1. NURSING CARE OF THE CLIENT:
RESPIRATORY SYSTEM

2. Nursing Dx: Respiratory
Dysfunction
 Ineffective Airway  Activity Intolerance
Clearance  Anxiety
 Impaired Gas
Exchange  Altered Nutrition:
Less than body
 Ineffective Breathing
Pattern requirement
 Impaired Verbal  Risk for Infection
Communication

5. Respiratory System
 Its primary function is
delivery of oxygen to
the lungs and
removal of carbon
dioxide from the
lungs.

6. Respiration
 Process of gas exchange
 Supply cells with oxygen for carrying on
metabolism
 Remove carbon dioxide produced as a waste
by-product.
 Two types of respiration: external and internal.

8. Respiratory Assessment
Health History
(allergies, occupation, lifestyle, health habits)
Inspection
(client's color, level of consciousness, emotional state)
(Rate, depth, quality, rhythm, effort relating to respiration)
Palpation and Percussion
Auscultation
(Listening for Normal and Adventitious Breath Sounds)

9. Assessment Review
Vital Signs
 Respiratory rate & heart rate WNL
 Oxygen saturation of 95% or higher

10. Assessment Review
Physical Assessment
 Speak a sentence of 12 words without
stopping for breath
 Walk and talk without stopping for breath
 No cyanosis, pallor, or jaundice
 Oral mucus membrane & nail beds pink with
rapid capillary refill

11. Assessment Review
 Fingertips and nails normal shape, no clubbing
 Anterior & posterior diameter of chest 2/3
smaller than lateral diameter
 Space between each rib larger than breath of
patient’s finger
 Breathes in through nose & out through mouth
& nose

12. Assessment Review
 Breathing quiet
 Air movement heard in all lobes of both lungs
 Sputum production minimal, clear or white
 Muscle development even with no muscle loss
on arms & legs
 Weight proportionate to height; not
underweight

13. Assessment Review
Psychological Assessment
 Oriented, not confused
 Energy level good, can engage in desired
work, recreational & personal activities

14. Assessment Review
Laboratory Assessment
 RBC
 Hemoglobin
 Hematocrit
 WBC
WNL for age & gender

15. Assessment: Inadequate
Oxygenation
 Resp rapid & shallow
 Respirations noisy
 Cannot speak >4 or 5 words without pausing
for breath
 Change in cognition, acute confusion
 Decreased oxygen saturation by pulse ox

16. Assessment: Inadequate
Oxygenation
 Skin cyanosis or pallor (lighter-skinned pts)
 Cyanosis or pallor of lips or oral mucus
membranes (pts of any skin color)
 Tachycardia
 Appears to strain to catch breath
 Fatigue

17. Physical Assessment:
Inadequate O2
 Take vital signs
 Auscultate all lung fields
 Monitor O2 sat
 Check recent Hgb, Hct, ABGs
 Assess cognition
 Assess use of accessory muscles

18. Physical Assessment:
Inadequate O2
 Assess presence of thick or excessive
secretions
 Assess ability to cough and clear airway

19. Intervention: Inadequate
Oxygenation
 Apply O2 & assess response
 Elevate HOB 30 degrees
 Suction if needed
 Notify MD
 Priortize & pace activities to prevent fatique

22. Assessing Lung Sounds

23. Adventitious Breath Sounds
 Fine crackles (dry, high-pitched popping…COPD,
CHF, pneumonia)
 Coarse crackles (moist, low-pitched
gurgling…pneumonia, edema, bronchitis)
 Sonorous wheezes (low-pitched snoring…asthma,
bronchitis, tumor)

24. Adventitious Breath Sounds
 Sibilant wheezes (high-pitched, musical …
asthma, bronchitis, emphysema, tumor)
 Pleural friction rub (creaking, grating… pleurisy,
tuberculosis, abscess, pneumonia)
 Stridor (crowing…croup, foreign body
obstruction, large airway tumor)

25. Diagnosing Respiratory
Disorders
Laboratory Tests Radiologic Studies
 Hemoglobin  Chest X-ray
 Ventilation-perfusion
 Arterial blood gases
scan
 Pulmonary Function
 CAT scan
Tests
 Pulmonary
 Sputum Analysis
angiography

26. Respiratory Disorders
Other diagnostic tests
 Pulse oximetry
 Bronchoscopy
 Thoracentesis
 MRI

27. Assessment: Upper Airway
Problems
 Voice changes
nasal quality if above palate
“breathy” or “whispery” if larynx or trachea
 Snoring
 Mouth breathing

