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mortality

Other Drugs: Morphine sulfate to manage pain and anxiety, diuretics to reduce edema, inotropic agents for heart failure

Independent

The primary concern for the nurse who is caring for a patient with PE includes the maintenance of airway, breathing, and circulation by support of the cardiopulmonary system. The most important independent measure before PE formation is prevention of thrombus formation. To prevent PE in high-risk patients, encourage early chair rest and ambulation as the patient's condition allows. Even patients who are intubated and mechanically ventilated with multiple catheters can be gotten out of bed without physiological risk for periods of chair rest. Provide active and passive range-of-motion at least every 8 hours for all patients on bedrest. Teach the family and significant others of an immobile patient how to perform passive range-of-motion exercises. If the patient is not on fluid restriction, encourage drinking at least 2 L of fluids a day to decrease blood viscosity. Use compression boots for patients who are on bedrest to increase venous return.

During anticoagulant therapy, protect patients from injury. Report any signs of increased bleeding, such as ecchymosis, epistaxis, hematuria, mucous membrane bleeding, decreasing hemoglobin or hematocrit, and bleeding from puncture sites. Restrict parenteral injections and venipunctures to essential procedures only. If the patient is ambulatory, provide a safe environment.

Provide information about the diagnosis and prognosis of PE, and explain all procedures and diagnostic tests. Set aside time each day to talk with the patient and family to allow for expression of their feelings. If the patient is a child, monitor the patterns of growth and development using age-appropriate milestones and developmental tasks. Provide age-appropriate play activities for children.

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