prepared:
Mardin Mazhar
Shanga Ismail
 Pulmonary embolism
 A pulmonary embolism (PE) is a life-
threatening condition where a blood clot
begins to move throug...
 EmbolismAn embolism - from the
Greek émbolos meaning "stopper" or "plug" -
is the term that describes a condition where
...
1. Fat Emboli
2. Air Emboli
3. Amniotic Fluid Emboli
4. Thrombus (Clot Emboli)
5. Septic embolism
6. Forigin body embolism...
circulatory condition characterized by a plug of fat blocking
an artery. The plug enters the circulatory system after the
...
the abnormal presence of air in the CV system resulting in
obstruction of blood flow. May occur if large quantity of
air i...
Amniotic Fluid Emboli (AFE):
occurs when amniotic fluid is drawn into the maternal
circulation and carried to the woman’s ...
Thrombus:
a condition in which a blood vessel is obstructed by a thrombus
carried in the bloodstream from its site of form...
 In the vast majority of cases, a pulmonary
embolism is caused by another type of blood
clot, called a deep vein thrombos...
 Surgery
 Being Stationary
 Breaking a bone
 Blood clotting disorders
 Decreased mobility
 History of previous blood...
 A pulmonary embolism can present signs and
symptoms that range from barely notable to
severe. In fact, some patients onl...
 Difficulty breathing (dyspnea)
 Coughing
 Coughing up blood-tinged sputum
 Shortness of breath
 Chest pain
 Wheezin...
ABGs levels show respiratory alkalosis and
hypoxemia.
• Pulmonary angiography shows location of
embolism and filling defec...
 The course of treatment for a pulmonary
embolism varies based upon the severity of
the embolus, the cause of the embolus...
 Although both drugs decrease fibrin formation,
they do so by different mechanisms:
 Heparin inactivates thrombin and fa...
 There are multiple ways to remove blood
clots, ranging from minimally invasive
procedures that are done by inserting tin...
 Known by a variety of names, including
Inferior Vena Cava Filter, IVC, and Greenfield
Filter, this is a tiny filter that...
 Thrombolytic drugs such as streptokinase
or tissue plasminogen activator (TPA) break up
and dissolve blood clots.
 Thro...
 A rare procedure where a clot is surgically
removed from the pulmonary system
 Preoperative angiography must be done to...
 Most people with a PE are treated successfully
and do not get complications. However, there
are some possible, serious c...
 Complications due to treatment. The anticoagulant
treatment can have side-effects. The main one is
bleeding elsewhere in...
 For any hospital patient, DVT prevention and risk reduction are
essential nursing goals. Whenever possible, only minimal...
 Anticoagulants.
 Graduated compression stockings.
 Pneumatic compression.
 Physical activity
 Prevention while trave...
 Impaired gas exchange R/T altered oxygen
supply S/T ventilation perfusion mismatch.
 Acute Pain R/T inflammatory proces...
Bed rest with active and passive range of motion.
– Keep the patient with fowler position to enhance
ventilation.
– Assist...
- Administer O2 to enhance oxygenation.
– Establish an IV line for fluids and drugs.
– Monitor and record intake and outpu...
-MINIMIZING THE RISK OF PULMONARY
EMBOLISM
-PREVENTING THROMBUS FORMATION
-ASSESSING POTENTIAL FOR PULMONARY
EMBOLISM
-MON...
 How does a Pulmonary Embolus cause
Hypoxemia? Hypoxemia is a deficient
oxygenation of the blood. A pulmonary
embolism is...
 What are the signs and symptoms of a
pulmonary embolism?
 What are the four major types of pulmonary
emboli?
 Are Pulm...
polmunary embolism(kwrdistan)
polmunary embolism(kwrdistan)
polmunary embolism(kwrdistan)
polmunary embolism(kwrdistan)
polmunary embolism(kwrdistan)
of 34

polmunary embolism(kwrdistan)

polmunary embolism
Published on: Mar 4, 2016
Published in: Health & Medicine      
Source: www.slideshare.net


Transcripts - polmunary embolism(kwrdistan)

