Last updated on December 28th, 2023
Here we will formulate a sample nursing care plan for Pulmonary Embolism (PE) based on a hypothetical case scenario.
It will include three sample nursing care plans with NANDA nursing diagnoses, nursing assessment, expected outcome, and nursing interventions with rationales.
For Pulmonary Embolism (PE) Case Scenario
A 57-year old male presents to the ED with complaints of fatigue, shortness of breath, and chest pain. The patient had a recent hospital admission 1 month ago where he was diagnosed with a left lower extremity DVT and sent home on coumadin. The patient reports that he stopped taking the coumadin once the pain and redness improved in his leg.
Upon assessment, the patient appears diaphoretic and restless. His fingers and lips are slightly cyanotic. He complains of dizziness and chest pain that is worse with inhalation. His temperature is 37.6 C, heart rate is 117 BPM, blood pressure is 87/55 mmHg, respiratory rate is 28 breaths per minute, and oxygen saturation is 89% on 4L nasal cannula.
The blood work reveals a normal INR of 0.9 and an elevated D-dimer of 700 ng/mL. His troponin level is 0.46 ng/mL and pro-BNP is 970 pg/mL. An EKG is performed to rule out myocardial infarction and the patient is found to be in sinus tachycardia with right heart strain noted in leads V1-3, II, III, and aVF. A CT of the chest is ordered and a large filling defect is seen in the pulmonary artery, confirming a pulmonary embolism.
The patient is admitted to the hospital with Pulmonary Embolism (PE).
#1 Sample Pulmonary Embolism Nursing Care Plan – Decreased cardiac output
Nursing Assessment
Subjective Data:
- The patient complains of fatigue, shortness of breath, and chest pain
Objective Data:
- Elevated heart rate of 117 BPM
- Hypotension of 87/55 mmHg
- Elevated D-dimer of 700 ng/mL
- Right heart strain shown on EKG
Nursing Diagnosis
Decreased cardiac output related to blood flow obstruction as evidenced by fatigue, shortness of breath, and right heart strain.
Goal/Desired Outcome
Short-term goal: The patient remains hemodynamically stable overnight with a reduction in chest pain and shortness of breath by the end of the shift.
Long-term goal: The embolus fully dissolves and the patient’s heart function returns to baseline.
Nursing Interventions with Rationales – Decreased cardiac output
| Nursing Interventions | Rationales |
| Administer anticoagulation | For uncomplicated pulmonary embolisms, anticoagulants are recommended. Anticoagulants such as Heparin or Lovenox are used in the prevention of blood clots but will not break down existing clots |
| If prescribed, administer thrombolytics | For submassive pulmonary embolisms, thrombolytics are recommended, especially when right heart strain or hemodynamic instability is seen. Thrombolytics such as alteplase will lyse or dissolve the blood clot. Thrombolytics must be carefully titrated and should be used with caution. Checking the dose with 2 nurses is often required to decrease the incidence of errors |
| Monitor for signs and symptoms of bleeding and institute bleeding precautions | Thrombolytics in particular come with a very high risk of bleeding. It’s important to monitor for any adverse effects such as bruising or sudden decreases in hemoglobin or hematocrit. Venipunctures may have to be temporarily limited to prevent bleeding |
| Perform frequent neurological checks | Neurological checks are particularly important during thrombolytic administration to monitor for a hemorrhagic stroke. They should be performed every 15 minutes for an hour, then every 30 minutes for the next 6 hours. Symptoms to monitor for are headache, nausea, vomiting, or sudden hypertension |
| Anticipate the use of therapies such as the EKOS endovascular system or procedures such as an embolectomy | The EKOS system uses a catheter with ultrasound technology to deliver the thrombolytic directly to the clot, decreasing the amount of drug that has to be used. The catheter stays in place for a few days, until the clot has completely dissolved. An embolectomy is a procedure that manually removes the clot. It can be performed either via a catheter or surgery. |
| If right-sided heart failure acutely worsens, anticipate the implantation of an RVAD | In the most severe cases, an RVAD (right ventricular assist device) may be temporarily implanted to mechanically support the right heart until recovery occurs |
#2 Sample Pulmonary Embolism Nursing Care Plan – Impaired gas exchange
Nursing Assessment
Subjective Data:
- The patient complains of fatigue, shortness of breath, and chest pain
Objective Data:
- The patient’s SPO2 is 89% on 4L nasal cannula
- His fingers and lips are cyanotic
- Right heart strain shown on EKG
Nursing Diagnosis
Impaired gas exchange related to inadequate oxygenation due to insufficient pulmonary blood flow as evidenced by fatigue, shortness of breath, cyanosis, and low SPO2.
