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Pulmonary Embolus and Nursing Interventions Essay (Critical Writing)

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Updated: May 5th, 2021

Introduction

Pulmonary Embolus (PE) is a serious health condition that affects over 900,000 people and causes approximately 300,000 deaths in the United States (US) annually (Yan, Wang, Su, & Ying, 2017). It is caused by the obstruction of blood flow in one or several pulmonary arteries. In most cases, PE occurs due to a thrombus even though in some few cases it is caused by tumors, air, fat globules, and septic clots among others.

This condition is one of the major causes of unexpected deaths across different age groups in the US. However, over 70 percent of cases have a missed diagnosis, which presents a significant challenge in different healthcare set-ups (Yan et al., 2017). This paper discusses the most significant manifestations of PE, associated risk factors, assessment procedures, and nursing interventions.

Three Most Significant Manifestations of PE

The signs of PE depend on different factors such as the extent to which the lungs are involved, underlying heart or lung disease, and the size of thrombus. However, the most significant manifestations of this condition include shortness of breath, chest plain, which worsens with breathing, and coughing (Ji et al., 2017).

Three Risk Factors

Common predisposing factors to PE are hereditary elements, cardiovascular disease, and surgery (Ji et al., 2017). If a person or his/her family members have the medical history of PE, one is likely to suffer from this condition. Some inherited disorders affect blood, which makes it prone to the development of thrombus. Similarly, cardiovascular diseases such as heart failure predispose individuals to blood clots. Finally, after surgery, blood is most likely to clot due to the immobility occasioned by the need to recover. When someone stops moving, blood flow through deep veins slows down, thus increasing the probability of developing a clot.

Three Assessments

According to York, Kane, Smith, and Minton (2015), for a patient who has undergone a major surgery, has been immobilized for some time, and he or she develops breathlessness suddenly, PE is the most likely underlying condition. In the case of Mrs. XX, she has the highlighted signs, and thus she most likely suffers from PE. Additionally, she has known chronic atrial fibrillation, which predisposes her to the possibility of having a blood clot.

The first assessment would be 12-lead electrocardiography (ECG). Normally, patients with PE do not have a particular ECG abnormality. However, this assessment will rule out acute myocardial infarction. The second method of assessment is an echocardiogram. This criterion is used together with or immediately after ECG. The rationale for this method is to examine the status of the heart and eliminate the possibility of other cardiovascular complications such as congestive heart failure.

The final diagnosis criterion would be CT pulmonary angiography (CTPA). The rationale for using this assessment is because the patient has already shown clinical signs of PE. CTPA provides high-resolution and accurate results within a short time. Additionally, this method of assessment is less invasive as compared to other alternatives that can produce similar results such as pulmonary angiography (York et al., 2015).

Three Nursing Interventions

York et al. (2015) note that approximately 30 percent of patients suffering from PE die if they do not get immediate care. The first nursing intervention for patients suffering from PE like Mrs. XX is gas exchange. Supplemental oxygen would help in the maintenance of oxygen saturation levels at a minimum of 92 percent (York et al., 2015). The delivery of oxygen in PE patients depends on the severity of the condition.

Common delivery options include “nasal cannula, noninvasive bi-level positive airway pressure ventilation, intubation, and mechanical ventilation” (York et al., 2015, p. 7). However, mechanical ventilation, which is mostly required in patients with acute PE, may lead to positive intra-thoracic pressure. This condition causes increased unstable hemodynamics such as sustained hypotension, which necessitates the next procedure. The second intervention measure would be hemodynamic support. Depending on the nature of unstable hemodynamics, different procedures can be initiated.

For instance, intravenous (IV) fluids are used in the treatment of hypotension. In cases where patients do not respond to this intervention, vasopressors can be used to achieve stable hemodynamics. Finally, pharmacological options can be employed. According to York et al. (2015), “Current clinical practice guidelines identify 3 thrombolytic therapies including, urokinase, streptokinase, and alteplase for patients with massive PE and/or hemodynamic instability, assuming bleeding risks are minimal” (p. 7). These drugs function by dissolving fibrin in blood clots, thus increasing pulmonary perfusion.

Conclusion

PE is one of the causes of unexpected deaths in the US, especially for hospitalized patients. This condition can have fatal outcomes even without showing clinical symptoms. Additionally, PE has numerous associated conditions like heart attack, congestive heart failure, and chest pains. However, in cases where a patient develops clinical symptoms of PE like in the case of Mrs. XX, the first assessment method would be EGG, followed by an echocardiogram, and finally CTPA. After confirming the presence of PE, nurses should address it through giving supplemental oxygen, hemodynamic support, and pharmacological interventions subsequently.

References

Ji, Q. -Y., Wang, M. -F., Su, C. -M., Yang, Q. -F., Feng, L. -F., Zhao, L. -Y., … Li, W. -M. (2017). Clinical symptoms and related risk factors in pulmonary embolism patients and cluster analysis based on these symptoms. Scientific Reports, 7(2), 1-9. Web.

Yan, C., Wang, X., Su, H., & Ying, K. (2017). Recent progress in research on the pathogenesis of pulmonary thromboembolism: An old story with new perspectives. BioMed Research International, 6516791, 1-10. Web.

York, N. L., Kane, C., Smith, C., & Minton, L. A. (2015). Care of the patient with an acute pulmonary embolism. Dimensions of Critical Care Nursing, 34(1), 3-9.

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