28. Assessment: Upper Airway
Problems
 Change in cognition or LOC or acute
confusion
 Decreased O2 sat
 Skin cyanosis or pallor
 Cyanosis or pallor of lips or oral mucus
membranes
 Tachycardia & dysrhythmia

29. Physical Assessment: Upper Airway
Problems
 Take vital signs
 Monitor O2 sat
 Assess for presence of thick or excessive
secretions
 Assess ability to cough and clear airway
 Assess nasal drainage & sputum for color &
blood

30. Physical Assessment: Upper Airway
Problems
 Check WBC & ABG levels
 Assess cognition
 Assess hydration status

31. Intervention: Upper Airway
Problems
 Suction
 Apply o2 & assess response
 Keep HOB elevated 30 degrees
 Notify MD
 Ensure venous access

32. Obstructive Sleep Apnea
 Intermittent absence of airflow through mouth
& nose during sleep
 Occlusion of the oropharyngeal airway
 Obstruction causes O2 sat, pO2, and pH to
rise & pCO2 to rise

33. Obstructive Sleep Apnea

35. Obstructive Sleep Apnea
 Loud storing during
sleep
 Excessive daytime
drowsiness
 Irritability
 Restless sleep

36. Obstructive Sleep Apnea
 Restore airflow  Weight reduction
 Prevent adverse  Alcohol abstinence
effects of disorder  Improve nasal
patency
 Avoid prone sleeping
position

37. Obstructive Sleep Apnea
 Treatment of
Choice:
Continous positive
airway pressure
(CPAP)

38. Obstructive Sleep Apnea
 Tonsillectomy  Adenoidectomy

39. Obstructive Sleep Apnea
 Uvuloplatopharyngopla
sty

40. Obstructive Sleep Apnea
 Disturbed Sleep Pattern
 Fatigue
 Ineffective Breathing Pattern
 Impaired Gas Exchange
 Risk for Injury
 Risk for Sexual Dysfunction

41. Tracheostomy
 Bypass upper airway
obstruction
1. esophagus
2. trachea
3. tracheostomy
tube

42. Tracheostomy
 Facilitate removal of
secretions

43. Tracheostomy
 Manage long-term
mechanical ventilation

44. Assessment: Infectious Resp
Problems
 Resp shallow & rapid
 Decreased O2 sat
 Skin cyanosis or pallor
 Cyanosis or pallor of lips & oral mucus
membranes
 Tachycardia
 Work hard to inhale & exhale
 Restless anxious or confused

45. Physical Assessment: Infections
 Vital signs
 Auscultate all lung fields
 Monitor O2 sat
 Assess cognition
 Assess sputum
 Assess ability to cough & clear airway

46. Lab Values: Infections
 Elevated WBC
 ABG:
pH lower than 7.35
HCO3 at or below 24 mmHg
PaCO2 at or below 45 mmHg
PaO2 below 90 mm Hg

47. Interventions: Infectious Resp
Problems
 Administer O2
 Upright position with arms resting on table or
armrests
 Chest physiotherapy/pulmonary hygiene
 Pace activities to prevent fatigue

48. Interventions: Infectious Resp
Problems
 Administer IV, oral, or inhaled drugs
 Respiratory therapy treatments
 Reassess resp status after resp therapy
 Ensure fluid intake 3 liters/day

49. Sinusitis

50. Sinusitis
 Pain & tenderness
 Headache, fever, mal
aise
 Nasal congestion
 Purulent nasal
discharge
 Bad breath

51. Sinusitis: Medication Therapy
 Antibiotics  Saline nose drops or
sprays
 Oral or topical
decongestants
 Systemic mucolytic
agents
 Antihistamines

52. Sinusitis: Interdisciplinary Care
 Drain obstructed
sinuses
 Control infection
 Relieve pain
 Prevent
complications

53. Sinusitis
 Endoscopic sinus surgery

54. Sinus Surgery: Caldwell Luc
procedure

55. Sinus Surgery: Antral irrigation

56. Sinusitis: Health Promotion
 Promote nasal drainage
 Encourage liberal fluid intake
 Judicious use of nasal decongestants
 Treat any obstructive process

57. Pneumonia
 Inflammation of lung parenchyma
 Infectious: Bacteria, viruses, fungal protozoa
 Noninfectious: aspiration of gastric contents,
inhalation of toxic or irritating gases
 Can be classified as community acquired,
nosocomial, or opportunistic

