LESSON PLAN

Class - Second year M.Sc Nursig

Name of the student teacher -
Number of students - 30
Subject - Medical Surgical Nursing II
Duration - 1 hour
Unit - XII (Respiratory system)
Venue - Govt. College of Nursing,
Topic - Lecture cum discussion
Kozhikode
Method of teaching - Pulmonary embolism
Date - 16/02/2021
Previous knowledge of students - Students have previous knowledge
Time - 10.00 am
regarding pulmonary embolism

from their previous classes

AV Aids used - Powerpoint, chart, leaflet, flash card

CENTRAL OBJECTIVE: After the completion of this class the students describe the concept about pulmonary embolism and its
various aspects and apply this knowledge in their future clinical practice with a positive attitude
SPECIFIC OBJECTIVE: At the end of the class, the students

● Define pulmonary embolism

● Explain the incidence of pulmonary embolism

● Identify the risk factors of pulmonary embolism

● List down the etiologies of pulmonary embolism

● Explain the pathophysiology of pulmonary embolism

● List down the clinical manifestations of pulmonary embolism

● Enlist the complications of pulmonary embolism

● Explain the diagnostic evaluation of pulmonary embolism

● Describe the management of pulmonary embolism

● Discuss the nursing management of pulmonary embolism

SL SPECIFIC CONTENT TIME TEACHER’S LEARNER’S AV EVALUATION
ACTIVITY
NO OBJECTIVES ACTIVITY AIDS METHOD

INTRODUCTION 1 mt Introducing the

topic
1 Pulmonary embolism is one of the
leading cause of preventable death in
hospitalized patients. The word
embolus derives from Greek word
meaning “plug” or “stopper”.

DEFINITION
Pulmonary embolism is the blockage Explain
2 Define 1 mt Listening Chart What is
of pulmonary arteries by a thrombus,
pulmonary pulmonary
fat or air embolus or tumor tissue.
embolism embolism?
 INCIDENCE

● 2nd most common cause of

3 Explain the unexpected death in most age
incidence of groups. 1 mt Explain with Listening Power
pulmonary
• Present in 60-80% of patients power point point
embolism
with DVT, more than 50 % them
are asymptomatic
• Account for 15 % of all
postoperative deaths

● A mortality rate up to 30% if

untreated due to recurrent
embolization and 2-8 % mortality
if well treated.
● The overall incidence is higher in
males compared with females.
● The incidence rises with
increasing age, particularly in
women after the age of 75 years

RISK FACTORS

⮚ Modifiable Risk Factors for

Venous Thromboembolism
● Obesity
 ● Metabolic syndrome
Identify the risk
factors of ● Cigarette smoking
4 2 mt Explains with Reads leaflet Leaflet What are the risk
pulmonary
● Hypertension leaflet factors of
embolism
pulmonary
● Abnormal lipid profile embolism?

● High consumption of red

meat and low consumption of
fish, fruits, and vegetables
⮚ Non modifiable:

● Advancing age Personal

● Family history of VTE

Congestive heart failure (So in
AHF prophylaxis is indicated)
● Chronic obstructive
pulmonary disease
● Acute infection

● Air pollution

● Postmenopausal hormone
replacement therapy
 ETIOLOGY
Virchow’s triad

● Venous stasis

● Hypercoagulability
List down the
etiologies of ● Vessel wall injury
What are the
pulmonary
etiological
5 embolism 1 mt Explains Listen
factors of
PATHOPHYSIOLOGY pulmonary
embolism?

