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Pulmonary embolis notes, Study notes of Nursing

Bryant and Stratton College-RichmondNursing

Detailed notes & practice questions related to Pulmonary Embolism

Typology: Study notes

2025/2026

Uploaded on 03/17/2026

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Pulmonary Embolism
1
1. Listen to the PE lecture before class: https://soundcloud.com/patty-cohen/pulmonary-
embolism?in=patty-cohen/sets/nurs-223-exam-1
2. Follow along with OneNote: https://1drv.ms/u/s!AhhtPrFos02yiS1n8L4ofEOQi1AL
3. Google Slides: https://docs.google.com/presentation/d/193XbmByTwd0DLlMUIZi-
qkfDD_d-EoyUjW6Glf7P35E/edit?usp=sharing
Audio Google Slides:
https://drive.google.com/drive/folders/1bSEHJv8M4ETwA8Jghy-QbzB-
bga0ZRAz?usp=sharing
Instead of worksheets this week complete the ATI practice assessment: Cardiac and
Respiratory Practice and upload results in Blackboard. Complete a focused review to
receive full points. But you must listen and prepare for lectures before class.
Pulmonary Embolism: Pathophysiology
• blockage of one or more pulmonary arteries by a thrombus, fat or air embolus, or tumor
tissue.
• Symptoms are sudden
• Most PE arise from DVTs in the lower extremities
• Most common preventable death in hospitalized patients
Virchow’s Triad: Stasis (s), hypercoagulability(h), endothelial damage(ed)
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Download Pulmonary embolis notes and more Study notes Nursing in PDF only on Docsity!

1. Listen to the PE lecture before class: https://soundcloud.com/patty-cohen/pulmonary- **embolism?in=patty-cohen/sets/nurs- 223 - exam- 1

  1. Follow along with OneNote: https://1drv.ms/u/s!AhhtPrFos02yiS1n8L4ofEOQi1AL
  2. Google Slides: https://docs.google.com/presentation/d/193XbmByTwd0DLlMUIZi-** qkfDD_d-EoyUjW6Glf7P35E/edit?usp=sharing Audio Google Slides: https://drive.google.com/drive/folders/1bSEHJv8M4ETwA8Jghy-QbzB- bga0ZRAz?usp=sharing Instead of worksheets this week complete the ATI practice assessment: Cardiac and Respiratory Practice and upload results in Blackboard. Complete a focused review to receive full points. But you must listen and prepare for lectures before class. Pulmonary Embolism: Pathophysiology
  • blockage of one or more pulmonary arteries by a thrombus, fat or air embolus, or tumor tissue.
  • Symptoms are sudden
  • Most PE arise from DVTs in the lower extremities
  • Most common preventable death in hospitalized patients Virchow’s Triad: Stasis (s), hypercoagulability(h), endothelial damage(ed)

Risk Factors: THROMBOSIS

  • T - travel, trauma (MVA)
  • H- hospital, hormones, (estrogen, tamoxifen), history of VTE
  • R - relatives (leiden V)
  • O - old age, estrogen therapy
  • M - malignancies
  • B - bone long bone fracture results in fat emboli, bone cement
  • O - obstetrics, orthopedic surgery, oncology
  • S - surgery, smoker
  • I - immobilize 4-5 days
  • S - sickness (nephrotic syndrome), smoking, Health Promotion and Maintenance
  • Encourage weight loss
  • Start PROM and AROM exercises for immobilized and postoperative patients.
  • Ambulate asap
  • Use anti-embolism and SCDs after surgery
  • Evaluate patient for criteria indicating the need for anticoagulant therapy.
  • Elevate the affected limb 20 degrees or more above the level of the heart to improve venous return
  • Prevent injury to the vessel lumen by preventing local pressure, trauma, infection, or sepsis.
  • Do not massage leg muscles
  • Administer prescribed prophylactic low-dose anticoagulant and antiplatelet drugs
  • Avoid the use of tight constricting clothing.
  • No pillows under the knee!
  • assess peripheral circulation
  • Encourage smoking cessation
  1. **Why should patients at risk for DVT be on stool softeners?
  2. What are important patient teaching points in regard to travel precautions?**
  • Nitroprusside is a vasodilator which helps alleviate pulmonary HTN. ABGs in PE
  • Early Resp Alkalosis from tachypnea; pH >7.45 PaCO2 < 35
  • Late Resp acidosis
  • Later metabolic acidosis d/t buildup of lactic acidosis
  • Hypoxemia PaO2 < 80 mmHg Labs in PE
  • positive D-dimer (normal D-dimer less than 0.40 mcg/mL) Dx testing
  • CT scan - (aka spiral or helical or CT angiography or CTA); Added advantage to assess other pulmonary abnormalities
  • V/Q scan for patient who cannot have contrast
  • Pulmonary angiography is the gold standard test
  • CXR to dx other conditions that mimic acute PE
  • Doppler ultrasound may confirm DVT/VTE Nursing dx
  • Impaired Gas Exchange
  • Anxiety
  • Acute pain
  • Fear Heparin
  • Heparin IV gtt unless the PE is massive, or the patient has hemodynamic instability
  • Unfractionated Heparin SC
  • LMWH (enoxaparin) SC
  • Heparin IV continues x 5 days
  • Warfarin is started on day one or two
  • Heparin continues until the INR reaches 2.0 to 3.
  • Monitor platelet count to detect HIT
  • Monitor INR (Warfarin) 6. The nurse should hold heparin products for a platelet level less than________________. Nursing implications for Heparin
  • Monitor PTT (or factor anti-Xa) and know expected therapeutic PTT range
  • PTT - should be 1.5 to 2.5 the control
  • ~ 60-80 sec for heparin if the control is 30 to 40 secs (pg 255 Med Surg)
  • Monitor patient for bleeding or bruising
  • Have Protamine Sulfate on hand

Nursing implications for Warfarin

  • monitor INR expected therapeutic 2. 0 - 3.
  • Have vitamin K (phytonadione) available because it is the antidote to be used in case of warfarin toxicity
  • Not a good choice for vegetarians
  • Teach patients not to increase Vit K foods Practice Medication knowledge here: https://quizlet.com/_8btxvi?x=1jqt&i=1vndzv Enoxaparin
  • Low molecular weight heparin (LMWH): check platelets and Hbg (at risk for HIT) before administering
  • do not aspirate prior to injection
  • take at same time each day
  • Mediation is given SC. Nursing implications for fibrinolytics
  • alteplase is used in PE when there is hemodynamic collapse
  • Fibrinolytics dissolve and break up the clot
  • Obtain baseline neuro assessment
  • Assess for bleeding q 8
  • measure abd girth q 8
  • reconstitute with sterile water only; right before use
  • admin with caution to patients who are on blood thinners already