I had a pt yesterday with bilateral PE's. This was my first PE pt so I was just wondering how to best care for this pt.
He was on facemask, fio2 50%. spo2 95%. All other Vitals stable, SOB with exertion, heparin drip...
Is it ok to do chest PT on a pt with PE? Pt seemed slightly wheezing with some scattered rhonchi towards end of my shift. I was scared to do the usual chest PT bc of dislodging PEs? Is this a valid concern???
What else could I have done to help with breathing? (I had HOB 45degree, gave some nebs, incentive spirometer)
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.
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.
Embolic strokes usually occur when clot dislodges from the arterial system (eg - aortic thrombus in pt with afib) and passes directly to the cerebral vasculature. Alternatively, a DVT can produce an embolic CVA if the patient has an abnormal connection between the arterial and venous systems (ie - patent foramen ovale), because these connections allow the clot to bypass the pulmonary vasculature entirely.
Clots do not pass through capillaries, which is why they lodge in the first place.
"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? QUOTE]
Yes, in large doses. But I couldn't sleep or get comfortable between the pain, and nausea. It knocked me flat enough I could hardly get my head off the pillow for a little while. But, I was on a sats monitor, and finally out of pain, and got some rest. I needed much less morphine (or less often) once the side effects were controlled. You don't want your PE patients moving around much anyway. The OP wanted to know what else she could have done for him, and the answer is, not much: pain control, keep a close eye on, and time.
leslie :-D
11,191 Posts
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