Pulmonary embolism (PE) refers to the obstruction of the pulmonary artery or one of its branches by a thrombus (or thrombi) that originates somewhere in the venous system or in the right side of the heart
Pathophysiology -When a thrombus completely or partially obstructs a pulmonary artery or its branches, the alveolar dead space is increased . The area, although continuing to be ventilated, receives little or no blood ﬂow. Thus, gas exchange is impaired or absent in this area.
Pathophysiology -In addition, various substances are released from the clot and surrounding area, causing regional blood vessels and bronchioles to constrict. This causes an increase in pulmonary vascular resistance. This reaction compounds (the ventilation–perfusion imbalance.)
Pathophysiology -The hemodynamic consequences are increased pulmonary vascular resistance from the regional vasoconstriction and reduced size of the pulmonary vascular bed. This results in an increase in pulmonary arterial pressure and, in turn, an increase in right ventricular work to maintain pulmonary blood ﬂow. When
Pathophysiology the work requirements of the right ventricle exceed its capacity, right ventricular failure occurs, leading to a decrease in cardiac output followed by a decrease in systemic blood pressure and the development of shock.
RISK FACTORS Venous Stasis (slowing of blood ﬂow in veins) -Prolonged immobilization (especially postoperative) -Prolonged periods of sitting/traveling -Varicose veins -Spinal cord injury -Hypercoagulability (due to release of tissue thromboplastin after injury/surgery) -Injury -Tumor (pancreatic, GI,, breast, lung) -Increased platelet count (polysalathemia, splenectomy
RISK FACTORS Venous Endothelial Disease - -Thrombophlebitis -Vascular disease -Foreign bodies (IV/central venous catheters) -Certain Disease States (combination of stasis, coagulation alterations, and venous injury) -Heart disease (especially heart failure) -Trauma (especially fracture of hip, pelvis, vertebra, lower extremities)
RISK FACTORS -Postoperative state/postpartum period -Diabetes mellitus -Chronic obstructive pulmonary disease c opD - Other Predisposing Conditions -Advanced age -Obesity -Pregnancy -Oral contraceptive use -Constrictive clothing -History of previous thrombophlebitis, pulmonary embolism
Clinical Manifestations 1.Dyspnea is the most frequent symptom; tachyapnea (very rapid respiratory rate) is the most frequent sign . The duration and intensity of the dyspnea depend on the extent of embolization. Chest pain is common and is usually sudden and pleuritic. It may be substernal and misdiagnosed with angina pectoris or a myocardial infarction. - Other symptoms include anxiety, fever, tachycardia, apprehension, cough, diaphoresis, hemoptysis, and syncope.
Assessment and Diagnostic Findings -The diagnostic workup includes a - ventilation–perfusion scan, -pulmonary angiography, -chest x-ray -, ECG, -peripheral vascular studies, and arterial blood gas analysis. -Doppler ultrasonography and venography
Prevention prevent deep venous thrombosis. 1. active leg exercises 2. The intermittent pneumatic leg compression device ( reduces venous stasis). 3. use of elastic compression stockings 4. anticoagulant therapy
Medical Management • General measures to improve respiratory and vascular status • Anticoagulation therapy • Thrombolytic therapy • Surgical intervention
GENERAL MANAGEMENT -Oxygen therapy is administered to correct the hypoxemia, relieve the pulmonary vascular vasoconstriction, and reduce the pulmonary hypertension. -Using elastic compression stockings or intermittent pneumatic leg compression devices reduces venous stasis.
GENERAL MANAGEMENT -These measures compress the superﬁcial veins and increase the vesecosity of blood in the deep veins by redirecting the blood through the deep veins. Elevating the leg (above the level of the heart) also increases venous ﬂow.
Anticoagulation Therapy. Anticoagulant therapy (heparin, warfarin sodium) has traditionally been the primary method for managing acute deep vein thrombosis and PE
Anticoagulation Therapy Heparin is used to prevent recurrence of emboli but has no effect on emboli that are already present. It is administered as an intravenous bolus of 5,000 to 10,000 units, followed by a continuous infusion initiated at a dose of 18 U/kg per hour, not to exceed 1,600 U/hour
Thrombolytic Therapy -Thrombolytic therapy (urokinase, strepto- kinase, alteplase, anistreplase, reteplase) also may be used in treating PE, particularly in patients who are severely compromised (eg, those who are hypotensive and have significant hypoxemia despite oxygen supplementation).-
Thrombolytic Therapy Thrombolytic therapy resolves the thrombi or emboli more quickly restores more normal hemodynamic functioning of the pulmonary circulation, Reducing pulmonary hypertension Improving perfusion, oxygenation, and cardiac output.
SURGICAL MANAGEMENT -Pulmonary embolectomy requires a thoracotomy with cardiopulmonary by- pass technique. -Transvenous catheter embolectomy is a technique in which a vacuum-cupped catheter is introduced transvenously into the affected pulmonary artery. Suction is applied to the end of the embolus and the embolus is aspirated into the cup .
Nursing management MANAGING OXYGEN THERAPY RELIEVING ANXIETY MONITORING FOR COMPLICATIONS PROVIDING POSTOPERATIVE NURSING CARE PROMOTING HOME AND COMMUNITY-BASED CARE
Mention nursing process of patient have Pulmonary Embolism ? DEFINE the following? thrombus Embolism Pulmonary vascular resistance -Pulmonary arterial pressure-The intermittent pneumatic leg compression device-Cardiopulmonary by pass technique