2305IntroductionThe primary organ of the vulnerable respiratory system is the lungs The

2305IntroductionThe primary organ of the vulnerable respiratory system is the lungs. The essential function of the lungs is to gets oxygen and exchange of the carbon dioxide. Pulmonary embolism is an acute thrombolytic disorder are affecting in the respiratory system. According to Ouellette (2019), when a thrombus that forms in the deep vein and travel in to the right side of the heart and lodges in the branch of the pulmonary artery known as pulmonary embolism. The pulmonary artery is carrying deoxygenated blood from the left ventricle to the lungs. The clot reduced the blood flow to the lung, and it causes debilitating symptoms including shortness of breath and it is a critical situation. The aim of this study to review the literature source to know more about,• Pulmonary embolism, epidemiology, risk factors, causes, and symptoms• Pathophysiology• Nursing management and education• Evaluation of the management• Knowledge gained and advancing role.Epidemiology, risk factors, causes, and symptomsAs per Konstantindes et al. (2014), pulmonary embolism is the third most medical emergency and average incidence per year 100-200 per 100,000 inhabitants. The pulmonary embolism is difficult to determine, sometimes it will not show any symptoms and sudden death may can occur. An estimated data regarding the pulmonary embolism is 317,000 deaths were related to VTE in the European union. Here,34% presented in the hospital as an emergency case and 59% died because of undiagnosed P.E. only 7% were diagnosed correctly before death. Population older than 40 years are more prone to get pulmonary embolism than younger people. According to Corrigan (2016), risk factors of the pulmonary embolism are age, venous in sufficiency, obesity, smoking, rheumatoid conditions, cardiovascular issues, history of venous thrombotic embolism, etc. Cause of pulmonary embolism by Murrel (2017), is an injury of the blood vessels caused by fracture or muscle tear. It may cause the formation of the blood clot in the vessels. Long term bed rest may cause pooling of blood in the lower extremities because of the gravity. Some medical conditions like cancer, bleeding disorders, after major surgeries, and chemo treatment is another causes for P.E. symptoms of pulmonary embolism are chest pain radiating to arm, jaw, neck, and the shoulder, shortness of breathing, tachycardia, tachypnea, cold and clammy skin, feeble and irregular pulse, and restlessness. Diagnostic methods are chest X-ray MRI, CT scan, angiography, and D-dimer test.PathophysiologyAccording to Fogoros (2019), an estimated about 50% of people with DVT may cause pulmonary embolism if it not treated. DVT mainly forms in the lower extremities, and it moves with blood to the right side of the heart through a large vein, inferior vena cava. The clots block the pulmonary artery. The pulmonary artery is pumping deoxygenated blood in to the lung for oxygenation. The clots block the pulmonary artery, small and large vessels of lungs. It will interfere the function of the lungs and may cause accumulation of carbon dioxide in the body. This may lead to catastrophic consequences.Nursing management and educationAn important role of the nurse is to identify high -risk patient to get the pulmonary embolism and reduce the incidence of the pulmonary embolism.All patients during the admission should test the risk factors for the thrombus formation and pulmonary embolism. According to Fawcelt and Rhynas(2012), history taking is a significant part of patient assessment. It will help to deliver an excellent quality of care to the patient. And to know about patient history of medical and surgical issues. As per Belleza (2017), family history of any cardiovascular disease will act as a predisposing factor of the pulmonary embolism. Therefore, history taking will help the nurses to identify the risk for the pulmonary embolism. Belleza (2012), said reviewing of patient medication also help the nurses to identify the risk for the P.E. As per Dr.Ticky and Dr.Cox (2014), said physical examination helps to find the initial signs of pulmonary embolism. Nurse should manage impaired gas exchange related to decreased pulmonary perfusion. According to Honorato and Cruz (2019), impaired gas exchange remains severe problem in the pulmonary embolism, it may cause sudden death if it is not treated properly. As per Martin (2018), the desired outcome is to maintain adequate gas exchange, as evidence by normal ABG value and oxygen saturation greater than 90%. Simultaneously, the patient to maintain normal heart rate, respiratory rate, and no alteration in the conscious level. Nursing intervention by Martin (2018), check the nail bed, skin, and mucous membrane to monitor the cyanotic episode. If the perfusion is impaired, peripheral skin become pale and cool. Monitor vital signs frequently, initial signs and symptoms of hypoxia and hypercapnia is