  • 1. prepared: Mardin Mazhar Shanga Ismail
  • 2.  Pulmonary embolism  A pulmonary embolism (PE) is a life- threatening condition where a blood clot begins to move through the vessels of the body and lodges in an artery in the lungs. In some cases, multiple clots (emboli) can move to the lungs.
  • 3.  EmbolismAn embolism - from the Greek émbolos meaning "stopper" or "plug" - is the term that describes a condition where an object called an embolus is created in one part of the body eg. Polmonary embolism,Brain embolism, Retinal embolism, Amniotic embolism, air ambolism, Thromboembolism , cholestrole embolism , Fat embolism, Septic embolism , Foreign body embolism
  • 4. 1. Fat Emboli 2. Air Emboli 3. Amniotic Fluid Emboli 4. Thrombus (Clot Emboli) 5. Septic embolism 6. Forigin body embolism 7. Septic embolism
  • 5. circulatory condition characterized by a plug of fat blocking an artery. The plug enters the circulatory system after the fracture of a long bone or traumatic injury to adipose tissue or to a fatty liver. Fat emboli are the result of the release of free fatty acids, causing a toxic vasculitis, followed by thrombosis, and obstruction of small pulmonary arteries by fat. Usually occurs within 12-36hrs after an injury.  Risk Factors o multiple fractures o Males o Patients 10 – 39 years old o Trauma to adipose tissue or liver o Burns o Osteomyelitis o Sickle cell c
  • 6. the abnormal presence of air in the CV system resulting in obstruction of blood flow. May occur if large quantity of air is inadvertently introduced by injection (as during IV therapy or surgery) or by trauma (puncture wound)  Risk Factors o Any surgical procedures that can lead to infusion of air o Creation of a pressure gradient of air entry (ex. Lumbar punctures, peripheral IVs, central venous catheter, etc.) o Positive pressure ventilation (during mechanical ventilation or scuba diving) o Blunt & penetrating trauma to the chest, abdomen, neck, or face can lead to entry of air
  • 7. Amniotic Fluid Emboli (AFE): occurs when amniotic fluid is drawn into the maternal circulation and carried to the woman’s lungs. Fetal particulate matter (skin cells, vernix, hair, and meconium) in the fluid obstructs pulmonary vessels. Failure of the right ventricle occurs early and can lead to hypoxemia. Left ventricle failure follows  Risk Factors o medical induction of labor, o multiparity, o cesarean section or operative vaginal delivery, o abruption, o placenta previa, and o cervical laceration or uterine rupture
  • 8. Thrombus: a condition in which a blood vessel is obstructed by a thrombus carried in the bloodstream from its site of formation. The area supplied by an obstructed artery may tingle & become cold, numb, and cyanotic. Thrombi can result from blood stasis, alterations in clotting factors, and injury to vessel walls.  Risk Factors  Immobility  A-fib, heart failure/MI, rheumatic heart disease  Prolonged surgery (longer than 30min)  Pregnancy  Postpartum period  Trauma  Mechanical ventilation  Obesity  Age > 55y/o
  • 9.  In the vast majority of cases, a pulmonary embolism is caused by another type of blood clot, called a deep vein thrombosis or DVT. A deep vein thrombosis typically forms in the veins of the legs. These clots can start to move until they lodge in a vessel that is too small to allow the clot to move any further, typically the small arteries of the lungs.
  • 10.  Surgery  Being Stationary  Breaking a bone  Blood clotting disorders  Decreased mobility  History of previous blood clots  History of previous pulmonary embolism  Smoking/Tobacco  Pregnancy or Recent Pregnancy  Obesity  Hormone therapy  Birth control pills
  • 11.  A pulmonary embolism can present signs and symptoms that range from barely notable to severe. In fact, some patients only notice the signs of the deep vein thrombosis that led to the pulmonary embolism and not the embolism itself. For this reason, the signs and symptoms of deep vein thrombosis that may seem unrelated to a lung condition, such as calf pain, are included in this list.
  • 12.  Difficulty breathing (dyspnea)  Coughing  Coughing up blood-tinged sputum  Shortness of breath  Chest pain  Wheezing  Leg pain  One leg that is larger than the other (typically the calf of one leg is swollen)  Feeling lightheaded  Feeling weak  Clammy or sweaty skin  Irregular heartbeat  Rapid heartbeat (tachycardia)
  • 13. ABGs levels show respiratory alkalosis and hypoxemia. • Pulmonary angiography shows location of embolism and filling defect of pulmonary artery. • Physical findings: clinical signs and symptoms. • Chest X-ray shows dilated pulmonary arteries, penumoconstriction, diaphragm elevation on the affected side. • Radioisotope lung scan.
  • 14.  The course of treatment for a pulmonary embolism varies based upon the severity of the embolus, the cause of the embolus, the number of emboli present, the general health of the patient and any medical condition that may affect the outcome of treatment.
  • 15.  Although both drugs decrease fibrin formation, they do so by different mechanisms:  Heparin inactivates thrombin and factor Xa, whereas warfarin inhibits synthesis of clotting factors.  Effects of heparin begin and fade rapidly, whereas effects of warfarin begin slowly but then persist for several days.  Different tests are used to monitor therapy:  PT is used to monitor warfarin: Normal range for the PT is between 10 and 13 sec.  aPTT is used to monitor heparin: Normal range for aPTT is between 28 to 34 sec.  Vitamin K is given to counteract warfarin whereas protamine is given to counteract heparin.
  • 16.  There are multiple ways to remove blood clots, ranging from minimally invasive procedures that are done by inserting tiny instruments into blood vessels and threading them through the vessel to the clot, to an emergency surgery to remove the clot.
