Primary Nursing Diagnosis

Impaired gas exchange related to impaired pulmonary blood flow and alveolar collapse

OUTCOMES. Respiratory status: Gas exchange; Respiratory status: Ventilation; Symptom control behavior; Treatment behavior: Illness or injury; Comfort level

INTERVENTIONS. Airway management; Anxiety reduction; Oxygen therapy; Airway suctioning; Airway insertion and stabilization; Cough enhancement; Mechanical ventilation; Positioning; Respiratory monitoring

H PLANNING AND IMPLEMENTATION Collaborative

Massive PE is a medical emergency. Make sure that the patient's airway, breathing, and circulation are maintained. Administer oxygen immediately to support gas exchange and prepare for the possibility of intubation and mechanical ventilation. Obtain intravenous (IV) access for administration of fluids and pharmacologic agents. Before administration of thrombolytic agents, draw a coagluation profile and complete blood count to obtain a baseline.

Although it is rare, severe cases of PE that are unresponsive to anticoagulant or thrombolytic therapy may require surgery. The least invasive technique is the insertion of a transvenous catheter into the pulmonary vasculature. If the procedure is unsuccessful, however, a thoraco-tomy may be required to remove the obstructing embolism. Patients prone to PE seeded from deep vein thrombi may have a prosthetic umbrella inserted into the inferior vena cava to trap the emboli.

792 Pulmonary Embolism

Pharmacologic Highlights

Medication or Drug Class

Dosage

Description

Rationale

Anticoagulants

Varies with drug and patient weight;

Sodium heparin;

Standard treatment is to

Getting to Know Anxiety

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