Pulmonary Embolism Concept Map, Schemes and Mind Maps of Medical Sciences

Download Pulmonary Embolism Concept Map and more Schemes and Mind Maps Medical Sciences in PDF only on Docsity! PREDISPOSING FACTORS Malignancy, immobility due to age or injury, congenital abnormalities, varicose veins, A.Fib and cardiac function, illness and inherited disorders, atherosclerosis COMORBIDITIES Old age (>75 years), hypertension, previous stroke, chronic obstructive pulmonary disease (COPD), diabetes mellitus, atrial fibrillation, cancer, deep vein thrombosis (DVT) and heart failure. Immobility, Surgery within last 3 months (especially pelvic and lower extremity surgery), obesity in women, heavy cigarette smoking. MEDICATIONS AND TREATMENT General: Oxygen- for hypoxemia - Fluids in case of circulatory shock : Avoid diuretics and vasodilators Opiates for pain BUT be careful with hypotension Medications: 1.Anticoagulants (antithrombin):Anticoagulant medications are a type of blood thinner (given for minimum of 3 months) HEPARIN : -Un fractioned Heparin -administered IV -Low Molecular Weight Heparin — subcutaneous -Taken orally, takes up to 5 days to have an effect 2.Thrombolytic Therapy( break up clots) e.g. IPA (tissue plasminogen activator), alteplase. reteplase, streptokinase, tenecteplase. urokinase -Individuals with > 12 years of education were at lower risk for VTE. -Blue-collar workers, farmers, and non-employed individuals had higher risks for VTE; White collar workers and professionals had lower risks. -In males and/or females, risks for VTE were increased for assistant nurses; farmers; miners and quarry workers: mechanics. (Sharp Chest) and pleuritic pain, exacerbated curing inspiration (Hall Mark Sign) DETERMINANTS OF HEALTH PATHOPHYSIOLOGY Venous stasis Hyper coagulopathy Injury to endothelial layer PULMONARY EMBOLISM ASSESSMENT FINDINGS Sudden Dyspnea accompanied by anginal Feeling of impending doom (Hall Mark Sign) Apprehension and restlessness Blood- Tinge sputum Chest pain Cough Crackles and wheeze on auscultation Cyanosis Distended neck veins Hypotension Petechiae over chest and axilla Shallow respiration Tachypnea and tachycardia PRECIPITATING FACTORS Obesity, estrogen therapy, venipuncture (minimize), dehydration, infection (treat), Usually the blood clot originates from a DVT in the leg. POTENTIAL RISKS Postoperative states: Major abdominal/pelvic surgery, hip/knee joint replacement, post-operative intensive care Obstetrics: Late pregnancy, Caesarian section, puerperium Lower limb affections: Fractures, extensive varicosities Malignancies: Abdominal/pelvic, advanced/metastatic stage Limited mobility: Hospitalization, geriatric care Miscellaneous: History of previous venous thromboembolism DIAGNOSTIC TESTS AND LAB FINDING -D-Dimer -Troponin -BNP -ABGs -CT Pulmonary angiography (CT- PA) -Ventilation-perfusion scan (V/Q scan) -Pulmonary angiogram -MRI @ Help RISK FOR BLEEDING r/t anticoagulant or thrombolytlc reglmen therapy · Assess tor history of a high-risk bleeding condition • Monitor IV dosage and delivery system · Assess tor signs and symptoms of bleeding; bleedJng from catheter insertion sites; GI or GU bleeding; bleeding from the respiratory tract; bleeding from mucus membranes: decreased hemoglobin and hematocrit • Administer anticoagulant therapy as prescribed · Monitor platelet counts. coagulation test results (INR). PT. aPTT. and hemoglobin and hematocnt · Monitor platelets and the heparin-induced platelet aggregation (HIPA) status -Il the patient is HIPA positive, stop all heparin products and consult a hematologist INEFFECTIVE BREATHING PATTERN r/t acute chest paln Assess the respiratory rate, rhythm, and depth. Assess tor any increase in the work of brealhing: shortness of breath and the use of accessory muscles. Assess characterlstics ol pain · Monitor ABG's Monitor oxygen saturation via pulse oxlmetry. · Position lhe patient in a sitting position, and change the position every 2 hours · Administer oxygen as prescribed Assist lhe patient with coughlng and deep breathing Group 2 PRIORITY NURSING ACTIONS Suspected Pu/monary Embolism 1. Notify the Rapid response team and heallh care provider (HCP) 2. Reassure the client and elevate the head ol the bed. 3. Prepare oxygen administrauon 4. Obtain Vital Signs and check tor lung sounds 5. Prepare to obtain artenal blood gas. 6. Prepare lor the administration of heparin therapy or other lherapies: embolectomy or placement of vena cava li Iter it necessary. 7. Document the event, interventions taken, and the dient's response to treatment. DEFICIENT KNOWLEDGE rii activlties to prevent embolism and setf-care alter diagnosis of embolism • Ascertain level of knowledge, including anticipatory needs. · Determine chent's abilrty, readiness, and barriers to learning. (patient maybe physically weak and unable to participate) · Use short, simple sentences and concept. Repeat and summarize as needed. Previde mutuai goal setting and learning contracts. PSYCHOSOCIAL ASPECTS -Life-changing event -Shock/distress at uncertainty Il had happened lo me. Why me? Il was awful noi knowing whal had caused il. -Loss of self -Change in focus or direction ,---- IMPAIRED GAS EXHANGE r/t altered blood flow to alveoli secondary to embolus · Monitor vital signs, noting any changes • Auscultate lung sounds · Assess skin color, nail beds, and mucus membranes lor color changes · Monitor ABGs • Monitor oxygenation via pulse oxlmeter · Assess lor calf tenderness, swelling, redness, and/or hardened areas · Administer oxygen as needed • Positton the pabent properly to facilitate ventilauon­ perlusion matching ANXIETY rii fear of suffocation • Review physiological factors, i.e. Post op pts .• Bed ridden pts., Pts with mobìhty problem, bone tractures (fat embolism) • lf irrational thoughts are present previde patìent with accurate information on current disease condrt1on thai contribute pt's anxiety. • Explain all activities. procedures, and issues that involve the client: use non-medicai terms and calm slow speech.