Lesson 3
PULMONARY EMBOLISM
CONTENTS
I. Introduction
II. Assessment
a. Risk Factors/Etiology
b. Clinical Manifestations
c. Diagnostic Examination/ Laboratory Tests
III. Treatment
IV. Nursing Intervention/Goals
V. Self Test / Self Directed Learning / Critical Thinking Drill
VI. References/Further Readings
I. Introduction
A pulmonary embolus is an obstruction of a pulmonary artery, most often the result of an
embolism caused by a blood clot (thrombus), air, fat or amniotic fluid. The severity of the
problem depends on the size of the embolus.
The right lobe is most frequently involved; of the clients who die, three fourths die within 2
hours.
The majority of pulmonary emboli arise from thrombi in the deep veins of the thigh or pelvic
cavity
A pulmonary embolus must originate from the venous circulation, or the right side of the heart.
II. Assessment
A. Risk Factors / Etiology
1. Conditions or immobility predisposing to venous stasis and/or deep vein thrombosis: surgery,
pregnancy, obesity, varicose veins, spinal cord injury, and prolonged periods of sitting
2. Hypercoagulation: dehydration, malignancy, pregnancy or uncomplicated vaginal delivery,
oral contraceptives, increased platelet count
3. Vascular injury: intravenous catheters, thrombophlebitis, vascular disease, leg fractures
B. Clinical Manifestations
1. Dyspnea
2. Sudden, unexplained, pleuritic chest pain
3. Tachypnea
4. Tachycardia
5. Hemoptysis
6. Apprehension
7. Hypotension and syncope
8. May result in sudden death if pulmonary embolus is large
C. Diagnostics
1. Pulmonary angiogram (definitive study)
2. Ventilation/perfusion radioisotope lung scan
3. Electrocardiogram (nonspecific)
4. Chest X-ray (nonspecific)
5. ABGs (decreased PaO2, normal or low PaCO2)
6. Enhanced spiral computed tomography
III. Treatment
A. Bed rest
B. Respiratory support
C. Anticoagulants (heparin, low-molecular-weight heparin – e.g. enoxaparine) to prevent further
thrombus formation
D. IV access for fluids and medications to maintain blood pressure
E. Small doses of morphine sulfate may be used to decrease anxiety, alleviate chest pain, or
improve tolerance to endotracheal tube
F. Thrombolytics
IV. Nursing Intervention
Goal No. 1: To identify problem and implement nursing measures to alleviate hypoxia
a. Position client to maintain patent airway.
1. Unconscious client: Position on side with the chin extended
2. Conscious client: Elevate the head of the bed and may position on side as well.
b. Encourage deep breathing.
c. Maintain adequate fluid intake
d. Administer O2 if dyspnea is present
e. Maintain calm approach, because increasing anxiety will potentiate anxiety.
f. Assess response to O2 therapy and notify physician of significant changes in respiratory function.
Goal No. 2: To monitor client’s respiratory function and response to treatment
a. Assess patency of airway and/or speaking ability
b. Evaluate vital signs (especially rate and depth of breathing), presence of chest retractions and/or
diaphoresis
c. Evaluate breath sounds
d. Check for presence of dysrhythmia and chest discomfort
Goal # 3: To prevent venous stasis prior to embolus trapping and further thrombosis (after surgery or
condition)
a. Prophylactic measures for the client who has undergone surgery
b. Prevent complications of immobilization
c. Elevate legs for about 20 minutes every 4 to 5 hours to facilitate venous return
d. Elastic stockings is advised; do not wear restrictive clothing
e. Maintain good fluid intake; avoid dehydration
V. Self Test / Critical Thinking Drill
SELF-TEST QUESTIONS
1. The nurse assesses a patient for a possible pulmonary embolism. What frequent sign of pulmonary
embolus does the nurse anticipate finding on assessment?
a. Cough
b. Hemoptysis
c. Syncope
d. Tachypnea
2. The nurse is planning the care for a patient at risk of developing pulmonary embolism. What nursing
interventions should be included in the care plan? (Select all that apply)
a. Encouraging a liberal fluid intake
b. Assisting the patient to do leg elevations above the level of the heart
c. Instructing the patient to dangle the legs over the side of the bed
d. Using elastic stockings, especially when decreased mobility would promote venous stasis
3. A nurse answers a call light and finds a client
CRITICAL THINKING DRILL
anxious, short of breath, reporting chest pain,
Case Study: Pulmonary Embolism
Sandy, a 37-year-old woman recovering from
multiple fractures sustained in a car accident,
was admitted to the intensive care unit for
treatment of a pulmonary embolism. Before
admission, she was short of breath after walking
and having a blood pressure of 88/52 mm Hg on the cardiac monitor. What action by the nurse takes
priority?
a. Assess the clients lung sounds
b. Notify the Rapid Response Team
c. Provide reassurance to the client
d. Take a full set of vital signs
4. A client has a pulmonary embolism and is started on oxygen. The student nurse asks why the client’s
oxygen saturation has not significantly improved. What response by the nurse is best?
a. Breathing so rapidly interferes with oxygenation
b. Maybe the client has respiratory distress syndrome
c. The blood clot interferes with perfusion in the lungs
d. The client needs immediate intubation and mechanical ventilation
5. A client appears dyspneic, but the oxygen saturation is 97%. What action by the nurse is best?
a. Assess for other manifestations of hypoxia
b. Change the sensor on the pulse oximeter
c. Obtain a new oximeter from central supply
d. Tell the client to take slow, deep breaths
