Question

Review the pathophysiology of PE( Pulmonary Embolism) , then answer and submit the following questions: 1. What places a patient at risk for PE? 2. What care interventions are needed to prevent PE development? 3. Identify PE manifestations that you might observe. 4. What diagnostic tests should be done immediately? 5. How would you prepare the patient for testing? 6. What would you tell the family? The patient? 7. Should you, as the nurse, contact the Rapid Response Team? Why? (If yes, when should you contact them?) 8. What would the patient look like if he/she were in respiratory acidosis?

Answer 1

Pulmonary embolism refers to the obstruction of the pulmonary artery or one of its branches by a thrombus that originates somewhere in the venous system or in the right side of the heart.

1 PE often occurs in people who are immobilized for a long time,using of medication pills including bith control pills,smoking,polycythemia,cancer,pregnancy and surgery.

2 For patients at PE ,the most effective approach for prevention is to prevent deep venous thrombosis.Active leg excercises to avoid venous stasis,early ambulation,and use of elastic compression stockings are generally preventive measures.Additional measures include anticoagulant therapy for people older than 40 years of age.Low molecular weightheparin is an alternative therapy.Sequential compression devices are often used to prevent venous stasis through compression and relaxation of calf muscles.

3Symptoms depend on the size of the thrombus and the area of the pulmonary artery occluded by the thrombus.Dyspnea is the most frequent symptom,and tachypnea is the most frequent sign.Chest pain is common and is usually sudden and pleuritic in origin.it maybe substernal and mimic angina pectoris or MI.Other symptoms include anxiety,fever,tachycardia,apprehension,cough,diaphoresis,hemoptysis and syncope.

4 Death from PE commonly occurs within 1 hou after the onset of symptoms,therefore early recognition and diagnosis are priorities.The initial diagnostic workshop include chest Xrays,ECG,Peripheral vascular studies,ABG analysis,and ventilation-perfusion (V/Q)scan.

5 All patients are evaluated for risk factors for thrombus formation and pulmonary embolus.The nurse does a careful assessment of the patients health history ,family history and medication record.On a daily basis ,the patient is asked about pain or discomfort in the extremities.In addition the extremities are evaluated for warmth ,redness and inflammation.

6 The nurse instructs the patient to move the legs in a "pumping"excercise so that the legmuscles can improve venous flow.The nurse also advises the patient not to sit or lie in the bed for prolonged periods ,not to cross the legs and avoid constrictive clothing.

7 yes,When caring for a patient with PE,the nurse must be alert for potential complication of cardiogenic shock or right ventricular failure subsequent to the effect of PE on the cardiovascular system.

8 Respiratory acidois ius a clinical disorder in which the ph is less than 7.35 and Pa CO2 is greater than 42 mm Hg .Sudden hypercapniaincreasedpulse,BP and respiratory rate,mental cloudiness and a feeling of fullness in the head.