Pulmonary Embolism

What is the most common cause of a pulmonary emboli?

A DVT

What is the nursing management for a pulmonary emboli?

stabilizing the cardiopulmonary system and anticoagulant therapy

Diagnostic testing for a pulmonary emboli

vital signs/lung sounds; ABGs; CXR (to rule out other causes/will not show a pulmonary emboli); V/Q lung scan (ventilation-perfusion lung scan: not used often; used when someone is allergic to contrast dye); D-dimer (not very reliable) (shows if there is fibrin clots in the body); Spiral CT (# 1 choice); pulmonary angiogram; continuous ECG monitor; troponin and BNP level (rule out MI)

Enoxaparin contraindications

*presence of any active bleeding *increased risk of hematoma in patients with spinal or epidural anesthesia *use with caution with concurrent use of aspirin, clopidogrel, and other antiplatelet medications *NOT TO BE USED IN PRESENCE OF THROMBOCYTOPENIA

Heparin indication

*rapid acting (within minutes) to prevent and treat deep vein thrombosis (DVT), pulmonary embolism, and emboli in atrial fibrillation

Warfarin side effects

*spontaneous bleeding *hypersensitivity reactions ( like dermatitis, fever, pruritus, urticaria) *red-orange discoloration of urine (not to be confused with hematuria); weakening of bones with long-term use leading to risk of fractures

Discharge instructions for someone on Warfarin will include education regarding which of the following? a. need for continued blood tests b. safety issues during warfarin therapy c. reportable changes in health status d. the need to adjust dietary intake of green, leafy, vegetables e. the need to change her method of contraception f. use of other medications g. the need to withhold the drug for a day or so if easy bruising is noted.

The answers are A, B, C, D, E, and F. Mrs. Marotta will be discharged on Coumadin (warfarin) therapy. She must have scheduled lab work, which will monitor her response to therapy and help insure a continued level of drug effectiveness and safety. Since bleeding is a major complication of anticoagulant therapy, Mrs. Marotta should avoid situations that could increase risk for injury and bleeding. This includes contact sports, sharp objects, and cluttered areas. She should not walk barefoot. She should use an electric razor for grooming, and a soft-bristle toothbrush for mouth care. She should also carry a card and wear a bracelet that identifies her as being on Coumadin (warfarin) therapy. Mrs. Marotta (and her family members) should be instructed to watch for signs and symptoms of bleeding. Mrs. Marotta should report any signs of bleeding to her healthcare provider immediately. Signs and symptoms that may occur with bleeding include confusion, bloody sputum, dark or bloody urine, dark stools, easy bruising, bleeding gums, and nosebleeds. Vitamin K is a Coumadin (warfarin) antagonist. Foods high in vitamin K (green leafy vegetables, bananas, tomatoes, fish) may decrease the anticoagulation effect of Coumadin (warfarin). Although these foods need not be avoided, Mrs. Marotta should know that significant changes in intake of these foods could alter the effects of Coumadin (warfarin). With Coumadin (warfarin) overdose, vitamin K is administered as an emergency measure to reverse the effects of Coumadin (warfarin). Oral contraceptives increase risk for thrombosis and are contraindicated in women with thromboembolic disease. Mrs. Marotta needs counseling about alternative birth control methods. Mrs. Marotta should avoid taking over-the-counter medications without first checking with her healthcare provider, to prevent an increase in bleeding or an inactivation of Coumadin (warfarin). Many herbal supplements interact with Coumadin (warfarin) and other medications. Arnica, clove, garlic, ginger, ginkgo, and licorice increase the anticoagulant effects of Coumadin (warfarin). St. John's Wart decreases the effects of Coumadin (warfarin). Aspirin and non-steroidal antiinflammatory drugs (NSAIDS) should not be used. These drugs decrease platelet aggregation and irritate gastrointestinal tract mucosa, and can increase risk for bleeding in a person taking Coumadin (warfarin).

Warfarin sodium (Coumadin) MOA

an oral anticoagulant that antagonizes vitamin K, which is necessary for the synthesis of clotting factors VII, IX, X and prothrombin. As a result, it disrupts the coagulation cascade.