  • 17.  Known by a variety of names, including Inferior Vena Cava Filter, IVC, and Greenfield Filter, this is a tiny filter that is surgically placed in the large blood vessel that returns blood from the body to the heart. This filter is designed to "catch" tiny blood clots before they are circulated through the heart and on to the lungs. Most often, these filters can be placed using minimally invasive techniques.
  • 18.  Thrombolytic drugs such as streptokinase or tissue plasminogen activator (TPA) break up and dissolve blood clots.  Thrombolysis is more expensive than anticoagulant therapy and is associated with a higher risk of bleeding, so its use should be restricted to patients who are likely to benefit from it.  They can be used for people who appear to be in danger of dying of pulmonary embolism.  However, except in the most dire situations, these drugs cannot be given to people who have had surgery in the preceding 2 weeks, are pregnant, have had a recent stroke, or tend to bleed excessively
  • 19.  A rare procedure where a clot is surgically removed from the pulmonary system  Preoperative angiography must be done to find and confirm the pulmonary embolism  An emergent embolectomy may be indicated for a patient with a severe obstruction who did not respond to the usual therapy  IVC filter is placed after embolectomy  Lewis et al. mentions the mortality rate of the procedure is 50%.
  • 20.  Most people with a PE are treated successfully and do not get complications. However, there are some possible, serious complications and these include:  Collapse - due to the effects of the blood clot on the heart and circulation. This can cause a cardiac arrest where the heart stops, and may be fatal.  The PE can cause a strain on the heart. This may lead to a condition called heart failure, where the heart pumps less strongly than normal.  Blood clots can occur again later (known as a recurrent PE). Anticoagulant treatment helps to prevent this.
  • 21.  Complications due to treatment. The anticoagulant treatment can have side-effects. The main one is bleeding elsewhere in the body - for example, from a stomach ulcer. About 3 in 100 patients will get significant bleeding due to anticoagulant treatment for a PE. Usually this type of bleeding can be treated successfully. This type of bleeding can (rarely) be fatal (in about 3 in 1,000 cases of PE). However, it is almost always safer to take the anti-clotting treatment than not to, so as to prevent another PE which could be serious.  If there are repeated small PEs, they may (rarely) contribute to a condition where there is high pressure in the lung blood vessels (called primary pulmonary hypertension).
  • 22.  For any hospital patient, DVT prevention and risk reduction are essential nursing goals. Whenever possible, only minimal sedation, if any, should be used as a way to keep patients more active. Neuromuscular blocking agents should be avoided because they’ve been linked to DVT. Use of sedation scales may provide a more consistent approach to sedation dosing, as might sedation and analgesia protocols.  Implementing and maintaining prophylactic measures as a standard practice for preventing DVT are essential. Protocols for ventilator management and weaning also may be crucial to restoring activity levels and liberating patients from mechanical ventilation.  Make sure you’re familiar with DVT and PE risk factors and signs and symptoms. Be aware that when PE is confirmed or strongly suspected, treatment must begin immediately. Be sure to monitor patients for pain, anxiety, and anticoagulant side effects (such as bleeding), and provide appropriate interventions.
  • 23.  Anticoagulants.  Graduated compression stockings.  Pneumatic compression.  Physical activity  Prevention while traveling  Take a break from sitting.  Fidget in your seat.  Drink plenty of fluids.  Wear support stockings.
  • 24.  Impaired gas exchange R/T altered oxygen supply S/T ventilation perfusion mismatch.  Acute Pain R/T inflammatory process caused by thrombus formation.  Risk for injury R/T hypercoagulable state.  Ineffective protection R/T prolonged bleeding S/T anticoagulation therapy.  Anxiety R/T pain and intrusive diagnostic and surgical tests and procedures.
  • 25. Bed rest with active and passive range of motion. – Keep the patient with fowler position to enhance ventilation. – Assist with turning, coughing, and deep breathing to mobilize secretions and clear airway. – Assess respiratory status to detect respiratory distress. – Assess cardiovascular status. An irregular pulse may signal arrhythmia caused by hypoxemia. If cause of PE by thrombophlebitis, temperature may be elevated. .
  • 26. - Administer O2 to enhance oxygenation. – Establish an IV line for fluids and drugs. – Monitor and record intake and output to detect fluid volume overload and renal perfusion. – ABGs monitoring to evaluate the need for mechanical ventilation. – Monitor laboratory studies because patient on heparin and need to evaluate electrolyte, CBC and Hct _RELIEVING ANXIETY _MONITORING FOR COMPLICATIONS _PROVIDING POSTOPERATIVE NURSING CARE _PROMOTING HOME AND COMMUNITY-BASED CARE
  • 27. -MINIMIZING THE RISK OF PULMONARY EMBOLISM -PREVENTING THROMBUS FORMATION -ASSESSING POTENTIAL FOR PULMONARY EMBOLISM -MONITORING THROMBOLYTIC THERAPY -MANAGING PAIN
  • 28.  How does a Pulmonary Embolus cause Hypoxemia? Hypoxemia is a deficient oxygenation of the blood. A pulmonary embolism is a sudden blockage in a lung artery, most often caused by a traveling blood clot from a vein in the leg. These clots are formed via the condition of deep vein thrombosis. A pulmonary embolism brings about lung tissue damage, hypoxia and other organ impairment as a result of your blood’s hypoxic state. Death can ensue
  • 29.  What are the signs and symptoms of a pulmonary embolism?  What are the four major types of pulmonary emboli?  Are Pulmonary embolisms usually single or multiple?

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