59. Pneumonia: Signs & Symptoms
Primary Atypical PNA Viral PNA
 Fever  Flu-like symptoms
 Headache  Headache
 Fever
 Myalgias
 Fatigue
 Arthralgias
 Malaise
 Dry, hacking, non
productive cough  Muscle aches

60. Pneumonia: Signs & Symptoms
Pneumocystis PNA  Dry, nonproductive
 Opportunistic cough
infection Respiratory distress
 Abrupt onset  Intercostal
 Fever retractions
 Tachypnea  Cyanosis
 SOB

61. Pneumonia
Interdisciplinary care Medications
 Prevention  Antibiotics
 Pneumococcal  Bronchodilators
vaccine  Agents to liquefy
 Influenza vaccine mucus

62. Pneumonia
Treatment Nursing Diagnosis
 Oxygen therapy  Ineffective airway
 Chest physiotherapy clearance
 Ineffective breathing
pattern
 Activity intolerance

63. Theresa
 A 20 year old college student
 Lives in a small dormitory with 30 other
students.
 Four weeks into the Spring semester, she was
diagnosed with bacterial pneumonia
 Admitted to the hospital

64. Teresa: High Priority Intervention
 Specimens for culture are taken prior to
beginning the antibiotic
 Administering prior to cultures may make it
impossible to determine the actual agent
causing the pneumonia.

65. Theresa: Bacterial Pneumonia
Sputume culture results
 most frequent strain of found in community-
acquired pneumonia
 Streptococcus pneumoniae

66. Teresa: Clinical Manifestations
 Fever Elderly
 Weakness
 stabbing or pleuritic  Fatigue
chest pain  lethargy
 Confusion
 tachypnea  poor appetite without
classic s & s

67. Treatment: Bacterial Pneumonia
 Started on Penicillin G
 Response between 1 & 2 days

68. Complications of Pneumonia
 Atelectasis Impaired gas
exchange
 Hypotension & shock
 Pleural effusion

69. Pneumonia: Impaired Gas
Exchange
 Results in hypoxia
 Earliest sign and symptom of which is a
change in the level of consciousness.

70. Interventions
 Oxygen by nasal cannula
 Plan for periods of rest during activities of daily
living.
 Monitor pulse oximetry readings every 4 hours.
 What oxygen delivery system would be most
effective for Theresa?

71. Nasal Cannula
 Low flow delivery device
 2 l/min = ~28%
 Higher flow rates (>5 l/min) dry nasal
membranes

72. Simple Face Mask
 Flow rates 6-12 l/min
 Delivers 35-50% O2
 Pt comfort issues (Maybe used for Mr.
Howe if SOB)

73. Non-Rebreathing Mask
 Delivers accurate, high concentrations of
oxygen
 Achieves 60-90% O2 delivery

74. Oxygen Conserving Cannula
 Built in oxygen reservoir
 30-50% O2 delivery
 Increased comfort

75. Nebulizers/Humidifiers
 02 is drying to mucous membranes
 Nebulizers
 Bubble-through humidifier
 >4 l/min
 Humidifiers
 Heated water

76. Tuberculosis
 Infection of the lung
tissue
 Mycobacterium
tuberculosis

77. Tuberculosis
Spread through droplet
nuclei:
 Coughing
 Sneezing
 Speaking
 Singing

79. Tuberculosis: Risk Factors
 Overcrowded, poor living  Close contact to
conditions infected person
 Poor nutritional status  Immune dysfunction;
 Previous infection HIV infection
 Inadequate treatment of
primary infection leads
 LTC facilities,
to multi-drug resistant Prisons
organisms  Elderly
 Substance abuse

80. Tuberculosis
Caseation necrosis
 Inhaled bacteria multiply
 Tubercle is formed
 Infected tissue dies
 Cheeselike center forms

82. Tuberculosis
If patient has adequate Inadequate immune
immune response: response
 Scar tissue develops
 TB can develop
around tubercle rapidly
 Walls off bacilli
 Infected, does not
develop TB

83. Reactivation TB
Suppressed immune system due to
 Age
 Disease
 Use of immunosuppressive drugs

84. Tuberculosis: Signs & Symptoms
 Fatigue  Dry cough
 Weight loss  Later productive,
 Anorexia purelent/blood
tingled
 pm fever
 Night sweats

85. Tuberculosis: Interdisciplinary
Care
 Early detection Tuberculin test
 Accurate diagnosis  Intradermal PPD
 Effective disease (Mantoux) test
treatment  Multiple-puncture
 Preventing spread to (tine) testing
others

