• Collection of particulate matter that enters venous circulation & lodges in pulmonary vessels
• Causes decreased systemic oxygenation; Vasoconstriction, pulmonary HTN, and impaired gas exchange
• Resulting in tissue hypoxia (bc deoxygenated blood shunts into arterial sys) & potential death
• Blood clots, DVT = most common

• Prolonged immobilization
• Central venous catheters
• Surgery
• Obesity
• Advancing Age
• Hypercoagulability
• Hx of thromboembolism
• Cancer diagnosis
• Smoking
• Pregnancy
• Estrogen therapy
• Heart failure
• Stroke
• Trauma

Assessment - Hx

• Sudden onset of breathing difficulty
• ID risk factors - hx of DVT, recent surgery, prolonged immobilization

• Dyspnea, sudden onset
• Pleuritic chest pain
• Apprehension, restlesness
• Feeling of impending doom
• Cough
• Hemoptysis - d/t pulmonary infarction

• Tachypnea
• Pleural friction rub
• Tachycardia
• S3 or S4 heart sound (LV failure or hypertrophy)
• Diaphoresis
• Fever, low grade
• Petechiae over chest and axillae (late finding)
• Decreased SaO2 (norm > 95%)

Often pt are treated for PE w/o diagnostic test b/c of instability

• ABG's - First, resp alkalosis (hyperventilation d/t to hypoxia and pain); Second, resp acidosis (deoxygenated blood is being delivered); Third, metabolic acidosis (buildup of lactic acid d/t tissue hypoxia)
• CXR - only if PE is large
• CT scan - most often used to diagnose
• D-dimer level - fragment of fibrin formed during lysis of a blood clot; Pos = recently had a clot that body is breaking down
• VQ Scan - uses radioisotope IV (pulmonary blood flow) and inhaled radioisotope (shows on ventilation)

1. Decreased gas exchange r/t disrupted pulmonary perfusion
2. Decreased CO r/t acute pulmonary HTN
3. Anxiety r/t hypoxemia and life threatening illness
4. Risk for injury (bleeding) r/t anticoagulation or fibrinolytic therapy

Nursing Interventions

1. Administer O2
2. Mon. pulse oximetry
3. Continuously mon. VS & cardiac/resp status
4. Monitor for cyanosis
5. Admin prescribed anticoagulants or fibrinolytics
6. Monitor for bleeding

All pt on anticoags should avoid IM injections, be monitored for bleeding/bruising, avoid hard toothbrushes, straight razors and rectal thermometers, avoid puncture sites and apply pressure to venopuncture sites when necessary.

• Heparin - Monitor PTT (norm 60-70), platelets; antidote = protamine sulfate
• Warfarin (Coumadin) - Monitor PT/INR, avoid foods high in Vit K; antidote = Vit K
• Lovenox - low mol weight Hepain; Don't have to monitor PTT, SubQ

• Embolectomy - surgical, remove clot; Only used for massive PE when pt not responding to therapy, LAST DITCH EFFORT.
• Vena Cava filter - for pt unable to take anticoagulants, have major or recurrent bleeding while receiving anticoags, have had an embolectomy and/or recurrent DVT's.

• Passive and active ROM for immobilized and post op pt
• Early post op ambulation
• TED hose
• Pneumatic compression device
• Avoid constrictive clothing
• Assess peripheral circulation frequently
• Elevate lower extremities
• Change pos q 2 hrs
• Ambulate as tolerated
• Refrain from massaging or compressing leg muscles
• No crossing legs
• Admin low dose anticoags and antiplatelet meds
• Avoid valsalva maneuver
• Encourage smoking cessation