Normally, the heart pumps blood to the lungs for oxygenation. Then, oxygen-rich blood is now carried into the system via the arteries. Once oxygen is utilized in the body, it enters another network of blood vessels called the veins. Veins carry unoxygenated blood to the heart and lungs. A clot or thrombus formed in the veins can be detached and carried into the bloodstream and can lodge into the pulmonary artery in the lungs.
When PE strikes unexpectedly, it may be the result of the passage of an asymptomatic thrombus into the pulmonary circulation. When a large thrombus blocks major pulmonary vessels, cardiogenic shock will occur, followed quickly by circulatory failure and death (Anderson & Audet. 2010).
What is a thrombus?
A thrombus is a blood clot or a solid mass of platelet that is formed in a vein.
What is an embolus?
An embolus is a blood clot that travels through the blood vessel
Pulmonary embolism is a medical emergency. Therefore, the immediate objective is to stabilize the cardiopulmonary system (Smeltzer, et al., 2010).
- Oxygen is administered to relieve hypoxemia and respiratory distress.
- Intravenous infusion lines to deliver medications and fluids.
- Position client in high fowler’s position.
- Prepare for intubation and mechanical ventilator if severe hypoxemia persists.
- Dobutamine (Dobutrex) is administered to treat hypotension.
- Monitor ECG continuously for dysrhythmias and right ventricular failure.
- Morphine and other sedatives are administered intravenously in small doses to alleviate anxiety and chest discomfort.
- Anticoagulation therapy intravenously with heparin sodium followed by continuous administration during the acute phase.
- Warfarin (Coumadine) is prescribed orally once heparin is discontinued.
- Monitor prothrombin time and partial thromboplastin time.
- Thrombolytic therapy to resolve thrombi or emboli quickly for patients who are severely compromised.
- Surgical management includes embolectomy, vein ligation or insertion of an umbrella filter.
Preventing pulmonary embolism
According to Morrell & Dunnill (1968), “Pulmonary embolism remains the most common preventable cause of death in hospital”. Therefore, measures to prevent pulmonary embolism should be initiated as soon as possible.
Prophylaxis is preferred to treatment, as venous thromboembolism can be hard to diagnose and, in the case of PE, there is often no warning that the patient is at risk (Anderson & Audet, 2010). Anticoagulant medications are used as prophylaxis especially after a major surgery. Also, early ambulation postoperative helps prevent the development of thrombus and promotes circulation. Clients with increase risk of developing deep vein thrombosis are encouraged to wear compression stockings.
Pulmonary Embolism Pathophysiology and Schematic Diagram
- Anderson, F. & Audet, A.M. (2010). Preventing Deep Vein Thrombosis and Pulmonary Embolism: A Practical Guide to Evaluation and Improvement. Retrieved from www.outcomes-umassmed.org.
- Black, J., & Hawks, J. (2009). Medical-surgical nursing: clinical management for positive outcomes (8th ed.).St. Louis, Mo.: Saunders/Elsevier Inc.
- Silvestri, L. A.(2005). Saunders Comprehensive review for the NCLEX-RN Examination. St. Louis, Mo.: Saunders/Elsevier Inc.
- Smeltzer, S., Bare, B., Hinkle, J. Cheever, K. (2010). Brunner & Suddarth’s Textbook of Medical Surgical Nursing.Wolter Kluwer Health/ Lippincott Williams & Wilkins.