Pulmonary Embolism

Mid complexity — Respiration

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