Heparin MOA

anticoagulant that exerts a direct effect on blood coagulation by enhancing the inhibitory actions of antithrombin on several factors essential to normal blood clotting, thereby blocking the conversion of prothrombin to thrombin and fibrinogen to fibrin

Anticoagulants for pulmonary emboli

*heparin *warfarin *lovenox

Enoxaparin (Lovenox) indications

prevention of postoperative deep vein thrombosis, pulmonary embolism; prevention of ischemic complications in unstable angina, or non-Q wave myocardial infarction, and ST-elevation MI

Heparin side effects

*injection site reactions and heparin induced thrombocytopenia may develop *may result in spontaneous bleeding

When planning cares for a patient at risk for pulmonary embolism the nurse prioritizes? a. maintaining the patient on bed rest b. using sequential compression devices c. encouraging the patient to cough and deep breath d. teaching the patient how to use the incentive spirometer

The answer is B: using sequential compression devices.

What are other causes of a pulmonary emboli?

fat from a break in a long bone, tumor (pieces that break off), or air

Warfarin contraindications

*bleeding disorders (hemophilia, thrombocytopenia) *lumbar puncture; regional anesthesia; or surgery of the eye, brain, or spinal cord *vitamin K deficiency; severe hypertension *pregnancy: category X; breast feeding (crosses into milk) *liver disease, alcoholism

Heparin precautions and contraindications

*bleeding tendencies: hemophilia, dissecting aneurysm, peptic ulcer *thrombocytopenia: uncontrollable bleeding, threatened abortion *postoperative patients: especially eye, brain, and spinal cord surgeries; lumbar puncture; and regional anesthesia

Warfarin indications

*long-term prophylaxis of thrombosis; is not useful in emergency because of delayed onset of action *prevents venous thrombosis and thromboembolism associated with atrial fibrillation and prosthetic heart valves *decreases risk of recurrent transient ischemic attacks (TIAs) and recurrent myocardial infarction

Heparin nursing implications

*monitor PTT (partial thromboplastin time) and aPTT (activated PTT): should be 1 1/2 to 2 times the control value (WATCH FOR BLEEDING) *may not be given orally, or by intramuscular injection *Protamine Sulfate is the antidote *caution patients not to take aspirin or any medication that decreases platelet aggregation (clopidogrel) unless ordered by HCP *administered either IV or SQ; apply firm pressure for 1 to 2 minutes; do not massage site after injection *dosage is prescribed in units, not milligrams

Nursing interventions for a pulmonary emboli

*monitor for hypoxemia; assess vital signs; listen to lung sounds frequently (rales); heart sounds; assess circulation (peripheral edema, JVD); monitor for feelings of anxiety/fear; HOB elevated (first thing/easiest thing); O2 applied and ordered; analgesics (morphine/tylenol)

Nursing implications for enoxaparin

1. medication is only administered SQ 2. protamine sulfate is antidote 3. always double-check; cannot be given to a patient receiving heparin 4. injections in abdomen should be 2 inches from umbilicus or any incisional area 5. advise patient to not take any over the counter medications, especially aspirin 6. check complete blood count, especially platelet count 7. monitor for bleeding: -guaiac stools for occult blood -hematuria -bleeding gums -excessive bruising 8. does not require activated partial thromboplastin time (aPTT) monitoring

Warfarin nursing implications

1. monitor prothrombin time (PT) and international normalized ratio (INR) as ordered (2 to 3 usually an acceptable INR for anticoagulation). 2. interacts with a large number of medications; consequently, evaluate medications for interactions before initiating therapy 3. monitor for bleeding tendencies; vitamin K is an antidote 4. teach patient to maintain intake of vitamin K (keep constant intake of foods such as green, leafy vegetables, mayonnaise, and canola oil) and do not abruptly increase or decrease intake 5. patient must advise all HCP if patient is taking warfarin, because it is very slow to be excreted from the body 6. teach patient to wear a medical alert bracelet

Two days after undergoing pelvic surgery, a patient develops marked dyspnea and anxiety. What is the first action that the nurse should take? a. raise the head of the bed b. notify the health care provider c. take the patient's pulse and blood pressure d. determine the patient's SpO2 with an oximeter

The answer is A. All of the activities are correct, but the first thing to do is to raise the head of the bed to facilitate breathing in the patient who is dyspneic.

