Good for seeing smaller lung arteries B. Dissolution of clot via chemical lysis of fibrin component, resulting in rapid removal of intraluminal thrombus and restoration of vessel patency 2. Maintain adequate cardiac and respiratory function until blockage resolves, usually within 10 to 14 days 2. Not recommended for patients with severe renal insufficiency, low body weight, active major bleeding, bacterial endocarditis, or thrombocytopenia b. Young adulthood: ECHO has been used to monitor improvement of obstruction, especially during treatment with fibrinolytic agents C. Heparin treatment failures 5.
Eliminates need for transport for invasive testing if positive 5.
Small doses of opiates intravenous morphine, 1 to 2 mg for discomfort and anxiety; avoid larger doses which may lead to respiratory depression 6. Most serious is intracranial bleeding: The synthetic pentasaccharide fondaparinux has also been evaluated for the short-term treatment of DVT and PE.
Good for seeing smaller lung arteries B. Oxygen via nasal cannula, mask, or both 3.
Pulmonary Embolism in the Postanesthesia Care Unit: A Case Study.
Emboli dissolve over course of several days because of natural fibrinolytic mechanisms d. Heparin treatment failures 5. Studies have not shown improved overall mortality compared to heparin Erdman et al. In cases of incomplete lysis, chronic pulmonary hypertension may result 2.
Intravenous unfractionated heparin standard treatment a.
Devices a. Heparin 1. Basic metabolic panel and complete blood count nursing case study pulmonary embolism were within the normal range. Medical Management of Pulmonary Embolism A. A normal ventilation scan with abnormal perfusion scan is associated with high probability of PE f.
Treatment Goals 1. Pertinent Diagnostic Testing A. Smart lte business plan scan requires injection of radioactive material albumin with technetium or iodine followed by imaging to detect area of nonperfusion suggestive of blocked artery d.
Continue treatment until therapeutic oral anticoagulation is complete 4. Invasive Testing: Discussion Venous thromboembolism VTE results from clot formation within the venous circulation and typically manifests as deep vein thrombosis DVT and pulmonary embolism PE.
Venous Doppler ultrasound of the lower extremities also revealed extensive deep venous thrombosis in his left lower leg. Indications see Table 2. More accurate when intravenous contrast material used c.
Usually show hypoxemia, hypocapnia, respiratory alkalosis, but not always seen, so ABGs do not play major role in diagnosis c. Critically ill patient needs to be monitored: Contraindications to thrombolytic therapy Erdman et al.
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Rapid restoration of hemodynamic function e. Current use a. Invasive procedure using contrast material: The long-term incidence of VTE among patients who have a prior history of VTE and who have metastatic cancer is also high.
Stops progression of thrombosis b. Lytic agents have short half-life: Prevention of recurrent thrombus formation d. For nursing case study pulmonary embolism discipline-specific case studies, navigate using the left menu. Does not bind to platelet factor 4; does not affect platelet aggregation 2. Disadvantages a. Gold standard for diagnosis of PE, but not often performed see Limitations 2.
Pulmonary Embolism | Nurse Key
Pre-existing lung disease atelectasis, pneumothorax, emphysema, chronic pulmonary lung disease may cause false-positive results: Prompt, Accurate Diagnosis with immediate stabilization using supportive care and anticoagulation therapy required for maximal outcome 1. Echocardiography ECHO a.
Low arterial oxygen PO2 highly suspicious for PE, especially if chest x-ray normal b. Monitor for adverse effects 1 Hemorrhage: Lung markings primarily blood vessels are diminished in area supplied by clotted artery d. Employs continuous movement of patient through scanner with concurrent rotating rapid scanning b.
Pulmonary Case Studies
His vital signs were: Massive PE without hemodynamic compromise c. Potential benefits a. You are currently viewing Pharmacist case studies. Pulmonary infarct shows triangular, wedge-shaped defect c. LMWH a. Access Pharmacy Website: High risk of systemic bleeding complications: Antithrombotic Therapy for Venous Thromboembolic Disease: Limitations a.
DVT and PE: A case study
Indicates massive PE in healthy patient or submassive PE in patient with pre-existing cardiopulmonary disease b. Dosage for DVT prevention hip and knee replacement: Action a. Noninvasive Testing 1. FDA approved nursing case study pulmonary embolism agents a. High level of technical expertise; expensive e. Proposed indications a.
Nuclear medicine lung scan American Thoracic Society, a. Case study cont'd In this case, the year-old patient had additive risk factors for VTE: Dissolution of clot via chemical lysis of fibrin component, resulting in rapid removal of intraluminal thrombus and restoration of vessel patency 2. Not suitable for routine use or screening D.
Normal does not exclude PE but makes diagnosis less likely d. Grade 1C is defined as a strong recommendation, although it has relatively low-quality evidence. Evaluates for acute cor pulmonale b. Local anesthetic and small incision in groin b.
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If blood replacement required, whole blood, packed red cells, fresh-frozen plasma, or cryoprecipitate may be given. Graduated compression stockings 8. Requires anticoagulation with heparin and followed by lifelong warfarin 3.
Allows visualization of pulmonary arteries via catheterization of groin, injection of contrast material, and x-ray 3. Serious major bleeding, thrombocytopenia, aminotransferase elevation, anemia d. Prevention of venous thromboembolism: Ventilation scan requires inhalation of radioactive gases or aerosols followed by imaging to detect nonventilated area c. Shock a.
Treat with acetaminophen 4 Hypotension: Intended Audience: ABG 4. Fondaparinux Arixtra: Shows where blood does not flow b. Detection of proximal vessel emboli easier than in segmental arteries; limited ability to detect emboli beyond segmental arteries 3.
If the individual has a familial or acquired thrombophilia, recurrent thromboembolism or ongoing risk factors, anticoagulation may be lifelong refer to Chapter 19Superficial Thrombophlebitis and Deep Vein Thrombosis for chronic anticoagulation management G. Surgical Management 1.
Deep Vein Thrombosis and Pulmonary Embolism after a Long Distance Drive
Prevent recurrence of thrombosis or other embolic events B. Important to reach therapeutic level as quickly as possible to prevent reoccurrence of PE: Grade 1B is a strong recommendation, with moderate-quality evidence.
Special coagulation studies, if necessary 3. Dosage for prevention of DVT in abdominal surgery: Warfarin Oral Anticoagulation 1. Dosage for prevention of DVT hip fracture surgery: Fibrinolytic Therapy 1. Faster recovery c. If active thromboprophylaxis is considered because of a perceived high risk of VTE, the use of properly fitted, below-knee graduated compression stockings GCSproviding mm Hg of pressure at the ankle Grade 2Cor critical thinking skills at work single prophylactic dose of low-molecular-weight heparin LMWHinjected prior to departure Grade 2C are suggested.
May show nonspecific changes in T-wave, S-T segment, or axis deviation: Guidelines for patient care Erdman et al.
For long-distance travelers with additional risk factors for VTE, the general measures listed above are recommended. He didn't receive active thromboprophylaxis and developed a second VTE episode which may have been preventable.