Goal/Desired Outcome
Short-term goal: The SPO2 will normalize and the patient will report an improvement in shortness of breath by the end of the shift.
Long-term goal: The embolism will fully dissolve and the patient will resume his normal daily activities with no fatigue or shortness of breath
Nursing Interventions with Rationales – Impaired gas exchange
| Nursing Interventions | Rationales |
| Administer oxygen as needed | Patients with a pulmonary embolism typically require supplemental oxygen to compensate for the decreased blood flow to the lungs |
| Monitor arterial blood gases to assess oxygenation | ABGs are a reliable way to monitor the patient’s progress and can facilitate the early detection of a worsening in condition |
| If oxygenation worsens, prepare for intubation | Extreme caution should be used when intubating as this can lead to hemodynamic collapse. Consider starting an inotrope such as norepinephrine in advance of intubation to support blood pressure. Ideally, thrombolysis should take priority over intubation |
| Educate the patient about deep breathing strategies and positions to facilitate easier breathing | Pursed lip breathing is a strategy that keeps airways open longer and decreases shortness of breath. Sitting upright or with the head of the bed elevated improves the delivery of oxygen. |
| Maintain bedrest | Temporarily maintaining bedrest will decrease the body’s oxygen consumption |
#3 Sample Pulmonary Embolism Nursing Care Plan – Knowledge deficit
Nursing Assessment
Subjective Data:
- The patient admits that he stopped taking his coumadin once DVT symptoms improved
Objective Data:
- INR level is within normal range
Nursing Diagnosis
Knowledge deficit related to the importance of anticoagulation post-DVT as evidenced by patient admission of coumadin discontinuation
Goal/Desired Outcome
Short-term goal: By the end of the shift the patient will verbalize a few complications of discontinuing anticoagulation too early, including loss of limb circulation, pulmonary embolisms, and strokes.
Long-term goal: The patient will continue home coumadin as evidenced by a therapeutic INR level.
Nursing Interventions with Rationales – Knowledge deficit
| Nursing Interventions | Rationales |
| Educate the patient about the link between DVTs and pulmonary embolisms | The majority of pulmonary embolisms develop when a portion of the DVT breaks off and becomes lodged in the pulmonary artery. To make an educated decision regarding medication compliance, the patient needs to understand the importance of continuing anticoagulation until the DVT is fully dissolved |
| Educate the patient about which foods to avoid when taking anticoagulation | With Coumadin, it’s important to limit consumption of green leafy vegetables, green tea, cranberry juice, and alcohol. With Eliquis, avoid grapefruit juice. |
| Teach the patient about strategies to avoid future DVTs | It’s important to instruct the patient to avoid sitting for long periods, making sure to walk or stretch at least every hour. Frequent exercise and compression socks can also decrease the incidence of DVTs |
| Educate the patient about the function of an IVC filter | An IVC filter is a small filter placed in the vena cava that prevents clots from entering the pulmonary artery and becoming a pulmonary embolism. An IVC filter is indicated for patients who currently have, or are at a high risk of developing, a DVT |
| Provide education on smoking cessation | Smoking dramatically increases the risk of developing blood clots |
| Educate the patient about the risk of anticoagulation in regards to falls | Anticoagulation significantly increases the risk of bleeding, which makes the risk of falling quite dangerous. To prevent falls, the patient should use assistive devices, wear non-slip socks, secure loose rugs, etc. |
Conclusion
To conclude, we created scenario-based three sample nursing care plans for Pulmonary Embolism (PE). This nursing care plan includes nursing assessment, NANDA nursing diagnosis, expected outcome, and nursing interventions with rationales.
Reference
Ackley, B., Ladwig, G., Makic, M., Martinez-Kratz, M., & Zanotti, M. (2020). Nursing Diagnoses Handbook: An Evidence-based Guide to Planning Care (12th ed.). Elsevier.
Herdman, T., Kamitsuru, S. & Lopes, C. (2021). NURSING DIAGNOSES: Definitions and Classifications 2021-2023 (12th ed.). Thieme.
Swearingen, P. (2016). ALL-IN-ONE CARE PLANNING RESOURCE (4th ed.). Elsevier/Mosby.
