1-36
1-36. EMBOLISM
An embolus is a blood clot or other foreign particle (fat globule or air bubble) floating in the bloodstream. The embolus is usually undetectable until it suddenly lodges in an arterial blood vessel. This may occur when the patient is apparently convalescing and progressing normally. If the embolus is sufficiently large and the arterial vessel which it obstructs supplies a vital area in the lungs, heart, or brain, the patient may die before any symptoms of embolism are detectable. A special type of embolism, pulmonary embolism, is caused by the obstruction of a pulmonary artery by an embolus. The most frequent cause of a postoperative pulmonary embolism is a thrombosed vein in the pelvis or lower extremities. Therefore, measures to prevent development of thrombophlebitis are the most important ones to take to prevent the possibly fatal complication of pulmonary embolism.
a. Signs and Symptoms.
NOTE: May or may not be observable.
(1) Sudden signs of shock and collapse.
(2) Sudden, sharp, stabbing chest pain.
(3) Sudden violent coughing and hemoptysis (spitting of blood).
(4) Pain, blanching, numbness, or coldness in an extremity.
b. Nursing Implications.
(1) Notify the registered nurse (RN) immediately.
(2) Ensure absolute bed rest. Elevate head of bed to relieve respiratory distress.
(3) Prepare to start oxygen by mask at 6 to 8 liters per minute.
(4) Take and record blood pressure, pulse, and respiration.
(5) Prepare to give medication by injection to relieve pain and acute apprehension. A narcotic drug such as morphine sulfate or meperidine hydrochloride is often ordered.
(6) Prepare to continue intensive nursing care and constant observation. (The total care of the patient who survives a pulmonary embolism is similar to that of a patient who has had a myocardial infarction.)