86. TB: Goals of Medication
Treatment
 Make the disease noncommunicable to others
 Reduce symptoms of the disease
 Affect a cure in the shortest possible time

87. Tuberculosis: Nursing Diagnosis
 Deficient Knowledge
 Ineffective Therapeutic Regimem Management
 Risk for Infection

88. Mr. Howe
 c/o dyspnea  Dx: R/O TB
 progressive wt loss  What additional
for several months questions should you
 Productive cough ask about Mr.
Howe’s cough?
 Night sweats
“wringing wet”

89. Assessing Cough
 How it feels
 How bad it is
 What makes it better or worse
 When it started
 Amount, color, odor, and consistency of sputum

90. Mr. Howe
 Diagnostic test  Mantoux test
expected for patient  Sputum for acid-fast
bacillus
 Chest X-ray
 History and Physical
Examination

91. Mantoux Test
 Positive result only indicate exposure or has
received BCG immunization
 BCG immunization: Eastern Europe and
countries where TB is endemic
 Is not diagnostic for active TB

92. Mantoux Test
 Give upper 1/3 surface of the forearm
 Needle is inserted with bevel up
 0.1 ml of purified derivative (PPD) inserted
intradermally)
 Read 48-78 hrs
 Induration 1.5 mm or greater is + (HIV or
immunosuppressed pts 5 mm or greater +

93. Sputum Studies
 Sputum Samples  early morning
 Expectoration tracheal  15 ml required
suction
 Obtain prior to
 Bronchoscopy
antibiotics
 Used to
 Ask pt to rinse mouth
 identify infecting
before collecting
organisms
specimen
 Confirm presence of
malignant cells

94. Mr. Howe: Bronchoscopy
ordered
Preparation
 Informed consent
 NPO after midnight
 Explain procedure, obtain baseline vs & ABG
 Atropine may be ordered to dry secretions

95. Bronchoscopy

96. Mr. Howe: Post Bronchoscopy
Complications
 Aspiration
 Infection
 Pneumothorax

97. Mr. Howe: Post Bronchoscopy
Care
 NPO until gag reflex
 Monitor vital signs
 Assess for dyspnea, hemoptysis, & tachycardia
 Notify MD if fever, difficulty breathing
 Semi-Fowler’s position
 Give H2O as first fluid
 Inform pt of possible expectoration of blood
tingled mucus

98. Tuberculosis: Drug Therapy

99. Mr. Howe’s Medication Regime
 Chemotherapy are Rifampicin
all Hepatotoxic
 n/v
Ethambutol  Thrombocytopenia
 optic neuritis  turns all bodily
 skin rash secretions a red-
orange color
(tears, sweat, etc)

100. Mr. Howe’s Medication Regime
INH Streptomycin
 peripheral neuritis  8th cranial nerve
(take Vitamin B 6 in damage
conjunction to  routine hearing test
prevent)
 caution in renal
 hepatotoxicity disease
 GI upset

101. Mr. Howe’s Medication Regime
Pyrazinamid
 Heptoxicity
 hyperuricemia
 monitor uric acid & hepatic function

102. Mr. Howe’s Hospital Care
 Teach handwashing, cover nose and mouth
when coughing, sneezing
 Droplet Isolation-negative pressure room
 Special particulate respirator mask
 Psychosocial support-reinforce need to take
medication

103. Mr. Howe’s Teaching Plan
 Preventive measures to avoid catching viral
infections
 Taken drugs in combination to avoid bacterial
resistance
 Take meds at the same time of day on an empty
stomach
 Follow med regimen 6-12 months as prescribed

104. Mr. Howe’s Teaching Plan
 Adequate nutritional status
 Annual check-up
 Annual Check-up: liver function tests
 Notify MD if signs of hepatitis, hepatoxicity,
neurotoxicity, & visual changes occur

105. Thoracentesis
 Used to obtain pleural fluid for
analysis
 Needle inserted between ribs
second and third intercostal
spaces
 Fluid withdrawn with syringe
or tubing connected to sterile
vacuum bottle

106. Thoracentesis
Pre-Procedure  Baseline vital signs
 Informed consent-  Make sure that a
explained & signed CXR has been
 Inform about completed
pressure sensations
that will be
experienced during
the procedure

107. Thoracentesis: Positioning
 Lying on the unaffected side with the bed
elevated 30 – 40 degrees
 Sitting on the edge of the bed with her feet
supported and her arms and head on a
padded overbed table.
 Straddling a chair with her arms and head
resting on the back of the chair.