the rapid respiratory rate, tachycardia and hypertension. As it gets worse patient’s blood pressure drops, heart rate become quick, and respiratory failure may occur. Monitor the patient for the signs and symptoms of hypoxia, like confusion, head ache, diaphoresis, restlessness, tachycardia, and pale skin. Because hypoxia may cause more dead space in the lungs, it will cause impaired gas exchange, auscultate the breath sounds, to access the equal air entry and crackles. Assess the patient for signs and symptoms of pulmonary infractions like fever, cough, breathing difficulty, blood in the sputum, the sudden sharp burning pain on the chest, pleural friction. Etc. A large blockage of the pulmonary artery will cause ischemic necrosis and infraction on the lung area. Watching over these symptoms helps for rapid detection and treatment of the pulmonary infraction. Pulmonary embolism often caused by deep vein thrombosis, so nurse should observe the signs and symptoms of DVT are calf tenderness, redness, edema, and hardness over the area. Prompt diagnosis of the DVT helps to prevent the PE to the patient. Monitor ABG as per doctor’s order. The increased respiratory rate may cause accumulation of carbon dioxide and decreased oxygen in the blood will cause respiratory acidosis. According to the ABG result, metabolic acidosis can be treated by physician. Monitor oxygen saturation is important, and it is the better method to know the level of oxygen in the blood. Bed rest is very important to the patient to reduce the oxygen demands. Vigorous activity may cause increase oxygen demand results respiratory failure. Position the patient in up right or semi fowlers position for the adequate lung expansion. It helps to increase the lung perfusion. Administer oxygen, it will help to maintain adequate oxygen level and decrease the effort of breathing, reduce dyspnea and promote comfort.Anticoagulation therapy is another choice of treatment for the pulmonary embolism. Nurses should observe the patient during the medication therapy. According to Martin (2018), administer medication as per doctor’s order. It helps to dissolve the clot exist in the body. Heparin or enoxaparin is used to treat and prevent the clot formation in the body. The patient who is taking anticoagulant therapy, the nurse should be aware of the risk for bleeding and abnormal blood profile. According to Gee (2018), anticoagulant is the first choice of treatment in the pulmonary embolism. Gulanick and Hyers (2014), says before starting the medication administration nurse should take the blood for the bleeding profile and history of bleeding episodes. It will help to know about the patient risk for bleeding and early detection of this will helps to reduce the risk. The medical condition contraindicated for the coagulation therapy is liver disease, ulcer disease, HIPA, and inflammatory bowel disease. As per Martin (2018), close monitoring of the vital signs is important. The signs of bleeding are tachycardia and hypotension. Orthostatic hypotension is showing reduced fluid circulation. The patient with orthostatic hypotension experienced dizziness while changing position. Martin (2018), said nurses should check the signs of bleeding, including changes in the color of the mucous membrane, alteration in the blood works, example low hemoglobin and hematocrit showing sign of bleeding. Other symptoms are melena, hematuria, petechia, purpura, etc. early detection of the bleeding helps the healthcare to start the treatment appropriately. As per him, laboratory works helps to find out the alteration in the coagulation profile. Platelet screening is important to identify the condition heparin – induced thrombocytopenia. If the patient is on iv heparin therapy, the nurse should check the intravenous site for the infiltration. If any bleeding occurs, immediately stop the infusion therapy and inform the doctor for the further order for the treatment. Repeat the blood works especially aPTT as per the doctor’s order. Notify the blood bank for the availability of the blood and blood products if needed. The nurse should take precautionary measures to prevent and reduce the risk for bleeding by using compressible vessels for IV site. Compressing venous site for 10 minutes and arterial site is 30 minutes. Instruct the patient to limit the activities during the anticoagulant therapy. Provide gentle oral care with soft brush to avoid bleeding from the gum. Avoid intra muscular injection to avoid soft tissue trauma. As per Gulanick and Hyer (2014), provide stool softer to avoid constipation during coagulation therapy. Advise the patient to avoid forceful coughing and sneezing, it may cause upper airway trauma and bleeding. As per Vinson et al. (2015), says the patient who discharged after P.E and its treatment, needed well developed education regarding the follow-up and lifestyle modification. Immediately after the discharge, follow-up

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