Pulmonary embolism

From: maybo malbog

Pulmonary embolism
Classification and external resources
Chest spiral CT scan with radiocontrast agent showing multiple filling defects both at the bifurcation and in the pulmonary arteries.
ICD-10	I 26.
ICD-9	415.1
DiseasesDB	10956
MedlinePlus	000132
eMedicine	med/1958 emerg/490 radio/582
MeSH	D011655

Pulmonary embolism (PE) is a blockage of the main artery of the lung or one of its branches by a substance that has travelled from elsewhere in the body through the bloodstream (embolism). Usually this is due to embolism of a thrombus (blood clot) from the deep veins in the legs, a process termed venous thromboembolism. A small proportion is due to the embolization of air, fat, talc in drugs of intravenous drug abusers or amniotic fluid. The obstruction of the blood flow through the lungs and the resultant pressure on the right ventricle of the heart leads to the symptoms and signs of PE. The risk of PE is increased in various situations, such as cancer or prolonged bed rest.
Symptoms of pulmonary embolism include difficulty breathing, chest pain on inspiration, and palpitations. Clinical signs include low blood oxygen saturation and cyanosis, rapid breathing, and a rapid heart rate. Severe cases of PE can lead to collapse, abnormally low blood pressure, and sudden death.
Diagnosis is based on these clinical findings in combination with laboratory tests (such as the D-dimer test) and imaging studies, usually CT pulmonary angiography. Treatment is typically withanticoagulant medication, including heparin and warfarin. Severe cases may require thrombolysis with drugs such as tissue plasminogen activator (tPA) or may require surgical intervention viapulmonary thrombectomy.

Clinical manifestation:
symtoms depend on the size of the thrombus and the area of the pulmonary artery artery occlusion.
1, DYSPNEA , IS THE MOST COMMON SYMPTOM . 2 ,TACHYPNEA IS THE MOST FREQUENT SIGN . 3 , CHEST PAIN IS COMMON USUALLY SUDDEN IN ONSET AND PLEURITIC IN NATURE , IT CAN BE SUBSTERNAL AND MAY MIMIC AGINA PECTORIS. 4 , fEVER , TACHYCARDIA , COUGH , DIAPHORESIS , HEMOPTYSIS , SYNCOPE , SHOCK , AND SUDDEN DEATH MAY OCCUR. 5 , MULTIPLE SMALL EMBOLI IN THE TERMINAL PULMONARY ARTERIOLES SIMULATE SYMPTOMS OF BRONCHOPNEUMONIA OR HEART FAILURE.
PREVENTION:
1 , AMBULATION OR LEG EXERCISE IN THE PATIENTS ON BED REST 2 , anticoagulation therapy before abdominothoracic surgery and every 8 to 12 hrs until discharge to from the hospital 3 , application of intermittent leg compression devices.
jesoga70therapy planning and goal:
The major goal include oxygenation , absence of additional thrombus, effective pharmacologic therapy minimal chest pain and anxiety , positive postoperative status , and effective home and community rate.
targe of preventing thombu fomation
1, encourage early ambulation and active and passive leg exercise 2 , instruct patient to move legs in a pumping exercise 3 , advise patient to avoid prolong sitting , immobility and constrictive clothing ., 3 do not permit dangling of legs and feet in adependent position 4., instruct the patient to place feet on floor or chair and to avoid crossing legs. 5 , do not leave intravenous catheter in veins for prolonged periods. 6 , advise patient to continue wearing antiembolism stockings as long as directed. 7 , recommend that patient change position regularly when traveling , walk occasionally and do active exercises of legs and ankles , 8 , advise patient to drink plenty of liquids. 9. , teach patient to report dark tarry stools immediately is all about how to promote home and community base therapy care.
Allevating anxiety
encourage patient to express feelings and concerns and answer question concisely and accurately , explain therapy and discribe how to recognize untoward efect early.