Pulmonary Embolism

Goals

1. Recognise respiratory insufficiency in a pulmonary embolism and apply nursing interventions.
2. Recognise and describe the compensatory mechanisms in respiratory insufficiency.
3. Recognise and describe the risk factors for pulmonary embolism.

Anamnese

• Name: Mr Dijkman
• Age: 49 years
• Family: Married
• Occupation: Sales representative
• Cultural: Not known

AMPLE

• A.Unknown
• M.No medication
• P.Colorectal carcinoma - Patellar fracture
• L.Unknown
• E.Increasing shortness of breath and chest pain

SBAR

• S.Mr Dijkman has just been admitted to your ward. Before admission he visited the out-of-hours GP service due to increasing shortness of breath and chest pain. The GP referred him directly to hospital for further assessment.
• B.Mr Dijkman is 49 years old and has a history of colorectal carcinoma and recently recovered from a patellar fracture.
• A.See ABCDE
• R.Please assess the patient using ABCDE and apply interventions where necessary.

Situation at the start of scenario

• A.Clear airway, alert, anxious.
• B.RR 20 breaths/min, symmetrical thoracic excursions, slightly increased work of breathing, using accessory breathing muscles, mildly distended jugular veins, normal breath sounds, saturation 93%.
• C.Normal colour, CRT 2 sec, HR 102 bpm, strong regular pulse, peripherally warm and dry, BP 128/72.
• D.Alert on AVPU, glucose 5.5, pupils PEARL.
• E.Temp 37.6°C, swollen red lower leg. Urine output: at home 3 hours ago (amount unknown).

Situation at the end of scenario

• A.Clear airway, alert, anxious.
• B.RR 28 breaths/min, symmetrical thoracic excursions, increased work of breathing, using accessory breathing muscles, distended jugular veins, normal breath sounds, saturation 86%.
• C.Normal colour, CRT 3 sec, HR 115 bpm, normal regular pulse, peripherally warm and clammy, BP 104/58, peaked P-wave on ECG.
• D.Alert on AVPU, glucose 5.5, pupils PEARL.
• E.Temp 37.7°C, swollen red lower leg.

Recommendations

• Perform ECG
• Perform CT angiography
• Anticoagulation