Question

Marie Perez, a 53-year-old patient, is day 1 after a gastric bypass. She complains of shortness of breath; her respiratory rate is 30 breaths/min, heart rate is 110 bpm, pulse oximetry 89% on room air, temperature is 100°F, and her blood pressure is 90/50 mm Hg. She complains of feeling anxious and having stabbing chest pain which gets worse with inspiration. She complains that she feels like she is going to pass out or possibly die.

(Learning Objective 7)

A. What could possibly be going on with the patient and what measures should the nurse provide immediately?

B. What risk factors does the patient have for a pulmonary embolus?

C. What measures are appropriate to manage a pulmonary embolism?

D. What measures are appropriate to help the patient in this case study prevent the reoccurrence of a pulmonary embolism?

Answer 1

ANSWER.

A. Changes in the vital signs of the patient and stabbing chest pain after one day

     of surgery may due to pulmonary embolism associated changes in the respiratory

     and cardiovascular system.

    Measures should the nurse provide immediately includes

           * Administration of oxygen to treat hypoxemia and changes in the respiratory

             rate.

           * Administration of drugs like dobutamine or dopamine to maintain normal blood

             pressure and dilate pulmonary vessels as per physicians order.

       * Administer sedatives or analgesics to relieve anxiety and chest pain.

           * Monitor ECG changes and give antiarryhmatic drugs if arrythmias occurs as per

             physicians order.

          * Administer IV fluids if required to maintain normal fluid volume in the body.

          * Prepare the patient for CT or pulmonary angiography.

B. Risk factors does the patient having pulmonary embolism.

           * Age more than 50 years.

                 * Surgery ( Gastric bypass).

                 * Prolonged bed ridden status after surgery.

C. Measures to manage pulmonary embolism.

        * Anticoagulant treatment.

                  * Anticoagulants are blood thinners which help to prevent formation

                    of blood clots or thrombus.

                           Eg; Warfarin,Heparin.

        * Thrombolytic treatment.

                  * Thrombolytivs useful to remove blood clots by activating the natural

                     fibrinolytic system which leads to lysis of blood clot or thrombus.

        * Surgical treatment.

                  * Surgical embolectomy - Surgical removal of embolus if the patient has

                                                            mass pulmonary embolism.

                  * Transvenous catheter pulmonary embolectomy is also used to surgically

                     removing moving clots or emboli which block the pulmonary vessels circulation.

D. Measures to prevent the reoccurance of pulmonary embolism.

                    * Regular exercises to prevent clot formation.

                    * Avoid prolong sitting,standing and immobility.

                    * Feet should be place on floor and avoid crossing legs.

                    * Avoid use of constrictive clothings.

                    * Smoking causes changes in the coagulation mechanism of the body

                      leads to formation of thrombus so do not use tobacco products.

                   * Use of compression stocking help to prevent formation of blood clots.