Pulmonary Embolism III: Nursing Management

Nurses should obtain a detailed patient history, particularly noting any history of deep vein thrombosis. Assess for dyspnea, chest pain, crackles, and right-sided heart failure signs like peripheral edema and jugular vein distention. Evaluate laboratory values including arterial blood gas results for hypoxemia and D-dimer levels, which when elevated suggest pulmonary embolism.

Monitor vital signs frequently, especially oxygen saturation and respiratory rate. Administer oxygen therapy as needed to maintain adequate oxygenation and prevent hypoxemia. Teach deep breathing exercises and incentive spirometry to improve ventilation and prevent atelectasis. Regular pulse oximetry assessment gauges therapy effectiveness and guides ongoing oxygen management.

Position patients in semi-Fowler's position to ease breathing discomfort and reduce pleuritic pain. Administer prescribed opioid analgesics for severe pain management. Frequently turn and reposition patients to enhance ventilation and perfusion. These interventions promote respiratory comfort and improve overall oxygenation while reducing chest pain.

Keep patients on bed rest during thrombolytic infusion and monitor vital signs frequently for adverse reactions. Avoid invasive procedures to prevent bleeding. Conduct international normalized ratio or activated partial thromboplastin time tests 3 to 4 hours post-infusion to confirm fibrinolytic system activation and assess anticoagulation effectiveness.

Instruct patients to wear anti-embolism stockings as directed, avoid prolonged sitting or sitting with legs crossed, and perform leg and ankle exercises during travel. Emphasize staying hydrated to prevent hemoconcentration, maintaining regular physical activity, achieving smoking cessation, and staying mobile to improve venous return and reduce clot formation risk.

Proper anticoagulant therapy prevents thrombus formation and recurrent pulmonary embolism. Patients must understand medication purpose, importance of adherence, and potential side effects. Regular blood tests monitor warfarin effectiveness, and dietary considerations affect anticoagulant efficacy. Follow-up appointments allow healthcare providers to monitor recovery and adjust treatments as necessary.

Educate patients to recognize signs of lower extremity circulatory compromise such as calf pain, leg swelling, and pedal edema indicating potential deep vein thrombosis. Pulmonary embolism recurrence symptoms include sudden chest pain, shortness of breath, and coughing up blood. Patients should know when to seek immediate medical attention.