2 PE questions

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I had a patient last week who was positive for a PE, Arixta 7.5mg and 5 mg of Coumadin was started. The patient was anxious and kept getting up and walking to the nurses station or walking around her room, I asked the doctor if this was o.k. and he said yes. The next day, as I am coming on shift, (can you guess what happens) the night nurse tells me that the patient is short of breath, a code 999 is called, patient tubed and sent to ICU.

Questions one: I thought all PE patient are on total bedrest, is this no longer true?

Question two: While assessing the patient I noticed that the palms of her hands are red and radial pulses are weak, why were her palms red?

Rachel RN (after 6 months I am still learning and asking more questions than ever)

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Specializes in cardiac/critical care/ informatics.

Once anticoags are started most patients are allowed to be up, I am not sure why her palms were red I am trying to think about that... something to do with circulation and the weak pulse due to the stress of her PE that apparently moved. It probably would have happened anyway... anytime a PE patient is anxious I really watch them that is one of the signs when they throw the PE.

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Specializes in Utilization Management.
I had a patient last week who was positive for a PE, Arixta 7.5mg and 5 mg of Coumadin was started. The patient was anxious and kept getting up and walking to the nurses station or walking around her room, I asked the doctor if this was o.k. and he said yes. The next day, as I am coming on shift, (can you guess what happens) the night nurse tells me that the patient is short of breath, a code 999 is called, patient tubed and sent to ICU.

Questions one: I thought all PE patient are on total bedrest, is this no longer true?

Question two: While assessing the patient I noticed that the palms of her hands are red and radial pulses are weak, why were her palms red?

Rachel RN (after 6 months I am still learning and asking more questions than ever)

Actually, I was wondering what type of anticoag she was on before the Coumadin kicked in? Heparin or Lovenox?

ETA: Just read up on Arixtra, so scratch that last question. I've never had a patient on it before. Must be pretty new, eh?

Not all PE patients are on total bedrest, but we usually ask them to call for an OOB assist and the extent of their OOB activities for the first day or two is to the BR and back. I've heard of patients with PE's on heparin who insist on going downstairs to smoke, :trout: but it's extremely rare for obvious reasons.

Her palms being red? Not a clue, but if it's clinically significant for PE patients, I'd be happy to be learn something new.

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Actually, I was wondering what type of anticoag she was on before the Coumadin kicked in? Heparin or Lovenox?

Not all PE patients are on total bedrest, but we usually ask them to call for an OOB assist and the extent of their OOB activities for the first day or two is to the BR and back. I've heard of patients with PE's on heparin who insist on going downstairs to smoke, :trout: but it's extremely rare for obvious reasons.

Her palms being red? Not a clue, but if it's clinically significant for PE patients, I'd be happy to be learn something new.

Before Coumadin she was getting Arixtra, it is similar to Lovenox.

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Specializes in Utilization Management.
Before Coumadin she was getting Arixtra, it is similar to Lovenox.

My bad, I edited. My first thought was to question how well her initial anticoag was working.

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I looked up pulmonary embolism + red palms and came up with secondary polycythemia which can occur in COPD pt and cases of extreme hypertension. I think the fact that her O2 SAT was in the low 80% and her blood pressure was 217/101 qualifies her.

Thanks for the help.

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Specializes in ER/ MEDICAL ICU / CCU/OB-GYN /CORRECTION.

What an interesting presentation.

I agree with the above but would consider some other pathologies.

Red palms are due to expansion of small blood vessels (capillaries) vaosdialtion.

Trousseau syndrome or MTP is characterized by the development of recurrent superficial thrombophlebitis due to an underlying malignacy

presenting with a spont PE 50 % -- it is assoc with a coagpathology

Since it sounds like she had a pulmonary shower thrombi may occur in the arterial system or the venous system of the extremities ?

Lesions consisting of tender erythematous cords or nodules typically appear in the subcutaneous fat over the trunk or extremities including palms

I do NOT understand why her MD allowed her to walk and did not give her a mild sedative ???

I did read that early ambulation is not significantly significant in death rates with Dx pulmonary embolisms but to keep in bed for inital work up is the correct work up according to all articles I have read.

Did they do a VQ scan CT ultrasound ? or a total work up for PE ?

Marc

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Rachel RN (after 6 months I am still learning and asking more questions than ever)
I would not feel bad about that. That is how you learn. Sorry I do not have the answer to your other questions.
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