and inflammation and pyrexia r/t the inflammatory process. You've administered oxygen, placed the patient in a high-Fowler's position, and procured sputum for laboratory testing. What other interventions can you enact?

Drag and drop the correct diagnostic test for the description. -[blank_start]Arterial blood gas[blank_end]: Shows hypoxemia (PaO2 <80 mmHg) and respiratory alkalosis (pH >7.45, PaCO2 <38 mmHg) caused by tachypnea and hyperventilation. -[blank_start]Perfusion lung scan[blank_end]: Radiotagged albumin is injected IV and distributed in the lungs by pulmonary blood flow. The lungs are then scanned for distribution of isotope; an area of the lung where it cannot be detected is suggestive of occluded blood flow and pulmonary embolism. -[blank_start]Chest x-ray[blank_end]: Shows pulmonary infiltration and, sometimes, pleural effusion. -[blank_start]Ventilation lung scan[blank_end]: A radiotagged gas is inhaled and the lungs are scanned for gas distribution. When in combination with a perfusion lung scan, it can identify areas of the lung that are ventilated but not perfused. -[blank_start]Chest CT with contrast[blank_end]: The PRINCIPAL test used to diagnose PE. Effectively shows large, central pulmonary emboli. -[blank_start]Pulmonary angiography[blank_end]: The DEFINITIVE test for PE when other less invasive tests aren't conclusive. A contrast medium is injected into pulmonary arteries so the pulmonary vascular system can be seen on X-ray. Makes it possible to detect very small emboli. -[blank_start]Electrocardiography[blank_end]: Ordered to rule out acute MI. Tachycardia and nonspecific T-wave changes are generally associated with PE. -[blank_start]ETCO2[blank_end]: Evaluates alveolar perfusion. The normal reading is 35-45 mmHg, but it is decreased when pulmonary perfusion is impaired. -[blank_start]Plasma D-dimer levels[blank_end]: Highly specific to presence of a thrombus. Tests for a fragment of fibrin formed during lysis of a blood clot. If elevated, it indicates thrombus formation and lysis.

You are caring an elderly patient admitted to the ER with a pulmonary embolism. Her daughter is her primary caretaker at home. The elderly patient had a hip replacement just 4 days prior, and was sent home with a prescription for warfarin. You ask her if she took her warfarin and she explained to you that she didn't because her daughter refused to pick up the prescription, stating that it was "dangerous and unnecessary". You speak to the daughter and she cries and states the following: "A close, trusted friend told me that warfarin is dangerous because it could cause my mother to bleed out. I looked at a couple websites that she sent me... I honestly didn't know that this would happen!" You assess that the daughter did not have malicious intent, but was uninformed about her mother's medications. You decide to educate the daughter. Which of the following statements, made by the daughter, shows that she still needs more teaching?

Which of the following is NOT a preventative measure that a nurse can enact to prevent DVT and pulmonary embolisms?

You have a new admit to the ICU. During hand-off, the med-surg RN that took care of the patient reported that she's having trouble breathing, had 10/10 chest pain, felt anxious, and couldn't stop coughing. When the RN took her vital signs, her heart rate was 110 BPM, RR 30 breaths/min, BP 104/66, temp 100.1 Fahrenheit, and SpO2 92%. She had inspiratory and expiratory crackles in her middle right lung. A chest CT on the patient showed a rather large pulmonary embolism, so the doctor has ordered a 5,000 U IV bolus of heparin, followed by a continual heparin infusion at 1,000 U/hr. The doctor has also ordered streptokinase. Select interventions you can enact for this patient.

The "antidote" to counteract heparin is protamine sulfate