Pulmonary Embolism
In this text, I concern myself with pulmonary embolism. In so doing, I will discuss the causes, symptoms as well as diagnosis of this medical condition. Further, I will also describe the condition’s prevention and treatment options, complications, and nursing interventions.
Pulmonary Embolism: Overview
In the words of Rhoades and Bell (2009), “pulmonary embolism is clearly one of the more important disorders affecting the pulmonary circulation.” Pulmonary embolism is in basic terms the blockage of an artery in an individual’s lung caused by blood clots originating from veins elsewhere in the body i.e. lower leg or thighs. As Rhoades and Bell further point out, the incidence of the disorder per annum happens to be in excess of 500,000. According to the authors, the disorder’s mortality rate could easily exceed 30% especially in those instances where the same is misdiagnosed.
Causes and Symptoms
As I have already pointed out above, pulmonary embolism results from the blockage of a blood vessel in an individual’s lung. The cause of the said blockage could as I have already pointed out be a blood clot originating from veins in the lower leg or even thigh. According to the National Heart, Lung and Blood Institute, National Institutes of Health — NHLBI, NIH (2011) the said clots in this case break free from where they travel to the lungs (via the bloodstream) thus causing the blockage. Although this is seen as the major cause of pulmonary embolism, other causes of the disorder have been identified. For instance, as NHLBI, NIH (2011) point out, although rare, part of a tumor or even an air bubble could travel to the lungs from where it could cause the blockage described above thus causing pulmonary embolism. In some cases, fat from the bone marrow of a broken bone could also travel to the lungs through the blood stream and cause pulmonary embolism (NHLBI, NIH, 2011). Other causes of the disorder are foreign materials, parasites and tumor cells (Rhoades and Bell, 2009). Dyspnea is in most cases the very first symptom of the disorder (Eckman, 2010). Other symptoms include but they are not in any way limited to severe cough, chest pain, as well as difficulties in breathing. It is however important to note that in some cases, pulmonary embolism may not have any specific symptoms.
Diagnosis
In the opinion of Rhoades and Bell (2009), given that pulmonary embolism does not manifest symptoms that could be regarded specific, the condition could be difficult to diagnose. Further, some of the symptoms of the diseases mimic those of several other lung and heart diseases. In most cases, the diagnosis of the disorder may involve a number of examinations and tests. After being questioned by the doctor, an individual in this case may need to undergo physical examination. This may be followed by several laboratory tests as well as clinical examinations. The perfusion scan according to Rhoades and Bell (2009) remains a major screening test for the condition. According to the authors, human serum albumin aggregates (labeled with a radionuclide) are in this case injected into a peripheral vein. Following the injection, the said aggregates “travel through the right side of the heart, enter the pulmonary vasculature, and lodge in small pulmonary vessels” (Rhoades and Bell, 2009). Blockage of an artery by a clot effectively means that blood flow to the affected area is obstructed. In that regard, the tagged albumin does not show in the affected region. The other tests which could be utilized in the diagnosis of pulmonary embolism include but they are not limited to blood tests, pulmonary angiography, CT scans, etc. (NHLBI, NIH, 2011).
Complications and Treatment
Some of the complications associated with pulmonary embolism could be severe. In that regard, the relevance of early treatment cannot be overstated. Complications according to Eckman (2010) could in this case include “pulmonary infarction, acute respiratory failure, acute cor pulmonale, and death.” According to the author, treatment of the disorder “is designed to maintain adequate cardiovascular and pulmonary function during resolution of the obstruction and to prevent embolus recurrence” (Eckman, 2010). Depending on how severe the disease is, treatment could in this case comprise of surgical procedures and/or medications. The utilization of anticoagulants is largely meant to prevent the clotting of blood. To dissolve blood clots, thrombolytics could be utilized. According to Eckman (2010), a vast majority of emboli resolve in ten to fourteen days. For this reason, treatment according to the authors could consist of oxygen therapy as well as anticoagulation. Anticoagulants such as heparin could be administered through the insertion of a tube or needle into a vein, as an injection, or as a pill (NHLBI, NIH, 2011). It is however important to note that in some severe cases, surgical procedures might have to be utilized so as to remove the clot. Sometimes, a patient might not be able to take anticoagulants. Such a situation might call for the utilization of surgery in which case an actual attempt is made to remove the blood clots. Surgery in the words of Eckman (2010) could consist of “vena caval ligation, plication, or insertion of a device (umbrella filter) to filter blood returning to the heart and lungs.” There exists a need to closely monitor pulmonary embolism patients discharged from the hospital after treatment.
