-Hypoxemia and Hypercapnia-Pulmonary Hypertension-Increased Work Load to the Right Ventricles-Right Sided Heart Enlargement-Right Sided Heart Failure<br />
-s/sx:*s/sx of the underlying pulmonary disease*s/sx of right sided heart failure-management:goals:1. improvement of ventilation2. treatment of the underlying lung disease <br />
3. treatment of the manifestations of the heartA. Continuous 24 Hour O2 Therapy-improvement may require 4-6weeks of O2 therapy-monitor pulse oximetry and ABGB. Chest Physiotherapy and Bronchial Hygiene ManeuversC. BronchodilatorsD. ET Intubation and Mechanical Ventilation<br />
E. Bed Rest F. Sodium Restriction G. Diuretic Therapy H. Digitalis Therapy I. ECG Monitoring-nursing management:*supportive to the medical management <br />
Pulmonary Embolism-obstruction of the pulmonary artery or one of its branches by a thrombus or thrombi-causes:*venous thrombosis*atrial fibrillationOcclusion of the Pulmonary ArteryIncreased Alveolar Dead SpaceVentilation/Perfusion ImbalanceHypoxemia and HypercapniaPulmonary HypertensionRight Ventricular FailureShock<br />
-s/sx:*dyspnea-most frequent symptom*tachypnea-most frequent sign*chest pain-sudden and pleuritic-mimics angina pectoris*anxiety, fever, tachycardia, apprehension, cough, diaphoresis, hemoptysis, syncope -less than 10% progresses to pulmonary infarction<br />
assessment and diagnosis:a. Ventilation Perfusion Scan (test of choice)b. Pulmonary Angiography (gold standard)c. CXR-infiltrates -elevation of the diaphragm-atelectasis -pleural effusiond. ECG-sinus tachycardia-PR interval progression-non specific T wave changese. Peripheral Vascular Studiesf. ABG<br />
-prevention:*prevention of DEEP VEIN THROMBOSIS -management: a. Emergency Management*Nasal O2 Therapy*IV access*Perfusion Scan, ABG, Hemodynamic Measurements*Dobutamine or Dopamine*ECG*Digitalis Glycosides, IV Diuretics and Anti- arrhythmics when appropriate<br />
*Blood Studies*ET Intubation and Mechanical Ventilation*Indwelling Urinary Catheter Insertion*Small Doses of Sedatives or Morphine<br />
b. General Management*O2 therapy*elastic compression stockings*intermittent pneumatic leg compression*elevation of the legc. Pharmacologic Management*Anticoagulation TherapyHeparin(IV bolus of 5T to 10T “U” then infusion of 18U/kg/hour not to exceed1600U/hour)Warfarin(begun within 24 hours after initiating Heparin therapy)<br />
*Thrombolytic TherapyUrokinase, Streptokinase, Alteplase CI: CVA w/in the past 2 monthsactive bleeding w/in the past 10 daysrecent labor & delivery severe hypertensiond. Surgical Management:*embolectomy*interruption of the inferior vena cavaTeflon clips<br />
-nursing management:a. Minimizing the risk of pulmonary embolismb. Preventing thrombus formationc. Assessing for potential pulmonary embolismd. Monitoring thrombolytic therapye. managing painf. managing O2 therapyg. relieving anxietyh. monitoring for complicationsi. post op nursing care<br />
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