A 45 year-old female presents to the emergency department with complaints of chest pain. The nurse immediately obtains a set of vital signs, gets an EKG (ECG), starts a 20 gauge peripheral IV, and places the client on oxygen, 2L NC. The EKG shows normal sinus rhythm, but the client appears anxious, is sweating, and clutching her chest with each breath. Upon assessment, the nurse notes redness and swelling of the right leg. This leads the nurse to suspect which of the following as the client's primary complaint? a. Pulmonary embolism b. NSTEMI c. Internal hemorrhage d. Stroke

The answer is A. Based on the client's symptoms and the nurse's observations, this client may have a pulmonary embolism. The EKG was normal, so the nurse would initially not suspect a myocardial infarction, but sweating, chest pain, and a low oxygen saturation, in addition to the signs of a DVT in the right leg all lead the nurse to suspect a PE. A DVT is the most common original source of a blood clot leading to a pulmonary embolism.

With pulmonary embolus, alveoli in the affected area are ventilated but not perfused. Affected areas are described as: a. dead space b. fibrotic c. hyperinflated

The answer is A. Dead space is an area of the lungs (alveoli) that is adequately ventilated but not adequately perfused. Dead space characterizes areas of the lung affected by pulmonary embolus (PE).

To adjust the dosage of Coumadin (warfarin), which lab value is monitored? a. PT/INR b. Bleeding time c. APTT

The answer is A. The prothrombin time (PT), reported as an international normalized ratio (INR) value, is used to adjust Coumadin (warfarin) dosage. PT time is generally maintained at an INR of 2 to 3.

Which of the following statements best characterizes pathophysiological changes that occur with pulmonary embolus (PE)? a. obstruction of pulmonary arterial blood flow occurs, resulting in pulmonary hypertension and hypoxemia b. obstruction of pulmonary venous blood flow occurs resulting in backflow of blood into alveoli and hypoxemia c. left ventricular failure causes accumulation of fluid in the lungs, resulting in hypoxemia

The answer is A. With pulmonary embolus (PE), partial or complete obstruction of pulmonary arterial blood flow occurs, resulting in pulmonary hypertension and hypoxemia. Alveolar collapse occurs in underperfused areas. Right ventricular failure can develop as a result of increased pulmonary vascular resistance. With a massive PE, hypotension and complete cardiovascular collapse and death can occur within minutes.

Mrs. Marotta's arterial blood gas (ABG) results are available: pH 7.50, PaCO2 32, HCO3 24, PaO2 60. ABG results reflect: a. hypoxemia and hypocapnia, and respiratory acidosis b. hypoxemia and hypocapnia, and respiratory alkalosis c. hypoxemia and hypercapnia, and respiratory acidosis d. hypoxemia and hypercapnia, and respiratory alkalosis

The answer is B. Arterial blood gas (ABG) results reflect respiratory alkalosis. pH is high (greater than 7.45), indicating an alkalotic state. PaCO2 is low (less than 35 mm Hg), indicating hypocapnia. HCO3 is normal (22-26 mEq/L), supporting a respiratory cause of the alkalosis. PaO2 is low at 60 mm Hg, indicating hypoxemia. When the ABGs were drawn, Mrs. Marotta was anxious and hyperventilating (blowing off CO2), which resulted in an alkalotic state. Hypoxemia and hypocapnia are common findings in patients with pulmonary embolus (PE), although ABGs are not evaluated for diagnostic reasons. They are used to assess oxygenation.

The nurse instructs a patient with a pulmonary embolism about administering enoxaparin after discharge. Which statement by the patient indicates understanding about the instructions? a. "I need to take this medicine with meals." b. "The medicine will be prescribed for 10 days." c. "I will inject this medicine into my upper arm." d. "The medicine will dissolve the clot in my lung."

The answer is B. Enoxaparin is a low-molecular-weight heparin that is administered for 10 to 14 days and prevents future clotting but does not dissolve existing clots. Fibrinolytic agents (e.g., tissue plasminogen activator or alteplase) dissolve an existing clot. Enoxaparin is administered subcutaneously by injection into the abdomen.

Mrs. Marotta is receiving an IV drip of heparin. You recall that heparin is administered to: a. dissolve clots b. prevent clot formation

The answer is B. Heparin is an anticoagulant. It inactivates prothrombin and prevents conversion of fibrinogen to fibrin, which interrupts the clotting process. Heparin prevents thrombus (clot) formation. Heparin also improves blood flow around clots, which allows clots to more readily dissolve, a natural process that takes about two weeks. Mrs. Marotta is receiving unfractionated heparin, which can be given IV or subcutaneously. Alternative treatment for pulmonary embolus (PE) involves use of subcutaneous low molecular weight heparin (enoxaparin), administered once or twice daily.

