Care for pt with PE

I don't think chest PT would be wise.

We usually just keep the breathing stable, treat for pain and cough and anti-coagulate.

I've had pt's go down to get cauterization but basically as a nurse, you are just supporting the pt.

strugglingnurse,

Having suffered PEs myself on two different occassions (first bilateral, second unilateral), I have to say that effective pain management helped my breathing more than anything. Those puppies REALLY hurt. As you well know, if it hurts to breathe, the patient is not going to do it all that well. Position of comfort is also important.

On the pain management front, I was surprised that opioids (morhpine and dilaudid) didn't relieve my pain at all. Toradol became my best friend for the limited amount of time I was able to take it. I would have screamed had I been able to breathe when my nurse told me that she did not know what to do since it was not time for my next dose of Toradol after she finally realized that the morphine had not worked!!! I mean, really!

It sounds like you handled your patient just fine. From a recent patient and soon-to-be RN, I would also like to thank you for really caring. Your patients will appreciate that as well. Good luck.

notadoc

PE? Pulmonary Emboli or Pulmonary Edema?

Thanks for your replies. The pt was on PCA morphine, (fresh postop) but hardly used it. He denied any pain.

Just wondering- has anyone seen TPA used for PE? If so, how soon after the diagnosis was it used, did they also start on anticoags?

Thanks.

PE? Pulmonary Emboli or Pulmonary Edema?

PULMONARY EMBOLI. sorry

Never do chest PT on a patient with Pulmoary Emboli. You don't want the clot dislodging and going to the brain or somewhere else. With Pulmonary Edema you could give Chest PT.

"Just don't forget the phenergan with the morphine", im confused bout this statement. Im new nurse so forgive me if im wrong. can't phenegran act as a sedative and if combined with morphine potentially supress the OP pt respiratory status?

Im just trying to understand and like i stated above i apologize if im confused =\.

pe x2 i think that you did pretty good, give comfort and let anti-coag do their job

don't understand how thrombi can navigate to brain with mantipulation

pe x2 i think that you did pretty good, give comfort and let anti-coag do their job

don't understand how thrombi can navigate to brain with mantipulation

If someone does chest PT on a patient with Pulm Emboli it can dislodge the clot and the clot will travel through the blood stream and can end up anywhere, including the brain

If someone does chest PT on a patient with Pulm Emboli it can dislodge the clot and the clot will travel through the blood stream and can end up anywhere, including the brain

Well, that was my thought initially, but then I started thinking about how tiny the capillaries surrounding the alveoli are. Whereever the clot is in the pulmonary vasculature, it seems like it would be unable to move past those tiny capillaries. But then again, there is also the microemboli phenomenon (clot fragments) too I guess - and that can't be good.

not knowing where the pe's are in the vasculature, the thought of chest pt may loosen some of the immobilized congestion, creating a backpressure that inevitably dislodges the clot.

for this 'visual' i'm having, i wouldn't do the chest pt.

control the pain so pt can breathe better.

leslie