108. Post Thoracentesis
 Apply pressure to  Monitor for blood-
puncture site tingled mucus
 Assess bleeding &  Assess for
crepitus hypoxemia,
 Semi-fowlers or  Assess for
puncture site up tachycardia
 Assess breath
sounds

109. Why is a chest x-ray ordered post
procedure?

110. Assessment: Lower Resp
Problems
 Resp shallow and rapid
 Decreased oxygen saturation
 Skin cyanosis or pallor
 Cyanosis or pallor of lips & mucus membranes
 Tachycardia
 Work hard to inhale & exhale

111. Assessment: Lower Resp
Problems
 Restless & anxious
 Thin compared to height
 Muscles of neck appear thick
 Arm & leg muscles appear thin
 Clubbed fingers
 Chest is barrel shaped
 Rib space more than a finger breath apart

112. Physical Assessment: Lower Resp
Problems
 Take vital signs
 Monitor O2 sat
 Assess cognition
 Assess sputum
 Assess ability to cough & clear airway

113. Lab Values: Lower Resp
Problems
 Elevated RBC, HCT, HGB
 Elevated WBC
 ABGs
ph <7.35
HCO3 > 24mm Hg
PCO2 > 45 mm HG
PaO2 < 80 mm Hg

114. Interventions: Lower Resp
Problems
 Upright position
 Chest Physiotherapy
 O2 low to maintain resp of 16 breaths minute
 Pace activities
 Administer inhaled drugs
 Respiratory therapy
 Fluid intake at least 3L daily

115. Bronchitis
 Common in adults  Acute bronchitis
follows a viral URI
Risk factors  Chronic bronchitis is
a component of
 Impaired immune
COPD
defenses
 Cigarette smoking

116. Bronchitis
 Viral, bacterial or
inflammatory
 Irritants cause
increased mucus
production and
mucosal irritation

117. Acute Bronchitis

118. Bronchitis: Signs & Symptoms
 Non-productive cough  Chest pain
 Later becomes  Moderate fever
productive
 Paroxysmal cough  General malaise

119. Bronchitis
Treatment Medications
 Symptomatic  ASA or tylenol
 Rest  Broad spectrum
 Increased fluid intake antibiotic
Nursing Intervention  Cough expectorant
 teaching

120. Asthma
 Chronic inflammatory disorder of the airways
 Brief (acute asthma fatal)
 Persistent irritation of the airways

121. Asthma: Risk Factors
 Allergies
 Family history occupational exposure
 Respiratory viruses
 Exercise in cold air
 Emotional stress

122. Asthma: Triggers
 Allergens
 Resp tract infection
 Exercise
 Inhaled irritants
 Secondhand smoke
 Medications

123. Asthma: Acute/early response
 Vasoconstriction
 Edema
 Mucus production

124. Asthma: Patho
 Inflammatory  Impaired mucus
mediators released clearing
 Activation of  SOB
inflammatory cells  trapping of air
 Bronchoconstriction impairs gas
 Airway edema exchange

126. Asthma: Signs & Symptoms
 Chest tightness  Fatigue, anxiety
 Cough, dyspnea, apprenhension
sheezing
 Tachycardia, Respiratory failure
 Breath sounds may
tachypnea,
prolonged expiration improve right before
failure

127. Asthma: Treatment
 Control symptoms Long term control
 Prevent acute  Anti-infammatory
attacks agents
 Restore airway  Long acting
patency bronchodialators
 Restore alveolar  Leukotriene
ventilation modifiers

128. Asthma: Treatment
Quick relief Administration
 Short acting methods
adrenergic  Metered-dose inhaler
stimulants (MDI)
 Anticholinergic drugs  Dry powder inhaler
 Methylxanthines (DPI)
 Nebulizer

129. Chronic Obstructive Pulmonary
Disease
 A collective term used
to refer to chronic
lung disorders
 Air flow into or out of
the lungs is limited

132. John
 Emphysema for 25 years
 H/O smoking
 Diagnosis: Bronchitis

133. John: Cigarette Smoking
 Major causative factor in the development of
respiratory disorders
 lung cancer
 cancer of the larynx
 Emphysema
 chronic bronchitis

134. During assessment you note the presence of a
“barrel chest”.
 “air trapping” in the lungs

135. Barrel Chest
 Slow progressive obstruction of airways
 Airways narrow
 Resistance to airflow increase
 Expiration slow and difficult
 Result: mismatch between alveolar ventilation and
perfusion, leading to impaired gas exchange