Given the pathophysiology of pulmonary embolus (PE), which of the following should be done first if a patient at risk for PE complains of chest pain and shortness of breath? a. take the patient's vital signs b. position the patient for optimal ventilation c. call the physician d. connect the patient to a cardiac monitor e. apply oxygen

The answer is B. Impaired gas exchange and hypoxemia characterize pulmonary embolus (PE). Optimizing ventilation and decreasing the work of breathing are priorities when PE is suspected. After ensuring a patent airway, optimal ventilation can be supported by elevating the head of the patient's bed. In general, sitting positions facilitate breathing and optimize ventilation by allowing downward movement of the diaphragm with inhalation.

Alternative treatment for pulmonary embolus (PE) involves use of subcutaneous low molecular weight heparin (enoxaparin). In patients receiving low molecular weight heparin, which of the following lab values is monitored? a. Prothrombin time (PT) b. Platelet count c. Activated partial thromboplastin time (APTT) d. International normalized ratio (INR)

The answer is B. Treatment with low molecular weight heparin or unfractionated heparin may cause heparin-induced thrombocytopenia (HIT), although HIT occurs more often with use of unfractionated heparin. Platelet count is checked before and during therapy. No other lab monitoring is required when low molecular weight heparin is used.

A pulmonary embolus is suspected in a patient with a deep vein thrombosis who develops dyspnea, tachycardia, and chest pain. Diagnostic testing is scheduled. Which test should the nurse plan to teach the patient about? a. d-dimer b. chest x-ray c. spiral (helical) CT scan d. ventilation-perfusion lung scan

The answer is C. A spiral CT scan is the most frequently used test to diagnose pulmonary emboli because it allows illumination of all anatomic structures and procedures a 3-D picture.

A client is brought into the ED after suffering a pulmonary embolism. The nurse has been monitoring the client's breathing and respiratory rate to assess for symptoms of impending respiratory failure. Which sign or symptom is most likely an indicator that the client is going into respiratory failure? a. Heart rate of 130 bpm b. Respiratory rate of 20/min c. Cyanosis of the lips and nail beds d. Consistent, productive cough

The answer is C. Respiratory failure is a life-threatening condition that can occur when a client has respiratory depression that does not respond to intervention. An example would be a client with a respiratory condition that suffers from dyspnea. If the nurse intervenes by administering oxygen and the client's condition does not improve, the client may be entering respiratory failure. Signs and symptoms of respiratory failure include cyanosis of the lips and nail beds, a respiratory rate less than 6/minute, use of accessory muscles to breathe, and mental status changes.

A client has experienced pulmonary embolism. The nurse should assess for which symptom, which is most commonly reported? a. hot, flushed feeling b. sudden chills and fever c. chest pain that occurs suddenly d. dyspnea when deep breaths are taken

The answer is C. The most common initial symptom in pulmonary embolism is chest pain that is sudden in onset.

The student nurse is reviewing the pathophysiology of a pulmonary embolism. The student correctly understands the pathway of a PE to be which of the following? a. Pulmonary vein - left heart - carotid artery - brain b. Pulmonary vein - left heart - aorta - deep vein c. Deep vein - right heart - pulmonary artery - pulmonary arterioles d. Deep vein - right heart - pulmonary artery - coronary artery

The answer is C. This is the correct pathway of a pulmonary embolism. It originates usually in a deep vein of the lower extremities or pelvis, and travels through the right side of the heart to the pulmonary vasculature where it lodges once it cannot travel any further due to its size.

If calf tenderness and swelling were identified in a patient at risk for deep vein thrombosis (DVT), which action would be indicated in response to these findings? a. Massage the calf to relieve venous congestion b. Raise the knee gatch of the bed to alleviate venous stasis c. Encourage the patient to walk to increase peripheral blood flow d. Elevate the patient's legs to promote venous return to the heart

The answer is D. Calf tenderness and swelling could indicate that deep vein thrombosis (DVT) is present. Whether or not DVT is present, leg elevation would be useful in alleviating swelling and discomfort, by promoting venous return to the heart.

To insure appropriate anticoagulation and adjust dosage, which of the following lab values is monitored while Mrs. Marotta receives unfractionated heparin? a. prothrombin time (PT b. bleeding time c. platelet count d. activated partial thromboplastin time (aPTT)

The answer is D. The activated partial thromboplastin time (APTT) is monitored in patients receiving unfractionated heparin. To insure adequate anticoagulation, the APTT (a clotting time in seconds) is commonly maintained at a level 1.5-2.5 times a control level. Heparin is ordered in a dosage required to achieve and maintain this level.

