Okay, let s talk pulmonary embolism.
The chances of you getting a question about pulmonary embolism on the actual NCLEX is
pretty low.
However, let s talk about the things you know in case you encounter one of these questions.
First of all, let s discuss what exactly is a pulmonary embolism.
Now, you re gonna hear pulmonary embolism as P.E. if you re working in the hospital.
You re just gonna be, you re just gonna know it s P.E., that s we re basically gonna call
it.
Okay, so, what is a P.E.?
Well a PE, first of all, it s pulmonary, okay, so, that means lungs, and then it s called
embolism.
So, what s in an embolism?
An embolus is a clot that breaks off and travels through the blood stream.
Okay, so what s gonna happen with the pulmonary embolism is a clot is gonna break off, usually
a DVT, something in the lower extremeties, it s gonna break off, travel through the blood
stream, into the right heart, an then into the blood supply of the lungs.
Okay, so, it s gonna get into the blood supply of the lungs, and eventually, it s gonna get
into a spot that it can no longer travel.
So, it s gonna get into this spot that it actually clogs off the blood supply to a portion
of the lungs.
And what s gonna happen there is you re gonna have all this blood that s trying to get perfused,
it s gonna try to reach this alveoli, and gets perfused with oxygen and it s not going
to be able to do so.
Okay, so that s what a pulmonary embolism is.
Understanding what happens here and then we re locking off that blood flow will help us
understand what some of the different symptoms are gonna be.
Okay, so, for your assessment on your patient.
First of all, it s gonna be anxiety.
If you think about this, these patients aren t able to profuse their blood and so, they
re gonna become very anxious.
They re gonna have tachycardia, tachypnea, they re gonna be breathing very fast, possibly
hypotension and a low grade fever, okay?
They will probably have a cough, this dry cough, they might have some hemoptysis with
it, which means a little bit of blood in their cough.
Okay, they got this blood clot in there, they might get a little blood with it.
Those altered mental status, okay, decreased level of consciousness.
These patients are no longer getting the oxygen that they need and so, they re neuro status
is gonna change.
They re gonna have diapheresis, you re gonna notice a sweating on them, this anxiety, this
change in the level of consciousness.
You re also gonna notice VQ mismatch, ventilation perfusion, this means the ventilation perfusion
scan, and what s that gonna show you is basically you re gonna see VQ mismatch.
Okay, that s what you need to know with that.
That s omething we can get into later.
You re gonna notice extremely low PaO2, their partial pressure of oxygen in their blood
is gonna be very low, obviously, they re not getting oxygen to the blood.
Pulmonary angio is gonna actually possibly show us the clot.
Management.
With this, we gonna need them, we need to get them oxygen, we need to provide supplemental
oxygen and be prepared for mechanical ventilation if we re unable to get their PaO2 where we
need it to be, then we need to offer them mechanical ventilation.
We re gonna offer them anti-coags to try to decrease that coagulation in their blood and
we re probably also thrombolytics at them, probably some TPA, or something like that
to break up that clot, to bust it, and to get blood flowing how it needs to.
Obviously, we re gonna get them opioids to treat this pain that they re gonna be having
and we need to give them anti-anxiety or anxiolytics, to help calm them and feel that we re gonna
be able to treat this and help them.
Another thing that we re gonna do is vena cava filter.
What this is, we have our inferior vena cava coming up from the lower extremities into
the heart with the vena cava filter is it just little tiny kinda metal shaped, cone,
triangular shaped net that actually sits in the inferior vena cava.
So, you ll see this IVC filter, and what that does, is that it s going to catch any clots
that break off, they re actually gonna caught in this little net and they will not be able
to travel to the lungs.
Okay, so that s an IVC filter is.
So, here is a pulmonary angio, this is an angiogram of, you re gonna see heart here,
lungs, and this is what doctors may use to be able to definitively diagnose PE.
Okay, so, that s what we need to know about PE mainly, anxiety, pain, and obviously, they
re not gonna be able to breathe as they need to.
So, we need to break up that clot, we need to prevent further clots, okay.
So, guys, that s what you need to know about PE.
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