136. Major symptoms to assess John
for
You should be alert for the following
presenting symptom of COPD?
 Increased dyspnea
 Sputum production

137. Emphysema
John is medicated with a bronchodilator to reduce
airway obstruction. Assess for
 Dysrhythmias
 Central nervous system excitement
 Tachycardia

138. Purse Lip Breathing
Recommended for John to:
 Decrease respiratory rate
 Increase alveolar ventilation
 Reduce functional residual
capacity

139. Venturi Mask is prescribed for John
because:
 Moderate Oxygen Flow
 Delivers precise, high-flow
rates
 24%-50%
 Humidification available
 Requires face mask

140. Bronchiectasis
A chronic dilation of the
bronchi caused by:
 pulmonary TB infection
 chronic upper
respiratory tract
infections
 complications of other
respiratory disorders

141.  Obstruction of a
pulmonary artery by a
bloodborne
substance

142. Pulmonary Embolism:
Common Cause:
 Deep vein thrombosis

143. Pulmonary Embolism

144. Other sources of Pulmonary
Emboli
 Fat Emboli
 From fractured long bones
 Air Emboli
 From IVs
 Amniotic fluid
 Tumors

145. Mrs. Perkins
 Mrs Perkins is suspected of having a
pulmonary embolus.
 What diagnostic test confirms this diagnosis?

146. Pulmonary Embolism
 The plasma D-dimer test is highly specific for
the presence of a thrombus.
 An elevated d-dimer indicates a thrombus
formation and lysis.
What assessment data would support that Mrs.
Perkins has experienced a pulmonary
embolus?

147. Clinical Manifestations of Pulmonary
Embolus
 Sudden, unexplained dyspnea, tachypnea
or tachycardia
 Cough
 Chest pain
 Hemoptysis
 Sudden changes in mental status (hypoxia)

148. Diagnosing Pulmonary Embolism
 Ventilation-Perfusion Scan
 Nuclear imaging test
 Determines percentage of each lung that is
functioning normally
 Pulmonary Angiography

149. Pulmonary Embolism
Mrs. Perkins pulse oximetry has decreased
to 90%. What does this indicate?
 The normal pulse oximeter reading is 93% -
100%.
 A reading of 90% indicates Mrs Perkins has an
arterial oxygen level of about 60

150. Pulmonary Embolism
With a diagnosis of PE, what intervention is
crucial for
Mrs. Perkins?
 Institute and maintain bedrest
 Bedrest reduces metabolic demands and
tissue needs for oxygen.

151. Management: Pulmonary Emboli
 Anticoagulation therapy
 Heparin
 Coumadin for ~6 months
 Thrombolytic therapy
 Use very cautiously only for acute, massive PE
 Urokinase, Streptokinase & tPA
 Inferior Vena Cava filter

152. Mrs. Perkins
Mrs. Perkins is receiving a heparin drip.
The bag hanging is 20,000 units/500 ml of
D5W infusing at 22 ml/hr. How many units of
heparin is Mrs Perkins receiving each hour?

153. Heparin Infusion
 880 units
20,000 divided by 500 = 40 units
If 22 ml are infused per hour, then 880 units
of heparin are infused each hour
40 x 22 = 880

154. Heparin Therapy
What nursing interventions should you implement for
Mrs Perkins receiving Heparin?
 Keep protamine sulfate readily available
 Assess for overt & covert signs of bleeding
 Avoid invasive procedures and injections
 Administer stool softeners as ordered

155. Pulmonary Embolism
Mrs Perkins PT is 12.9 and PTT is 98. What are
your
implications for administering heparin to Mrs
Perkins?
 A normal PTT is 39 seconds
 58-78 is 1.5 to 2 times the normal value and is
within the normal therapeutic range
 A PTT of 98 means Mrs Perkins is not clotting;
medication should be held.

157. Pulmonary Embolism
The doctor has ordered Coumadin for Mrs.
Perkins. PT = 22 PTT = 39 INR = 2.8
What action should you implement
 Give the Coumadin because the theurapeutic
INR level is 2-3.
 What is the antidote for Coumadin?

158. Pulmonary Embolism: Teaching
 Use a soft bristle toothbrush to reduce the risk
of bleeding
 Avoid aspirin
 Aspirin is an antiplatlet which may increase
bleeding tendencies.

159. Pulmonary Embolism: Teaching
 Wear a medic alert band
 Increase fluid intake to 2-3L day (increases fluid
volume which prevents DVT the common cause
of PE)

160. IVC Filters
 Greenfield  Bird’s Nest Filter
Filter