What is the primary nursing intervention for a patient suspected of having a pulmonary embolism, based on the initial assessment findings?

C) Start an intravenous line for fluid resuscitation

D) Encourage the patient to ambulate

What is the most appropriate initial nursing action for a patient suspected of having a pulmonary embolism who presents with mild shortness of breath and chest discomfort?

A) Administer supplemental oxygen

B) Encourage the patient to perform deep breathing exercises

C) Position the patient in Trendelenburg position

D) Obtain an arterial blood gas analysis

What is the primary purpose of initiating anticoagulation therapy in a patient diagnosed with a small pulmonary embolism?

B) To prevent further clot formation

A) To dissolve the existing embolus

B) To prevent further clot formation

C) To increase oxygen saturation levels

A patient receiving anticoagulation therapy has an INR of 2.0. What does this INR value indicate?

B) The patient has achieved the therapeutic range for anticoagulation.

A) The patient is at risk for bleeding complications.

B) The patient has achieved the therapeutic range for anticoagulation.

C) The patient requires a higher dose of anticoagulants.

D) The patient has subtherapeutic anticoagulation levels.

What is the primary purpose of using compression stockings in a patient with a diagnosed thrombus in the calf vein?

C) To enhance blood flow and reduce swelling

A) To completely dissolve the thrombus

B) To prevent the thrombus from becoming an embolus

C) To enhance blood flow and reduce swelling

D) To eliminate the need for anticoagulation therapy

Which of the following nursing interventions is appropriate for a patient with a small, non-occlusive thrombus in the calf vein receiving anticoagulation therapy?

B) Educate the patient on the importance of maintaining mobility

A) Encourage bed rest to prevent dislodgement of the thrombus

B) Educate the patient on the importance of maintaining mobility

C) Advise the patient to avoid wearing compression stockings

D) Instruct the patient to stop anticoagulation therapy if symptoms improve

What is the primary purpose of wearing compression stockings in patients with a thrombus in the calf vein?

A) To enhance circulation and reduce swelling

C) To improve oxygen saturation levels

What is the most important nursing intervention to prevent progression of a thrombus in a patient with a diagnosed deep vein thrombosis (DVT)?

B) Advise the patient to wear compression stockings as prescribed.

A) Encourage the patient to maintain bed rest.

B) Advise the patient to wear compression stockings as prescribed.

C) Recommend the patient to increase fluid intake significantly.

D) Suggest the patient avoid any form of physical activity.

pulmonary embolism - Nursing Case Study

Pathophysiology

• Primary mechanism: A pulmonary embolism occurs when a blood clot, often originating in the deep veins of the legs (deep vein thrombosis), travels to the lungs and blocks a pulmonary artery. This obstruction impairs blood flow, reducing oxygenation.

• Secondary mechanism: The blockage increases pressure in the pulmonary arteries, straining the right side of the heart as it works harder to pump blood through the narrowed vessels. This can lead to right heart failure if untreated.

• Key complication: Reduced oxygen supply to the body can cause symptoms like sudden shortness of breath, chest pain, and potentially lead to tissue damage or organ dysfunction due to decreased oxygen delivery.

Patient Profile

Demographics:

32-year-old female, office worker

History:

• Key past medical history: Mild asthma, no previous thromboembolic events

• Current medications: Inhaler (albuterol) as needed for asthma

• Allergies: Penicillin

Current Presentation:

• Chief complaint: Shortness of breath

• Key symptoms: Mild chest discomfort, slight cough, occasional palpitations

• Vital signs: Blood pressure 118/76 mmHg, heart rate 88 bpm, respiratory rate 18 breaths/min, temperature 98.6°F, oxygen saturation 96% on room air

Section 1

Initial Assessment Findings:

During the initial nursing assessment, the patient, a 32-year-old female office worker, presents with mild shortness of breath and slight chest discomfort consistent with early-stage pulmonary embolism. On examination, the patient appears alert and oriented, with no signs of acute distress. Her skin is warm and dry, and her capillary refill time is less than 2 seconds, indicating adequate peripheral circulation. Auscultation of the lungs reveals clear breath sounds bilaterally, with no wheezing or crackles noted, which suggests that despite her mild asthma, there is no acute bronchoconstriction. Heart sounds are normal, with no murmurs or extra heart sounds detected. The patient reports occasional palpitations but denies any previous episodes of syncope or severe chest pain.

The patient's vital signs are stable, with a blood pressure of 118/76 mmHg, heart rate of 88 beats per minute, respiratory rate of 18 breaths per minute, and oxygen saturation of 96% on room air. These findings indicate that while the patient is experiencing some respiratory symptoms, her cardiovascular status remains stable. The patient denies any significant leg pain or swelling, which could be indicative of deep vein thrombosis, the common precursor to pulmonary embolism. However, given her recent symptoms and history of mild asthma, further diagnostic testing is warranted to confirm the presence of a pulmonary embolism and assess its severity.

The initial nursing care plan focuses on monitoring the patient's respiratory status and vital signs closely, ensuring comfort, and maintaining communication with the healthcare team for any changes in her condition. Education is provided to the patient regarding the importance of reporting any worsening of symptoms, such as increased shortness of breath, chest pain, or dizziness, which could indicate a progression of the embolism or the development of new complications. This approach ensures a comprehensive assessment of the patient's current status and prepares for further diagnostic evaluation.

