MDC 4: EXAM 2 STUDY GUIDE WITH COMPLETE SOLUTION!!
PE occurs when
Answers :• inappropriate blood clotting forms a VTE or DVT in a vein in the legs
or the pelvis and a clot breaks off and travels to the right side of the heart
• clot then lodges in the pulmonary artery, obstructing the alveolar perfusion and
outflow, which results in increased alveolar dead space and creating a ventilation-
perfusion mismatch
• platelets collect on the embolus, triggering the release of substances that cause
blood vessel constriction
Major risk factors for VTE leading to PE are:
Answers :• Prolonged immobility
• Central venous catheters
• Surgery
• Pregnancy
• Obesity
• Advancing age
• General and genetic conditions that increase blood clotting
• History of thromboembolism
• Smoking
• Estrogen therapy
• heart failure
• stroke
• cancer (particularly lung or prostate)
• trauma
• heparin-induced thrombocytopenia
septic clots may develop from
,Answers :• pelvic abscess
• infected IV catheter
• illegal drug injections
Prevention of Pulmonary Embolism
Answers :• Start passive and active range-of-motion exercises for the extremities
of immobilized and postoperative patients.
• Ambulate patients as soon as possible after surgery.
• Use pneumatic compression devices after surgery as prescribed.
• Evaluate patient for criteria indicating the need for anticoagulant therapy.
• Give prescribed prophylactic low-dose anticoagulant or antiplatelet drugs after
specific surgical procedures as soon as surgical bleeding risk has subsided.
• Teach patients to avoid the use of tight garters, girdles, and constricting clothing.
• Prevent pressure under the popliteal space (e.g., do not place a pillow under the
knee; instead, use an alternating pressure mattress).
• Perform a comprehensive assessment of peripheral circulation every 8 hours.
• Elevate the affected limb 20 degrees or more above the level of the heart to
improve venous return, as appropriate.
• Change patient position every 2 hours or ambulate as tolerated.
• Refrain from massaging leg muscles.
• Instruct patients not to cross their legs.
• Teach the patient and family about precautions.
• Encourage smoking cessation.
• Weight reduction
Pulmonary Embolism (Classic Signs and Symptoms)
,Answers :• Sudden onset of dyspnea
• Sharp, stabbing chest pain
• Apprehension, restlessness
• Feeling of impending doom
• Cough
• Hemoptysis
• Diaphoresis
• Increased respiratory rate
• Crackles
• Pleural friction rub
• Tachycardia
• S3 or S4 heart sound
• Fever, low grade
• Petechiae over chest and axillae (usually only associated with fat embolism
syndrome [FES])
• Decreased arterial oxygen saturation (SaO 2)
• Distended neck veins
• syncope
• Cyanosis
• Hypotension
PE lab tests
Answers :• hyperventilation triggered by hypoxia and pain first leads to respiratory
alkalosis
• later, metabolic acidosis results from buildup of lactic acid caused by tissue
hypoxia
, • BNP
• D-dimer levels
→ if low or normal rules out PE
→ if the value is higher further testing is needed
Management of Pulmonary Embolism
Answers :• Apply oxygen by nasal cannula or mask
• Reassure patient that the correct measures are being taken
• Place patient in high-Fowler position
• administering anticoagulation or fibrinolytic therapy to improve tissue perfusion
• Apply telemetry monitoring equipment
• Obtain venous access
• Assess oxygenation continuously with pulse oximetry
• Assess oxygenation continuously with pulse oximetry.
• Assess respiratory status at least every 30 minutes
→ listen to lung sounds, measure rate and rythm of respirations, check skin color,
capillary refill, and trachea
• Assess cardiac status by:
→ comparing BP in both arms, assess cardiac monitor for dysrhythmias, check for
neck vein distention
• Examine the chest for presence of petechiae
• Assess for bleeding
• Institute Bleeding Precautions
Massive PE
Answers :• Possible Symptoms:
PE occurs when
Answers :• inappropriate blood clotting forms a VTE or DVT in a vein in the legs
or the pelvis and a clot breaks off and travels to the right side of the heart
• clot then lodges in the pulmonary artery, obstructing the alveolar perfusion and
outflow, which results in increased alveolar dead space and creating a ventilation-
perfusion mismatch
• platelets collect on the embolus, triggering the release of substances that cause
blood vessel constriction
Major risk factors for VTE leading to PE are:
Answers :• Prolonged immobility
• Central venous catheters
• Surgery
• Pregnancy
• Obesity
• Advancing age
• General and genetic conditions that increase blood clotting
• History of thromboembolism
• Smoking
• Estrogen therapy
• heart failure
• stroke
• cancer (particularly lung or prostate)
• trauma
• heparin-induced thrombocytopenia
septic clots may develop from
,Answers :• pelvic abscess
• infected IV catheter
• illegal drug injections
Prevention of Pulmonary Embolism
Answers :• Start passive and active range-of-motion exercises for the extremities
of immobilized and postoperative patients.
• Ambulate patients as soon as possible after surgery.
• Use pneumatic compression devices after surgery as prescribed.
• Evaluate patient for criteria indicating the need for anticoagulant therapy.
• Give prescribed prophylactic low-dose anticoagulant or antiplatelet drugs after
specific surgical procedures as soon as surgical bleeding risk has subsided.
• Teach patients to avoid the use of tight garters, girdles, and constricting clothing.
• Prevent pressure under the popliteal space (e.g., do not place a pillow under the
knee; instead, use an alternating pressure mattress).
• Perform a comprehensive assessment of peripheral circulation every 8 hours.
• Elevate the affected limb 20 degrees or more above the level of the heart to
improve venous return, as appropriate.
• Change patient position every 2 hours or ambulate as tolerated.
• Refrain from massaging leg muscles.
• Instruct patients not to cross their legs.
• Teach the patient and family about precautions.
• Encourage smoking cessation.
• Weight reduction
Pulmonary Embolism (Classic Signs and Symptoms)
,Answers :• Sudden onset of dyspnea
• Sharp, stabbing chest pain
• Apprehension, restlessness
• Feeling of impending doom
• Cough
• Hemoptysis
• Diaphoresis
• Increased respiratory rate
• Crackles
• Pleural friction rub
• Tachycardia
• S3 or S4 heart sound
• Fever, low grade
• Petechiae over chest and axillae (usually only associated with fat embolism
syndrome [FES])
• Decreased arterial oxygen saturation (SaO 2)
• Distended neck veins
• syncope
• Cyanosis
• Hypotension
PE lab tests
Answers :• hyperventilation triggered by hypoxia and pain first leads to respiratory
alkalosis
• later, metabolic acidosis results from buildup of lactic acid caused by tissue
hypoxia
, • BNP
• D-dimer levels
→ if low or normal rules out PE
→ if the value is higher further testing is needed
Management of Pulmonary Embolism
Answers :• Apply oxygen by nasal cannula or mask
• Reassure patient that the correct measures are being taken
• Place patient in high-Fowler position
• administering anticoagulation or fibrinolytic therapy to improve tissue perfusion
• Apply telemetry monitoring equipment
• Obtain venous access
• Assess oxygenation continuously with pulse oximetry
• Assess oxygenation continuously with pulse oximetry.
• Assess respiratory status at least every 30 minutes
→ listen to lung sounds, measure rate and rythm of respirations, check skin color,
capillary refill, and trachea
• Assess cardiac status by:
→ comparing BP in both arms, assess cardiac monitor for dysrhythmias, check for
neck vein distention
• Examine the chest for presence of petechiae
• Assess for bleeding
• Institute Bleeding Precautions
Massive PE
Answers :• Possible Symptoms:
