Pulmonary Embolism and Obesity Question and Answer
A client with obesity is diagnosed with pulmonary embolism (PE). Which assessment data would the nurse expect to find? Select all that apply.
- Bradycardia
- Chest pain
- Chills and fever
- Hypoxemia
- Tachypnea
- Tracheal deviation
Pulmonary Embolism and Obesity Question and Answer
Answer
Correct answer
2,4,5
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Explanation
A pulmonary embolus is a blood clot that usually originates from the deep veins of the legs (>90%), travels to the pulmonary circulation, and obstructs a pulmonary artery or one of its branches, resulting in decreased perfusion in relation to ventilation and impaired gas exchange (hypoxemia).
Clients are at risk for formation of venous thromboembolism (VTE) when the conditions detailed in Virchow’s Triad are present. Clients at risk for PE include those with prolonged immobilization (eg, during hospitalization if not ambulatory), obesity, recent surgery, varicose veins, smoking, heart failure, advanced age, or history of VTE.
The assessment data most characteristic of PE include:
- Dyspnea (85%)
- Pleuritic chest pain (60%)
- Tachycardia
- Tachypnea
- Hypoxemia (impaired gas exchange, decreased perfusion with normal alveolar ventilation, shunting)
- Apprehension and anxiety
A more atypical presentation can be associated with a larger sized PE, and may include manifestations of cardiopulmonary compromise and hemodynamic instability (eg, right ventricular dysfunction, pulmonary hypertension, systemic hypotension, syncope, loss of consciousness, distended neck veins).
(Option 1) A classic manifestation of PE is tachycardia to compensate for hypoxemia (not bradycardia).
(Option 3) Chills and fever can indicate the presence of an infection and are not characteristic of PE. However, a low-grade fever without chills can occur 1-2 weeks after PE due to inflammation.
(Option 6) Tracheal deviation is a symptom of tension pneumothorax. The trachea deviates from midline toward the unaffected side, away from the collapsed lung.
Pulmonary Embolism and Obesity Question and Answer Educational objective:
Classic clinical manifestations of PE include dyspnea, pleuritic chest pain, tachycardia, tachypnea, hypoxemia, and feelings of apprehension and anxiety. Risk factors for PE include those detailed in Virchow’s Triad (eg, hypercoagulability, venous stasis, and endothelial damage). Massive PE can cause syncope and hemodynamic instability.