DESCRIBE DISEASE PROCESS AFFECTING PATIENT (INCLUDE PATHOPHYSIOLOGY OF DISEASE PROCESS)
Pulmonary Embolism (PE) is the blockage of one or more pulmonary
... [Show More] arteries by a thrombus, fat or air embolus, or tumor tissue. These clots do not stop moving until they lodge at a narrowed part of the circulatory system. A pulmonary embolus consists of material that gain access to the venous system and then to the pulmonary circulation. The embolus travels with blood flow through smaller blood vessels until it lodges and obstructs perfusion of the alveoli. The lower lobes of the lungs are most commonly affected and approximately ten percent of patients die from a massive PE within the first hour. Anticoagulants significantly reduces mortality.
Lewis, S. M., Bucher, L., Heitkemper, M. M., & Harding, M. M. (2017). Medical-surgical nursing: Assessment and management of clinical problems. St. Louis, MO: Elsevier.
DIAGNOSTIC TESTS (REASON FOR TEST AND RESULTS)
• 12-lead electrocardiogram (ECG) such as T-wave
inversion, ST-segment elevation, or the development
of an abnormal Q wave (may show changes
PATIENT INFORMATION
Vernon Watkins is a 69- year-old male who
ANTICIPATED PHYSICAL
FINDINGS
• Shortness of breath
• Chest pain
• Nausea
indicative of ischemia)
+ • Chest X-ray-may show infiltrates, atelectasis,
elevation of the diaphragm on the affected side, or a
pleural effusion
• Spiral CT-Scan with contrast
• Arterial blood gas analysis-it may show hypoxemia and hypocapnia (from tachypnea).
• D-dimmer test
• Prothrombin time
• International normalized ratio
Department 4 days ago with
complaints of nausea, vomiting, and severe abdominal pain and was admitted for emergent surgery for bowel perforation and underwent a hemicolectomy.
• Vomiting
• Abdominal pain
• Anxiety
• Fever
• Tachycardia
• Apprehension
• Diaphoresis
• Hemoptysis
• Syncope
ANTICIPATED NURSING INTERVENTIONS
• Maintain oxygen saturation greater than 92%
• If SpO2 less than 92% administer oxygen therapy to relieve hypoxemia and dyspnea and position client in high- Fowler’s 90 degrees
• Initiate and maintain IV access.
• Administer prescribed medications
• Withhold medications that may cause respiratory depression
• Place 12 lead ECG to monitor cardiac status (dysrhythmias)
• Vital signs every 4 hours
• Monitor for signs of bleeding.
• Assess wound and IV site regularly.
• Chest X-Ray
• Spinal CT-scan with contrast
• Request need for arterial blood gas/stat labs
• Check to aPTT in six hours and then follow nurse driven IV heparin protocol
vSim ISBAR ACTIVITY STUDENT WORKSHEET
INTRODUCTION Aurora Vera primary nurse at the medical surgical unit
Your name, position (RN), unit you are working on
SITUATION Vernon Watkins is a 69-year-old male who presented to the Emergency Department 4 days ago with complaints of nausea, vomiting, and severe abdominal pain and was admitted for emergent surgery for bowel perforation and underwent a hemicolectomy.
Patient’s name, age, specific reason for visit
BACKGROUND Admitted on 07/22/2020 with a primary diagnosis of postoperative hemicolectomy. He is also getting treated for a pulmonary embolism.
Current orders:
-IV normal saline at 25 mL/hour
-Oxygen to maintain SpO2 over 92%
-Continuous ECG and SpO2 monitoring
-Chest X-ray
-Spiral CT-scan
-12 Lead ECG - Cardiac monitoring
-D-dimer
-Check PTT Q6hrs and follow-up nurse driven IV
-Heparin protocol
-Arterial blood gas
-Venous blood analysis Medications:
Morphine sulfate 4-6 mg IV push Q4hrs. PRN pain (withheld due to respiratory condition) Heparin 80 units kg bolus
Heparin 18 units/kg/hr (25,000 units in 250 mL dextrose 5%)
Patient’s primary diagnosis, date of admission, current orders for patient
ASSESSMENT I monitor the patient’s vital signs, oxygen level, and heart rhythm. Temp: 99, RR: 24, Pulse: 112, BP: 156/94, Sp02: 91%, Pain: 3 (0/10). HOB High Fowler’s. Heart sounds: rapid. Lungs: Clear bilaterally. Midline abdominal incision that is clean, dry and intact. No redness, swelling or drainage. AOX3. Bowel sounds present on all 4 quadrants. Last bowel movement was yesterday. Urinary output was 400 mL at 0600. IV in right antecubital and is intact, no redness, swelling or bleeding.
Heparin 80 units/kg bolus then 18 units/kg per hour IV patient has 1440 units/hr in 250 ml dextrose 5% in water. Spinal CT detected a clot in segmental artery of left and right upper lung. 12 Lead ECG shows sinus rhythm with signs of right heart strain consistent with pulmonary hypertension. ABG: respiratory alkalosis. Venous blood: Cl 101, HC03 21.1, aPTT 31, and PT 10. D-Dimer 0.9. The client is allergic to
Penicillin.
Current pertinent assessment data using head to toe approach, pertinent diagnostics, vital signs
RECOMMENDATION
• Continue to maintain adequate 02 levels
• Continue to maintain Pain levels
• Continue to monitor vital signs and observing for signs of respiratory distress
• Continue ECG monitoring
• Continued monitoring of aPTT and PT values and adjust Heparin accordingly.
• Monitor for bleeding.
• Although patient would not be ambulating at this point. When clot is resolved and doctor orders, ambulate patient from bed and apply
thrombotic preventive devices (compression stockings and SCDs).
• Provide the patient with education on ways to prevent blood clots through early ambulation. The use of SCD when in bed and compression stockings
the first 24 hours post-operative, 12 hour daily wear thereafter
Any orders or recommendations you may have for this patient
PHARM-4-FUN PATIENT EDUCATION WORKSHEET
NAME OF MEDICATION, CLASSIFICATION, AND INCLUDE PROTOTYPE
MEDICATION: Heparin
CLASSIFICATION: Blood formers; Coagulators; Anticoagulant PROTOTYPE:
SAFE DOSE OR DOSE RANGE, SAFE ROUTE
Treatment of Thromboembolism
Adult: IV 5000-U bolus dose, then 20,000–40,000 U infused over 24 h, dose adjusted to maintain desired APTT or 5000–10,000 U IV piggyback q4–6h SC 10,000–20,000 U followed by 8000–20,000 U q8–12h
Child: IV 50 U/kg bolus, then 20,000 U/m2/24 h or 50–100 U/kg q4h or 15–25 U/kg/h Open Heart Surgery
Adult: IV 150–300 U/kg Prophylaxis of Embolism
Adult: SC 5000 U q8–12h
PURPOSE FOR TAKING THIS MEDICATION
Prophylaxis and treatment of venous thrombosis and pulmonary embolism and to prevent thromboembolic complications arising from cardiac and vascular surgery, frostbite, and during acute stage of MI. Also used in treatment of disseminated intravascular coagulation (DIC), atrial fibrillation with embolization, and as anticoagulant in blood transfusions, extracorporeal circulation, and dialysis procedures. (Holland,2007).
PATIENT EDUCATION WHILE TAKING THIS MEDICATION [Show Less]