The nurse is caring for an older adult patient who underwent a left total knee arthroplasty. On the third postoperative day, the patient reports shortness of breath, slight chest pain, and that "something is wrong." Temperature is 98.4°F, blood pressure is 130/88 mm Hg, respirations are 36 breaths/min, and oxygen saturation is 91% on room air. What is the priority nursing action? a. Notify the health care provider. b. Administer a nitroglycerin tablet sublingually. c. Conduct a thorough assessment of the chest pain. d. Sit the patient up in bed as tolerated and apply oxygen.

The answer is D. The patient's clinical picture is most likely pulmonary embolism, and the first action the nurse takes should be to assist with the patient's respirations. For this reason, the nurse should sit the patient up as tolerated and apply oxygen before notifying the physician. The nitroglycerin tablet would not be helpful, and the oxygenation status is a bigger problem than the slight chest pain at this time.

The nurse is admitting a patient with a diagnosis of pulmonary embolism. What risk factors is a priority for the nurse to assess (select all that apply.)? a. Obesity b. Pneumonia c. Malignancy d. Cigarette smoking e. Prolonged air travel

The answers are A, C, D, and E. An increased risk of pulmonary embolism is associated with obesity, malignancy, heavy cigarette smoking, and prolonged air travel with reduced mobility. Other risk factors include deep vein thrombosis, immobilization, and surgery within the previous 3 months, oral contraceptives and hormone therapy, heart failure, pregnancy, and clotting disorders.

The student nurse asks the nurse preceptor what can cause a pulmonary embolism. The nurse correctly responds by naming which of the following potential causes of a pulmonary embolism? Select all that apply. a. Blood clot b. Plasma c. Air d. Tumor e. Fat

The answers are A, C, D, and E. Blood clot: A blood clot is the most common material that lodges in the pulmonary vasculature, causing a pulmonary embolism. Air: Air trapped in venous circulation can cause a pulmonary embolism. Trauma, surgery, and central line catheter insertion are a few common sources for an air embolism. Tumor: In addition to certain cancers causing hypercoagulability in a client, it is also possible for part of a tumor to break off and enter the venous circulation, eventually causing a pulmonary embolism. Fat: Fat can cause a pulmonary embolism. This most often results from a long bone or pelvis fracture in which fat makes its way into the venous circulation and eventually lodges in the pulmonary vasculature.

Because Mrs. Marotta is receiving IV heparin, which of the following are included in her plan of care? Select all that apply a. Use infusion pump for heparin drip b. Avoid mixing heparin with other medications c. Assess for bleeding d. Assess level of consciousness e. Avoid rigorous mouth care f. Assess for Homan's sign

The answers are: A, B, C, D, and E. Use infusion pump for heparin drip: An infusion pump should be used for a heparin infusion, to ensure continuous administration of the precise heparin dose. An infusion pump should be used for all medications that require precise infusion to avoid serious injury resulting from administration of incorrect doses (low or high). An infusion pump is preferred for all IV infusions, when possible. Infusion pumps should have free-flow protection. Avoid mixing heparin with other medications: Heparin can be inactivated if mixed with other medications, and should not be mixed in an IV container with other medications. Assess for bleeding: Bleeding is a major complication of anticoagulant therapy. Stools and emesis should be checked for blood. Evidence of bleeding (melena, ecchymosis, bleeding gums, nosebleeds, bleeding at IV sites) should be reported. Assess level of consciousness: Bleeding is a major complication of anticoagulant therapy. Cerebral bleeding, if it occurs, usually results in a gradual change in level of consciousness. Therefore, assessment of level of consciousness is indicated for all persons on anticoagulants. When a person is discharged on anticoagulant therapy, it is important that family members know to report any confusion or disorientation. Avoid rigorous mouth care: With anticoagulant therapy, minor traumas may cause bleeding. Aggressive mouth care should be avoided to prevent bleeding. Soft-bristle toothbrushes or swabs should be used for mouth care.

