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Prepared by:

Kristine Joy ElizadaBSN-3D

Pulmonary Embolism



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.



Risk Factors

Precipitating

factors

-lung disorders

-surgery

-diabetes mellitus

-Hx of

thromboembolism-polycythemia

-obesity,burns

-immobilization

Predisposing

factors

age

sex

hereditary



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



Clinical Manifestations

Dyspnea

Chestpain

Hypotension

Restlessness

Hemoptysis



Diagnostic test

Chest X-rays

Lung scans

ECG

ABG



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.



Cor Pulmonale

Pulmonary Heart Disease



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.



Risk Factors

Predisposing factors

-Middle aged and elderly

males

Precipitating factors

± Smoking

± COPD

± Bronchial asthma

± Pulmonary emboli

± Obesity



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



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



Diagnostic Tests

Echocardiogram or angiogram

ABG analysis

ECG

Pulmonary function test



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



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.

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