Nursing assessment for pt with possible Pulmonary Embolism

[ghurricane]

For my ER rotation I had a pt present with s/sx of a PE, dyspnea, SOB, pale, sweaty, pain 7/10, and decreased LOC.

upon assessment I obtained new vitals and pulse ox, full pain assessment, lung and heart sounds, ECG, chest x-ray, ABG's, UA and sputum sample to rule out possible infection. However I felt like I totally missed something.

Also, when it comes to getting a proper medical history, I obtained allergies, contraception, smoking hx, and recent trauma. Is there anything else that would be beneficial to know other then this regarding pt hx?

Thanks:nurse:

[sunnycalifRN]

any hx of A-fib , DVT's, coagulopathy?

[tablefor9, RN]

Family hx, recent travel, pregnancy hx

[ghurricane]

no pt hx of afib, dvt or coagulopathy.

only allergy is Sulfa meds, and currently on the pill. 1 ppd smoking for 8 years, and a recent trip from Asia. I suppose the long flight might have been a precipitating factor.

[ghurricane]

I didn't even think about pregnancy. Thank you. Although she only had 2 children age 3 and 6.

[highlandlass1592, BSN, RN]

The long trip and birth control pills (as well as smoking history) put her at higher risk for PE's. I would also have wanted a CBC and a basic panel (which would have included creatinine, you're probably going to do a stat PE protocol CT, which some places call a spiral CT). Also may want to do a work up for tPA, if the PE is severe enough I've had to administer tPA to break it up.

[Do-over, ASN, RN]

D-dimer?

[NurseAdida]

CT of the chest r/o PE

LE doppler US r/o DVT

[tablefor9, RN]

Pill+Smoker+flight=clot

ding-ding-ding, I think you have a winner!

[nurse2033, MSN, RN]

I would want to know the results of your first tests. Was SaO2 low? What was the location, nature, and duration of her pain? You say first that the patient had s/s of PE, however, the symptoms you list wouldn't put PE first on my list. The age of the patient is always pertinent. Without knowing the history of event, test results or vitals, this could be a pneumo, hyperventilation, costochondritis, bronchitis, pneumonia, pleuresy, pleural effusion, trauma, MI, or pericarditis. PEs often have no pain. Bad PEs lead to hypoxia, hypotension, AMS and death. Your initial findings will lead you to further assessments. Without knowing all the details it is impossible to know what else should have been done.

[Belle Epoque]

Ditto. Thought MI over PE.

How did pt respond to 02 therapy and what did the labs show?

[KyPinkRN]

no pt hx of afib, dvt or coagulopathy.

only allergy is Sulfa meds, and currently on the pill. 1 ppd smoking for 8 years, and a recent trip from Asia. I suppose the long flight might have been a precipitating factor.

On the pill and smoking raises significant risk for blood clots.