Pulmonary Embolus for Certified Emergency Nursing (CEN)
Included In This Lesson
Study Tools For Pulmonary Embolus for Certified Emergency Nursing (CEN)
Outline
Pulmonary Embolus
Definition/Etiology:
Obstruction (air, fat, bone, amniotic fluid, or clotted blood) lodges in branch of pulmonary artery causing partial or total occlusion and potential infarct
Risk factors:
- Previous DVT
- Surgery within the past 4 weeks
- Current estrogen use
- Active or metastatic cancer
- Recent travel with relative immobility
- IV drug use
- Advanced age
- Smoking
- Hypercoagulable state
Pathophysiology:
No blood supply to the affected area of the lung causes bronchoconstriction and pulmonary vasoconstriction resulting in alveolar hypoventilation.
- Blood clot migrates from another part of the body, usually the right side of the heart, the pelvis, or from a deep vein thrombosis (DVT) in the legs
- Fat embolism can occur 24–48 hours after a long bone fracture – petechiae of the chest and axilla
- Amniotic fluid embolism shows up shortly after delivery
- Air – inadvertent injection of air in an IV; dive injuries
Tools:
- PE Rule-out
- PERC – Pulmonary Embolism Rule-out Criteria
None of the following present:
- hormone use
- Age >50
- DVT/PE history
- coughing blood
- lower extremity swelling unilaterally
- SpO2 less than 95%
- HR >99
- surgery/trauma within past 28 days
Wells Score:
- Symptoms of DVT (+3)
- pulmonary embolism most likely (+3)
- HR greater than 100 beats/min (+1.5)
- immobilization of 3 days or surgery in previous 28 days (+1.5)
- previous PE/DVT (+1.5)
- hemoptysis (+1)
- malignancy with treatment in past 6 months or palliative (+1)
Score of less than or equal to 4 qualifies to rule out with D-dimer
Clinical Presentation:
- Sudden shortness of breath
- Tachypnea, tachycardia
- Cough with possible hemoptysis
- Diaphoresis
- Syncope
- Fever
- Crackles upon auscultation
- Accentuated S2 heart sound
- Jugular vein distention (JVD)
- Hypotension
- Elevated ESR, D-dimer
- New onset RBBB, peaked P waves, depressed T waves
Collaborative Management:
- Labs: D-dimer, BNP
- D-dimer best if low index of suspicion
- EKG
- Chest X-ray, CT/MRI/V/Q scan, echocardiogram
- V/Q scanning – sufficient to confirm PE
Interventions:
- Maintain ABCs
- Supplemental O2
- Cardiac and pulse oximetry monitoring
Meds:
- Anticoagulants: heparin, low-molecular-weight heparin
- Fibrinolytics
Evaluation | Patient Monitoring | Education:
- Hemodynamic status
- Level of consciousness
- Cardiac rate and rhythm
- Breath sounds and pulse oximetry
- Pain relief
Linchpins: (Key Points)
- Lungs perform activity (gas exchange)
- Activity requires energy
- Energy comes from blood supply
- Blocked blood supply
- Decreased activity (gas exchange)
Transcript
For more great CEN prep, got to the link below to purchase the “Emergency Nursing Examination Review” book by Dr. Laura Gasparis Vonfrolio RN, PHD
https://greatnurses.com/
References:
- Emergency Nurses Association. (2017) Emergency Nursing Core Curriculum, 7th Edition. PA: Saunders
- Egging, D. (2017). Respiratory Emergencies and Thoracic Trauma. In CEN Online Review. Emergency Nurses Association.
NCLEX
Concepts Covered:
- Circulatory System
- Emergency Care of the Cardiac Patient
- Cardiac Disorders
- Cardiovascular
- Shock
- Shock
- Disorders of the Posterior Pituitary Gland
- Endocrine
- Disorders of Pancreas
- Disorders of the Thyroid & Parathyroid Glands
- Hematology
- Gastrointestinal
- Upper GI Disorders
- Liver & Gallbladder Disorders
- Newborn Complications
- Lower GI Disorders
- Multisystem
- Neurological
- Nervous System
- Central Nervous System Disorders – Brain
- Renal
- Respiratory
- Urinary System
- Respiratory System
- Noninfectious Respiratory Disorder
- Test Taking Strategies
- Note Taking
- Basics of NCLEX
- Prefixes
- Suffixes
- Medication Administration
- Gastrointestinal Disorders
- Respiratory Disorders
- Pregnancy Risks
- Labor Complications
- Hematologic Disorders
- Fundamentals of Emergency Nursing
- Factors Influencing Community Health
- Delegation
- Perioperative Nursing Roles
- EENT Disorders
- Basics of Chemistry
- Adult
- Emergency Care of the Neurological Patient
- Acute & Chronic Renal Disorders
- Emergency Care of the Respiratory Patient
- Respiratory Emergencies
- Studying
- Substance Abuse Disorders
- Disorders of the Adrenal Gland
- Behavior
- Documentation and Communication
- Preoperative Nursing
- Endocrine System
- Legal and Ethical Issues
- Communication
- Understanding Society
- Immunological Disorders
- Infectious Disease Disorders
- Oncology Disorders
- Female Reproductive Disorders
- Fetal Development
- Terminology
- Anxiety Disorders
- Cognitive Disorders
- Musculoskeletal Trauma
- Intraoperative Nursing
- Tissues and Glands
- Vascular Disorders
- Renal Disorders
- Eating Disorders
- Prenatal Concepts
- Microbiology
- Male Reproductive Disorders
- Sexually Transmitted Infections
- Infectious Respiratory Disorder
- Depressive Disorders
- Personality Disorders
- Psychotic Disorders
- Trauma-Stress Disorders
- Peripheral Nervous System Disorders
- Integumentary Disorders
- Neurologic and Cognitive Disorders
- Integumentary Disorders
- Newborn Care
- Basics of Mathematics
- Statistics
- Labor and Delivery
- Proteins
- Emergency Care of the Trauma Patient
- Hematologic System
- Hematologic Disorders
- Developmental Considerations
- Skeletal System
- Digestive System
- Urinary Disorders
- Postpartum Care
- Basic
- Musculoskeletal Disorders
- Bipolar Disorders
- Metabolism
- Cardiovascular Disorders
- Concepts of Population Health
- Musculoskeletal Disorders
- EENT Disorders
- Postpartum Complications
- Basics of Human Biology
- Postoperative Nursing
- Neurological Emergencies
- Prioritization
- Disorders of Thermoregulation
- Writing
- Community Health Overview
- Dosage Calculations
- Neurological Trauma
- Concepts of Mental Health
- Health & Stress
- Endocrine and Metabolic Disorders
- Childhood Growth and Development
- Prenatal and Neonatal Growth and Development
- Concepts of Pharmacology
- Integumentary Important Points
- Emotions and Motivation
- Renal and Urinary Disorders
- Developmental Theories
- Reproductive System
- Adulthood Growth and Development
- Psychological Emergencies
- Growth & Development
- Basics of Sociology
- Somatoform Disorders
- Reading
- Intelligence and Language
- Oncologic Disorders
- Med Term Basic
- Med Term Whole
- Central Nervous System Disorders – Spinal Cord
- Muscular System
- Neonatal
- Learning Pharmacology
- Pediatric
- Psychological Disorders
- State of Consciousness
- Sensory System