The nurse is caring for a client with a history of heparin use for a DVT, and a current pulmonary embolism. The nurse notes the following new order on the chart: "heparin, 80 units/kg IV bolus now, then continuous infusion of 18 units/kg/hr". The nurse knows to check which of the following lab values prior to initiating the first dose? Select all that apply. a. Hematocrit b. Platelet count c. APTT d. Hemoglobin e. Base excess

The answers are: A, B, C, and D. Platelet Count: The nurse must get a baseline platelet count on this client. Heparin use places a client at risk for a condition called 'Heparin Induced Thrombocytopenia (HIT). This is an adverse drug reaction in which the baseline platelet count rapidly drops, causing thrombosis. Additionally, if the client's platelet count is initially 100,000/mm or lower, heparin is contraindicated. Hematocrit: A baseline H&H (hemoglobin and hematocrit) is important for the nurse to note. Any drop in the baseline H&H would lead the nurse to suspect hemorrhage, which is a risk with anticoagulation. APTT:Activated partial thromboplastin time (aPTT) measures clotting time. A baseline must be obtained and compared with subsequent values to determine heparin titration. Hemoglobin: A baseline H&H (hemoglobin and hematocrit) must be assessed prior to heparin administration. Since heparin is an anticoagulant, it thins the blood, leading to an increased risk for bleeding. If future H&H values indicate a drop, the nurse would suspect bleeding.

Which of the following hemodynamic parameters should be followed? a. tidal volume b. right atrial pressure c. cardiac output d. pulmonary artery occlusion pressure e. pulmonary artery pressure

The answers are: B, C, D, and E. Right atrial pressure: Right ventricular dysfunction is a complication of pulmonary embolus (PE). Right ventricular failure can develop as a result of increased pulmonary vascular resistance. Right atrial pressure (RAP) should be closely monitored. RAP, which measures pressure in the right side of the heart (right atrium), will increase if the right side of the heart (ventricle and atrium) fails as a pump. Cardiac output: Cardiac output (CO) from the right side of the heart, and subsequently the left side of the heart, will decrease if the right side of the heart fails as a pump. CO should be closely monitored. Pulmonary artery occlusion pressure: With decreased output from the right side of the heart due to right-sided heart failure, pulmonary artery occlusion pressure (PAOP, PCWP) will decrease because of decreased preload for the left atrium. PAOP/PCWP should be closely monitored. Pulmonary artery pressure: Pulmonary artery pressure (PAP) should be closely monitored. PAP may be very high if the catheter is near the embolus and an area of pulmonary hypertension. PAP will be low with right ventricular failure.

Even though Mrs. Marotta does not exhibit signs of deep vein thrombosis (DVT), she has risk factors that predispose her to DVT. These include: a. gallbladder disease b. recent surgery c. obesity d. refusal to ambulate e. refusal to use incentive spirometer f. use of oral contraceptives

The answers are: B, C, D, and F. Recent surgery: Any surgery that requires administration of anesthesia and immobilization for more than 45 minutes increases risk for deep vein thrombosis (DVT). With surgery, imposed immobility and the depressive effects of anesthetics on circulation increase risk for DVT. Risk for DVT is especially increased with orthopedic, abdominal, thoracic, and genitourinary procedures. Obesity: Obesity increases risk for deep vein thrombosis (DVT), because it increases venous stasis. Any factor that alters blood flow and results in venous stasis contributes to thrombosis. Refusal to ambulate: Refusal to ambulate after surgery increases risk for deep vein thrombosis (DVT). Any factor that alters blood flow and results in venous stasis may contribute to thrombosis. Bed rest and immobility are associated with venous stasis. Venous return to the heart is slowed when activity level is decreased. Regardless of the reason for bed rest or immobility, these always increase risk of thrombosis. Adequate pain control is important after surgery. If incisional pain results in decreased mobility, it may contribute to risk for DVT. Use of oral contraceptives: Use of oral contraceptives increases risk for deep vein thrombosis (DVT). Estrogen replacement therapy and pregnancy also increase risk for DVT.

Signs and symptoms of pulmonary emboli?

anxiety; dyspnea/tachycardia (shallow, fast breathing); chest pain; hypoxemia (O2 stat decreased); rales or large sounding crackles; fever; diaphoresis; hemoptysis

What does a pulmonary emboli cause?

decreased perfusion; hypoxemia; and if large enough right sided heart failure

Side effects of enoxaparin

immune-mediated thrombocytopenia and bleeding episodes

Pulmonary Embolism

life-threatening blood clot in the lungs caused by an embolus from a vein in the lower extremity or from clots that form from a major surgery

Enoxaparin (Lovenox) MOA

low-molecular-weight heparin with a great affinity for factor Xa in providing anticoagulation action; provides a predictable anticoagulant response