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 Struik
• Age: 67 years
• Family: Lives alone
• Occupation: Retired
• Cultural: Not known

AMPLE

• A.Unknown
• M.Metoprolol tartrate 50 mg once daily
• P.Prostate carcinoma
• L.Unknown
• E.Increasing shortness of breath and chest pain

SBAR

• S.Mr Struik has just been admitted to your ward. Before admission he visited the GP due to increasing shortness of breath and chest pain. The GP referred him to hospital.
• B.Mr Struik is 67 years old and has a history of prostate carcinoma and hypertension.
• 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 22 breaths/min, symmetrical thoracic excursions, increased work of breathing, using accessory breathing muscles, distended jugular veins, normal breath sounds, saturation 91%.
• C.Normal colour, CRT 2 sec, HR 107 bpm, strong regular pulse, peripherally warm and clammy, BP 130/70.
• D.Alert on AVPU, glucose 6.5, pupils PEARL.
• E.Temp 37.9°C, swollen red lower leg. Urine output: at home 5 hours ago (amount unknown).

Situation at the end of scenario

• A.Clear airway, alert, anxious.
• B.RR 30 breaths/min, symmetrical thoracic excursions, increased work of breathing, using accessory breathing muscles, distended jugular veins, normal breath sounds, saturation 85%.
• C.Normal colour, CRT 3 sec, HR 125 bpm, normal regular pulse, peripherally warm and clammy, BP 100/53, peaked P-wave on ECG.
• D.Alert on AVPU, glucose 7.4, pupils PEARL.
• E.Temp 38.0°C, swollen red lower leg.

Recommendations

• Perform ECG
• Perform CT pulmonary angiography
• Anticoagulation