Pulmonary Embolism (PE) Lecture Notes

Overview

• Pulmonary Embolism (PE): A life-threatening blockage in the pulmonary vasculature caused by an emboli or blood clot occluding a pulmonary artery.
• Most commonly caused by a Deep Vein Thrombosis (DVT).

Causes and Risk Factors

• DVT in the legs can travel to the lungs, affecting circulation and gas exchange.
• Risk factors:
  • Immobility
  • Smoking
  • Combined oral contraceptives (estrogen and progesterone)
  • Obesity
  • Surgery
  • Atrial fibrillation
  • Pregnancy
  • Long bone fractures (e.g., femur) causing fat emboli

Signs and Symptoms

• Shortness of breath
• Anxiety
• Chest pain on inspiration
• Tachycardia
• Tachypnea
• Hypotension
• Petechiae (red dots on skin) indicating fat emboli

Diagnosis and Labs

• D-dimer: Elevated in presence of a clot (DVT or PE).
• CT scan: Used for PE diagnosis.

Treatment

• Medications:
  • Anticoagulants: Warfarin, Heparin
  • Thrombolytics: Alteplase (breaks up clots)
• Surgical Interventions:
  • Thrombectomy (removal of clot)
  • Vena cava filter (catches clot before reaching lungs)

Nursing Care

• Sit patient upright for easier breathing.
• Administer oxygen as ordered.
• Initiate Heparin immediately (fast-acting anticoagulant).
• Begin Warfarin alongside to achieve therapeutic levels over several days.
  • Monitor PT and INR levels (Therapeutic INR: 2-3).

Patient Education

• Maintain consistent intake of Vitamin K (affects Warfarin's effectiveness).
• Be aware of bleeding risks:
  • Avoid aspirin
  • Prevent falls
  • Use soft toothbrush and electric razor
  • Avoid forceful nose blowing

DVT Prevention

• Encourage cessation of smoking.
• Increase mobility.
• Wear compression stockings.

Quiz Questions

1. What is the most common cause of a pulmonary embolism?
   • Answer: Deep Vein Thrombosis (DVT)
2. What lab will be elevated in the presence of a clot?
   • Answer: D-dimer
3. How should a patient modify their intake of vitamin K while on warfarin?
   • Answer: Maintain a consistent intake of vitamin K