Prevention
Before discussing the prevention measures in regard to pulmonary embolism, it would be prudent to highlight the main risk factors. As I have already pointed out elsewhere in this text, pulmonary embolism results from blood clots formed elsewhere in the body and later on transported to the lungs. The said clots could in this case be caused by long periods of immobility, damaged walls of the veins, etc. In regard to long periods of immobility, this could result from extended resting or sitting periods. On the other hand, damage to the walls of the veins could result from lower leg trauma. It is also important to note that the blood of some individuals could for some reason have an increased or enhanced clotting potential. Reasons for this could include smoking, cancer or the utilization of some medications.
Avoiding the risk factors I have highlighted above remains one of the most appropriate ways of preventing pulmonary embolism. For instance, given that long periods of immobility remain one of the main risk factors, an individual should avoid sitting for long periods of time. For instance, during airplane flights that happen to be particularly long, one should occasionally stretch his or her legs so as to avoid pooling of blood in the legs. The same case applies to long car trips. It would also be prudent for cigarette smokers to kick the habit so as to lower their chances of developing pulmonary embolism. According to Eckman (2010), patients should also be encouraged to walk after surgery. This according to the author could help in the prevention of venostasis. Patients should also be warned not to cross their legs or have them in a dependent position for extended periods of time (Eckman, 2010). This according to the authors could help in the prevention of thrombosis formation.
Nursing Interventions and Considerations
Nursing interventions according to Chohan and Munden (2006) include administering the prescribed drugs. I.M injections according to the authors should be avoided. In addition to the said injections, lower leg massage should also be avoided. Early postoperative ambulation and the utilization of incentive spirometry should be encouraged (Chohan and Munden, 2006). As the authors further point out; “vital signs, respiratory status, pulse oximetry, signs of DVT, complications…” should also be monitored.
It should also be noted that the impaired perfusion of the patient’s lung tissue could cause acute pain. In such a case, the relevant pain medication should be administered. The patients should also in this case be assisted to assume a more comfortable position. In addition to controlling pain, the said interventions in this case also enhance the patient’s comfort in an attempt to promote quick relief. In some cases, anticoagulation therapy comes with a risk of injury. With this in mind, evidence of bleeding should be assessed. The patient’s pulse and blood pressure should be evaluated in an attempt to identify signs of bleeding. These interventions help in detecting hemorrhage or bleeding as a result of the said therapy. Signs of bleeding could include but they are not limited to low blood pressure and rapid pulse. In addition to being monitored for side effects associated with anticoagulants, patients should also be monitored for anxiety and pain. To relieve anxiety, Eckman (2010) recommends that the relevant procedures as well as treatments be explained to patients. According to the author, the patient’s family should also be encouraged to participate in his or her care.
Conclusion
In conclusion, it is important to note that to prevent serious complications; pulmonary embolism should be treated immediately. Those who happen to be at high risk of the disease should consult their doctor before taking a long car trip or flight. This way, they can be well advised on the precautions to take to prevent the formation of blood clots.
References
Chohan, N. & Munden, J. (Eds.). (2006). Lippincott Manual of Nursing Practice. Ambler, PA: Lippincott Williams & Wilkins.
Eckman, M. (2010). Professional Guide to Pathophysiology (3rd ed.). Ambler, PA: Lippincott Williams & Wilkins.
NHLBI, NIH (2011, July 01). Explore Pulmonary Embolism. Retrieved February 8, 2013, from the National Heart, Lung and Blood Institute, National Institutes of Health website: http://www.nhlbi.nih.gov/health/health-topics/topics/pe/
Rhoades, R. & Bell, D.R. (Eds.). (2009). Medical Physiology: Principles for Clinical Medicine (3rd ed.). Philadelphia, PA: Lippincott Williams & Wilkins.
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