Section 2

New Diagnostic Results:

Following the initial assessment, the healthcare team proceeded with diagnostic testing to confirm the suspected pulmonary embolism. A D-dimer test was conducted, which returned elevated levels, suggesting the presence of a clotting event. To further investigate, a CT pulmonary angiography was performed, revealing a small embolus in the right lower lobe pulmonary artery. This finding confirms the presence of a pulmonary embolism, but its small size and the absence of significant hemodynamic compromise indicate that it is in an early and stable stage.

The laboratory results, including complete blood count, electrolytes, and renal function tests, were within normal limits, indicating no immediate systemic complications. Arterial blood gas analysis showed a slight reduction in PaO2 at 75 mmHg, consistent with mild hypoxemia, but other parameters were within normal ranges, supporting the assessment of stable, early-stage pulmonary embolism. These results provided a clearer picture of the patient's condition and allowed the healthcare team to continue with targeted interventions.

The nursing care plan was adjusted to include anticoagulation therapy, as prescribed by the physician, to prevent further clot formation and facilitate clot resolution. The patient was educated on the importance of medication adherence and potential side effects of anticoagulants, such as increased bleeding risk. Continued monitoring of vital signs, respiratory status, and oxygen saturation was emphasized, along with reinforcing the need for the patient to report any new or worsening symptoms. This strategic approach ensures vigilant observation and enables timely intervention should the patient's condition change, promoting a proactive management of her pulmonary embolism.

Section 3

Response to Interventions:

Following the initiation of anticoagulation therapy, the patient was closely monitored to assess her response to the treatment. Over the next 24 hours, the patient remained hemodynamically stable, with vital signs consistently within normal limits: blood pressure at 120/80 mmHg, heart rate at 78 beats per minute, respiratory rate at 18 breaths per minute, and oxygen saturation maintained at 94% on room air. The patient reported feeling slightly more energetic and noted a decrease in her shortness of breath, indicating a positive response to the prescribed therapy.

Regular monitoring of laboratory values was continued to ensure therapeutic anticoagulation levels and to identify any potential bleeding complications. The patient's international normalized ratio (INR) was measured and found to be 2.0, which was within the therapeutic range for anticoagulation. The healthcare team was satisfied with these results, as they indicated effective anticoagulation without signs of excessive bleeding. Additionally, the patient was encouraged to stay hydrated and to ambulate as tolerated to help prevent further clot formation.

The patient was educated on recognizing signs of potential complications, such as unusual bruising, blood in the urine or stool, and persistent headache, which could suggest bleeding. With stable clinical parameters and an appropriate therapeutic response, plans for a safe transition to home care were discussed. The patient expressed understanding of the discharge instructions, including the importance of follow-up appointments to reassess her condition and adjust therapy as needed. The collaborative approach between the healthcare team and patient ensured a comprehensive management plan and prepared the patient for a successful recovery at home.

Section 4

New Diagnostic Results:

As the patient continued to respond positively to anticoagulation therapy, the healthcare team proceeded with further diagnostic testing to ensure comprehensive management of her condition. A follow-up Doppler ultrasound of the lower extremities was performed to assess for any residual or new deep vein thrombosis (DVT), which could potentially contribute to further embolic events. The results revealed a small, non-occlusive thrombus in the patient's left calf vein. This finding was consistent with her initial presentation and was considered a minor complication, as it posed a low risk for additional pulmonary embolism due to its size and location.

Given this new information, the nursing team reinforced the importance of continued anticoagulation therapy and encouraged the patient to maintain mobility, as physical activity could aid in resolving the thrombus. The patient was reminded of the need for regular blood work to monitor INR levels and was reassured that her current therapeutic regimen was appropriate for managing her condition. Additionally, the patient was advised to use compression stockings to further reduce the risk of clot progression and improve circulation in the affected limb.

The healthcare team reviewed the patient's discharge plan, ensuring that she was comfortable with self-management strategies and understood the significance of adherence to her medication and lifestyle modifications. The patient was scheduled for a follow-up appointment in one week to evaluate her response to therapy and to reassess the thrombus via ultrasound. With clear instructions and a supportive care plan, the patient was well-prepared to continue her recovery at home, with confidence in her ability to manage her condition and prevent further complications.

Section 5

Response to Interventions:

One week after implementing the care plan, the patient returned for her follow-up appointment, eager to discuss her progress with the healthcare team. Upon arrival, the nursing team conducted a thorough assessment to evaluate her response to the interventions. The patient reported feeling generally well, with minimal discomfort in her left calf, and noted that she had been diligently wearing her compression stockings as advised. She also stated that she maintained an active lifestyle, incorporating daily walks into her routine, which she found beneficial for her overall well-being.

Vital signs were stable: blood pressure was 118/76 mmHg, heart rate was 76 beats per minute, respiratory rate was 16 breaths per minute, and oxygen saturation was 98% on room air. The nursing team noted that the patient appeared well-hydrated and in no acute distress. Upon reviewing her lab results, it was found that her INR was within the therapeutic range at 2.5, indicating effective anticoagulation management. A follow-up Doppler ultrasound was performed, revealing that the small thrombus in the left calf vein had not progressed and showed signs of gradual resolution.

The healthcare team commended the patient for her adherence to the treatment plan and reinforced the importance of continuing these strategies to ensure her recovery. The patient expressed confidence in managing her condition and was motivated to maintain her current regimen. With her positive response to interventions and stable clinical status, the team scheduled another follow-up in two weeks to continue monitoring her progress and to discuss any further adjustments needed in her care plan.