Welcome back future nurses. It's Christine from Nurse in the Making and today we're going to talk about PE, which stands for pulmonary embolism. If you're following along in the MedSurge flashcards, I'm in the cardiovascular section on the card PE. Let's get started by talking about what a PE is. PE stands for pulmonary embolism.
This falls beneath the large umbrella of a VTE, which stands for venous thromboembolism. These are clots which occur in any vessel of the body. DVTs, deep vein thrombosis, and PEs both fall under that umbrella of VTE.
I have an entire video talking about DVTs. A link should be popping up if you want to check that out. When a clot sits in the leg as a DVT and it dislodges, it can travel upward into the lungs, causing the pulmonary vessels to become blocked. And this is when it becomes a PE.
When a vessel is blocked, gas exchange cannot take place and this is dangerous for many reasons. A pulmonary embolism can also be from an air bubble which has entered the bloodstream. This could have happened from an accidental injection of air from a syringe.
It also could happen from going to the surface too quickly while deep-sea diving or from trauma. PE's can also be caused by small fat deposits but this is very rare. The point is any of these things, air, fat, or clot can block normal blood flow which cuts off much needed air exchange.
So who is at risk for developing a pulmonary embolism? Well first off a patient already diagnosed with the DVT is at huge risk for developing a PE. If that clot breaks off and travels upward it can cause a PE.
Other risk factors include trauma or surgery, any disruption of blood flow. A hypercoagulable state, you want to think pregnancy or oral contraceptive use. Immobility like bed rest, bed bound patients, these can all increase someone's risk for developing a PE.
But again, the most common cause are those blood clots or a dislodged DVT. Diagnosing a PE is very similar to diagnosing a DVT. Remember it. Both these sit under the VTE umbrella.
So a D-dimer lab test will likely be ordered to check for that protein fragment which is sitting in the blood, telling us a clot is somewhere to be found. An elevated level or a level greater than 0.5 should raise a red flag. Since a D-dimer test only tells us there is a clot somewhere in the body, we need to do a CT scan and a chest x-ray to visualize the lungs and locate exactly where that suspected clot is hiding.
When a patient has a pulmonary embolism, their symptoms can be alarming. Some things to look out for are shortness of breath, rapid breathing, which makes sense because the body is trying to compensate for that blocked airway. The patient will have an increased heart rate as the heart works harder to compensate.
Oxygen saturation will go down since the patient's not getting the oxygen that they need. Often these patients complain of chest pain. They may feel anxious, restless, or afraid. Some patients will experience a sense of what we call impending doom.
This can actually happen for a patient with blood clots where they are overcome with the feeling that something bad is about to happen. If a patient ever mentions this, act. Take this seriously. The body works in amazing ways and as a nurse it is your responsibility to listen and advocate for them.
Since pulmonary emboli can be life-threatening, once they are found and diagnosed, treatment begins immediately. Heparin will likely be administered usually by an IV drip to prevent the clot from growing in size and to prevent new clots from forming. Nursing tip is that heparin is a high alert medication, meaning two nurses will need to verify this drug.
Thrombolytics, which are medications to help dissolve the clot. Sometimes these clots dissolve on their own, but treatment will be decided based on what is seen in those diagnostic tests. If it's needed, surgical intervention might be necessary. A surgical embolectomy may be used.
Let's break apart that word. Ectomy means the removal of, and emboli means a clot, so it's just removing the clot from the body. Much like a DVT or any unwanted clot, we want to prevent them from even forming in the first place. Well, how do we do this? The use of TED stockings and compression devices help promote that blood flow, especially when in bed or they are post-operative.
We encourage leg exercises and early ambulation for those post-op patients. This is extremely important. We do this to get the blood moving.
If someone will be traveling for a long flight or a long car ride, remind them to stand, walk around, or perform simple leg exercises. We want to encourage our patients to stop smoking since smoking hurts our vascular system. You want to educate your patient about any anticoagulant therapy if ordered.
Things like heparin, warfarin, lovinox. These are very important medications and these patients should understand the importance of taking them when scheduled. But something to know is that treatment is very different than prevention. For prevention, we want to get them up and moving.
But for treatment, it's pretty much the opposite. We want to do everything in our power to keep that clot in the same spot. Isolate it and prevent it from migrating anywhere. So for treatment we think bed rest, avoid massaging the area, avoid heat, avoid anything that can open up the vessels or could break up the clot causing it to go straight to the lungs.
Don't forget to subscribe to my YouTube channel for weekly nursing school videos, daily nursing school quizzes, and all things to help you pass nursing school. Happy studying future nurses!