Pulmonary Embolism NCLEX Review Care Plans
Nursing Study Guide on Pulmonary Embolism
Pulmonary embolism is a serious and life-threatening medical condition resulting from a blockage in one of the pulmonary arteries in the lungs.
The most common cause for developing pulmonary embolism is deep vein thrombosis (DVT), which develops due to a blood clot formed in the lower extremities.
When a portion of the blood clot detaches, it travels to the bloodstream going to different areas of the body.
The clot can lodge into the lungs, impeding the circulation of blood flow to the lungs causing pulmonary embolism.
This can cause serious respiratory difficulties that can be fatal if not treated promptly.
Preventive measures against deep vein thrombosis lower the risk of developing the disease.
Signs and Symptoms of Pulmonary Embolism
The nature of symptoms and severity depend on the size and location of the blood clot, how much of the lung is affected and presence of any underlying condition.
Some symptoms may be vague and can take a while to occur while some are severe and sudden. These include:
- Sudden and severe shortness of breath that gets worse with activity
- Chest pain that is sharp and felt upon inhalation causing breathing difficulties
- Cough. It may be bloody or may produce a blood-tinged sputum
- Rapid, irregular heartbeat
- Light headedness or dizziness
- Diaphoresis – Excessive sweating
- Leg pain or swelling commonly seen in the calf area
- Cyanosis – Clammy or bluish discoloration of the skin
Causes and Risk Factors of Pulmonary Embolism
Pulmonary embolism develops when an embolus, a particle that moves through the blood vessels, reaches and blocks the arteries in the lungs.
It can be from a blood clot (most common root cause), a tumor, a broken bone, o air bubbles.
When a blood clot develops in deep veins of lower extremities (DVT) and a fragment of it breaks off, it is then called an embolus.
This travels through the bloodstream and may get lodged into the pulmonary artery.
If multiple clots are involved, this can result in the obstruction of blood supply in the arteries and may even cause lung tissues to die, a condition known as pulmonary infarction, which then leads to inadequate oxygenation within the body.
There are certain conditions and treatments that increase the risk for pulmonary embolism such as:
- Surgery. One of the leading causes for formation of blood clots especially in the case of big operations
- Family history of venous blood clots or pulmonary embolism
- Cardiovascular diseases particularly heart failure
- Cancer. Particularly cancers in the brain, ovary, pancreas, colon, stomach, lung and kidney and those in advanced stage. Chemotherapy and intake of Tamoxifen or Raloxifene also increases risks for blood clots.
- Blood or clotting disorders
- Prolonged immobility
- Supplemental estrogen
Complications of Pulmonary Embolism
Pulmonary embolism is a life-threatening condition that requires immediate intervention.
Around thirty three percent of undiagnosed and untreated cases do not survive.
Early diagnosis and treatment reduce the mortality rate for this condition.
Obstruction of the arteries in the lungs brought about by pulmonary embolism, forces the heart to compensate by pumping harder which increases blood pressure, a condition known as pulmonary hypertension.
In the long run, pulmonary hypertension causes the heart to gradually weaken.
There are also rare occasions wherein it progresses to chronic pulmonary hypertension or chronic thromboembolic pulmonary hypertension, where the small emboli periodically occur and develop at a later time.
Diagnosis of Pulmonary Embolism
- Medical history and Physical Assessment
- D dimer and other blood tests
- Chest X-ray
- CT Pulmonary angiography. Detects abnormalities thru 3D images
- Ventilation-perfusion scan (V/Q scan)- used when there is contraindication for contrast and radiation exposure
- Pulmonary angiogram- provides better visualization of the blood flow in the lung arteries
Treatment of Pulmonary Embolism
The treatment goal for pulmonary embolism is the prevention of clot formation and removal of an existing clot.
This involves surgery and medication therapy. Immediate intervention is vital to prevent further complications and mortality.
Since there is a risk of developing another venous thrombosis or pulmonary embolism, it is important to remain on certain medications and have regular doctor visits for monitoring and evaluation.
1. Medications. The following medications may be given orally or intravenously and are usually prescribed to prevent clot formation.
- Anticoagulant or blood thinners. These drugs inhibit formation of new clots and prevents enlargement of existing clots. Its side effects include bleeding which is why it is important to observe bleeding precaution at all times.
- Thrombolytics or clot dissolvers. Although the clots usually dissolve on their own, thrombolytics helps speed up the process. Thrombolytics can be given in emergency situations.
2. Surgery. In case of pulmonary embolism that is unresponsive to medications, surgical intervention is recommended, which may include:
- Embolectomy. This is the surgical removal of a blood clot through an open surgery or the use of a catheter, a thin flexible tube threaded into the blood vessels. It is indicated if the clot is too extensive and lethal.
