About

➀ Read and Learn

The following course content

Introduction

What’s lurking behind those deep veins? Does knowing a patient’s risk for getting a pulmonary embolism (PE) after surgery save lives? Absolutely it does. But it is better than that. Risk stratification equips healthcare providers with the precise tools to target the kind of care a patient needs to reach a positive outcome.  Now, while it is true that healthcare providers are the ones who utilize the classification of risk for a PE among their patients most of the time, being aware of the patient’s comorbidities is the nurse’s job as well. One of the first things you do when receiving your patient assignment is to review the patient’s past medical history. This course will explain how important it is to gather as much information as possible, especially for the operative patient’s health and well-being.  

While having the right tools to provide optimal care is at the top of the list in healthcare, utilizing the right resources is equally important to global health management. According to the Centers for Disease Control and Prevention (CDC), approximately 900,000 Americans are affected by deep vein thrombosis or pulmonary embolisms. Furthermore, it’s estimated that between 60,000 to 100,000 people in the United States die each year from either Deep Vein Thrombosis (DVTs) or pulmonary embolisms (3). Just think about the burden that places on healthcare. If we, as nurses, will make even the smallest of impacts on our patient’s safety and well-being, then we must equip ourselves with knowledge; the kind of knowledge that contributes to positive patient outcomes. 

You may be asking yourself, “How does all this information affect me, the nurse?” Nurses are the educators. Therefore, this course is designed to highlight necessary skills to re-educate and/or refresh those skills that help identify PEs after surgery. Most importantly, however, is educating our patients to manage their own health effectively.  

Current Practice 

The risk of having pulmonary embolism is highest during the first 5 weeks after surgery (2). However, there are several other factors that contribute to the risk stratification of a PE after surgery, which include advanced age, advanced cancers, and malignant tumors (6). 

Some of the additional undercurrents of getting a PE after surgery prolonged operating times, sitting for long periods of time or bedrest, being overweight or obese and taking birth control (2, 6). With those kinds of patient-associated risks, who isn’t at risk for getting a PE? We will discuss this idea more in-depth below. 

Global Implications

The study of the origins of a PE date back to the 19th century. Since then, scientists have been making correlations between trauma within the body, the body’s fragile vasculature, and the obstacles within the vessels that carry blood (4). Additionally, with the rise of the COVID-19 pandemic, many people develop abnormal blood clots after having a COVID infection. Researchers believe this may be due to the high levels of inflammation in the body (7). 

There are dozens of worldwide cardiological and medical organizations that categorize risk for a PE. And they all use different methods, systems, and techniques to categorize the risks for developing a blood clot-related disease. Patients may present with a DVT or PE. However, the CDC estimates that about 25% of people who have a pulmonary embolism, the first symptom is sudden death (3).  

Risk Factors for Pulmonary Embolism

There are many variables for a patient developing a PE, including modifiable and non-modifiable risk factors.   

(2, 6, 7, 9)

Signs and Symptoms of Deep Vein Thrombosis

If you have ever cared for a post-operative patient, you know that most DVTs are found in the lower extremities. However, upper extremity DVTs also exist and hold the potential to be more fatal, especially if they are in or near major veins. Patients may also have complaints of minimal soreness or pain in their lower extremities, with or without redness (9).  

Other signs and symptoms of a DVT include increased swelling in one or more of the limbs, and sometimes any unusual numbness or tingling in any one of the patient’s extremities. Symptoms of a pulmonary embolism include dyspnea, anxiety, pleuritic chest pain, palpitations, wheezing, and even coughing up blood (9).  

Diagnostic Tests

A blood clot may be diagnosed through the following tests:  

• D-dimer: May be used to determine the presence of a blood clot. * This test is mostly used to rule out the presence of a blood clot and not to definitively diagnose. 

• Ultrasound, Computerized Tomographic Pulmonary Angiography (CTPA), and/or a ventilation/perfusion scan (V/Q) are preferred and most accurate methods to determine the presence of a VTE/PE.  

*Typically, when the Ultrasound or CT is positive for PE, healthcare providers would begin patients on anticoagulation therapy if it not contraindicated (1, 5, 9).  

Pulmonary Embolism Management & Treatment  

Management of the patient with a DVT or PE will depend on where the blood clot is and its size. It is typically assumed that the larger the clot, the more dangerous. Without getting too technical, different screening tools are utilized, and what is great about them is that they are effective in streamlining therapy (8, 9).  Currently, the best practices for a PE/VTE are based on what phase of treatment is needed. 

Newly diagnosed patients are started on an anticoagulant medication, which is based on their risk stratification. Some classes of anticoagulant medications for treating pulmonary embolisms are vitamin K antagonists (e.g. warfarin), unfractionated heparin, low molecular weight heparin, and new oral anticoagulants (e.g. rivaroxaban and apixaban). Anticoagulant medication selection is based on the patient’s hemodynamic stability, medical history, compliance, and current medications (9). 

Patient Education 

What can we teach our patients about managing a DVT or PE? One of the most important, underestimated feats we can teach them is to stay hydrated. Nurses should also encourage early ambulation post-operatively. 

Next is the importance of medication compliance. Being consistent with medication intake is so important across all aspects of healthcare management. 

Additionally, we need to teach the importance of staying active and monitoring for potential side effects of anticoagulant, which can include prolonged bleeding, being short of breath, feeling dizzy, and any unusual bruising. Patients should be instructed to report any of these symptoms to their healthcare provider immediately (9).   

➁ Complete Survey

Give us your thoughts and feedback

➂ Click Complete

To receive your certificate