- Vein filter. Inferior vena cava filter placement is recommended for people unable to tolerate anticoagulants and those who have recurrent clots despite the medications. A catheter is used to position the filter in place and is gently inserted in the vein either through the groin or neck going to the right side of the heart.
Nursing Care Plans for Pulmonary Embolism
Nursing Care Plan 1
Nursing Diagnosis: Impaired Gas Exchange related to altered oxygen supply secondary to pulmonary embolism, as evidenced by shortness of breath, oxygen saturation of 82%, restlessness, and reduced activity tolerance
Desired Outcome: The patient will demonstrate adequate oxygenation as evidenced by an oxygen saturation of at least 96% (88-92% in COPD patients).
|Assess the patient’s vital signs, especially the respiratory rate and depth. Auscultate the lungs and monitor for wheezing or other abnormal breath sounds.||To create a baseline set of observations for the pulmonary embolism patient, and to monitor any changes in the vital signs as the patient receives medical treatment.|
|Monitor the color of skin and mucous membrane.||Peripheral cyanosis (bluish discoloration of the skin, ear lobes, or nail beds) may be evident with hypoxemia. Central cyanosis involving the mucosa may indicate further reduction of oxygen levels.|
|Administer thrombolytics and/or anticoagulants as prescribed.||The airways experience impaired gas exchange primarily due to an embolus.|
|Provide humidified oxygen as prescribed.||To reduce the risk of drying out the lungs.|
|Reposition the patient by elevating the head of the bed and encouraging him/her to sit on an upright position. Encourage pursed lip breathing and deep breathing exercises.||To improve the delivery of oxygen in the airways and to reduce shortness of breath and risk for airway collapse.|
|Refer the patient to a chest physiotherapist.||To enable to patient to receive more information and specialized care in the removal of thick lung secretions and enabling of improved gas exchange.|
Nursing Care Plan 2
Nursing Diagnosis: Deficient Knowledge related to new diagnosis of pulmonary embolism as evidenced by patient’s verbalization of “I want to know more about my new diagnosis and care”
Desired Outcome: At the end of the health teaching session, the patient will be able to demonstrate sufficient knowledge of pulmonary embolism and its management.
|Assess the patient’s readiness to learn, misconceptions, and blocks to learning (e.g. denial of diagnosis or poor lifestyle habits).||To address the patient’s cognition and mental status towards the new diagnosis of pulmonary embolism and to help the patient overcome blocks to learning.|
|Explain what pulmonary embolism is, its cause and treatment plan. Avoid using medical jargons and explain in layman’s terms.||To provide information on pulmonary embolism and its pathophysiology and management in the simplest way possible.|
|Inform the patient the details about the prescribed medications (e.g. drug class, use, benefits, side effects, and risks) to treat pulmonary embolism. Ask the patient to repeat or demonstrate the self-administration details to you.||To inform the patient of each prescribed drug and to ensure that the patient fully understands the purpose, possible side effects, adverse events, and self-administration details.|
|Educate the patient about pursed lip breathing and deep breathing exercises.||To strengthen the respiratory muscles, reduce shortness of breath, and lower the risk for airway collapse.|
|Prepare the patient for surgery if indicated.||To prepare the patient physically and mentally for an embolectomy or vein filter.|
Nursing Care Plan 3
Nursing Diagnosis: Activity intolerance related to imbalance between oxygen supply and demand as evidenced by fatigue, overwhelming lack of energy, verbalization of tiredness, generalized weakness, and shortness of breath upon exertion
Desired Outcome: The patient will demonstration active participation in necessary and desired activities and demonstrate increase in activity levels.
|Assess the patient’s activities of daily living, as well as actual and perceived limitations to physical activity. Ask for any form of exercise that he/she used to do or wants to try.||To create a baseline of activity levels and mental status related to fatigue and activity intolerance.|
|Encourage progressive activity through self-care and exercise as tolerated. Explain the need to reduce sedentary activities such as watching television and using social media in long periods. Alternate periods of physical activity with 60-90 minutes of undisturbed rest.||To gradually increase the patient’s tolerance to physical activity. To enable the patient to pace activity versus rest.|
|Teach deep breathing exercises and relaxation techniques. Provide adequate ventilation in the room.||To allow the patient to relax while at rest and to facilitate effective stress management. To allow enough oxygenation in the room.|
|Refer the patient to physiotherapy / occupational therapy team as required.||To provide a more specialized care for the patient in terms of helping him/her build confidence in increasing daily physical activity.|
Other nursing diagnoses:
- Ineffective Breathing Pattern
- Risk for Bleeding
Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier. Buy on Amazon
Gulanick, M., & Myers, J. L. (2017). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon
Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2018). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier. Buy on Amazon
Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier. Buy on Amazon
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