Explain the Due to the etiological factors like

pathophysiology DVT
of pulmonary
embolism

5 mt Explain with Write down

Embolism travels up through the chart the notes
6 inferior vena cava to the hearts and
lungs

Pulmonary artery obstruction

 Release of humoral substances

Decreased alveolar perfusion

Pulmonary embolism

CLINICAL MANIFESTATION

→ Dyspnoea is the most common

List down the presenting symptom, occurring in
clinical 85% of patients with PE.
manifestations of
→ Hypoxemia- a mild to moderate
pulmonary What are the
embolism hypoxia with a low PaCO2 is a clinical
common finding manifestation of
7 → Tachypnoea 5 mt Ask questions Answer to the Power pulmonary
question point embolism?
→ Chest pain

→ Cough Listening
Explains
 → Hemoptysis

→ Crackle

→ Wheezing

→ Fever

→ Accentuation of the pulmonic

heart sound
→ Tachycardia

→ Syncope

→ Sudden changes in mental status

as a result of hypoxia

COMPLICATIONS

Enlist the ● Pulmonary infarction-

complications of Infarction results in alveolar
pulmonary necrosis and hemorrhage.
embolism Occasionally the necrotic tissue What are the
becomes infected and an abscess complications of
may develop. pulmonary
embolism?
● Pulmonary hypertension- It
8 3 mt Explains Listening Flash
results from hypoxia. Pulmonary
card
hypertension eventually results
in dilation and hypertrophy of
 the right ventricle.

DIAGNOSTIC EVALUATION

⮚ History and physical

Explain the examination

diagnostic ⮚ D-dimer test – it helps to
evaluation of measure the amount of linked
pulmonary fibrin fragments. These
embolism fragments are the result of clot
degradation. A positive result
suggest that clot may be present.
⮚ Spiral CT scan – most frequently
9 used test to diagnose PE. An IV 4 mt Explains Listening Power
injection of contrast media is point
required to view the blood
vessel. It helps to provide three-
dimensional picture and assist in
emboli visualization.
⮚ Ventilation perfusion scan –
Perfusion scan involves IV
injection of radioisotopes. A
scanning device images the
pulmonary circulation.
Ventilation scanning involves
inhalation of radioactive gas
such as xenon. Scanning reflects
the distribution of gas through
 the lungs.
⮚ Pulmonary angiography- it is the
most sensitive and specific test
for PE. It involves insertion of a
catheter through the antecubital or
femoral vein, advancement to the
pulmonary artery and injection of
contrast medium.
⮚ ABG analysis- PaO2 is low
because of inadequate
oxygenation.
⮚ Chest X-ray

⮚ ECG

⮚ Serum Troponin level

⮚ b-type natriuretic peptide (BNP) –

frequently elevated.

MANAGEMENT

● Medical management

⮚ oxygen therapy is administered to

correct the hypoxemia, relieve the
pulmonary vascular constriction
 and reduce pulmonary
hypertension.
⮚ In some situation, endotracheal
intubation and mechanical
ventilation are needed to maintain
adequate oxygenation.
⮚ Deep breathing and coughing
Describe the
management of exercise and using incentive
pulmonary spirometry are important to
embolism prevent or treat atelectasis.
⮚ Using elastic compression What are the
stockings to reduce venous stasis. medical and
surgical
⮚ Establish IV lines
management of
⮚ Anticoagulation therapy pulmonary
embolism?
→ Subcutaneous administration of 30 mt Explains Listening Power
Low Molecular Weight Heparin point
10
(LWMH) – enoxaparin has been
found to be more effective than
unfractioned heparin.
Unfractioned IV heparin can be as
effective but is more difficult to
titrate to therapeutic levels.
Monitoring the aPTT is not
necessary or useful when using
LMWH.
→ Warfarin (Coumadin) should be
 initiated within the first 3 days of
heparinization and is administered
for 3 to 6 months.
Fibrinolytic agent

→ Tissue plasminogen activator

(tPA) or alteplase, urokinase,
streptokinase dissolve the
pulmonary embolus and the
source of the thrombus in the
pelvis or deep leg veins.

● Surgical management

⮚ Pulmonary embolectomy
This can be achieved via a
vascular (catheter) or surgical
approach.
⮚ IVC filter
An inferior vena cava filter
device is percutaneously placed
at the level of the diaphragm in
the inferior vena cava via the
femoral vein. It prevents
migration of large clots into the
pulmonary system.
NURSING MANAGEMENT

⮚ Minimize the risk of pulmonary

embolism
⮚ Preventing thrombus formation

⮚ Assessing potential for

pulmonary embolism
⮚ Monitoring thrombolytic therapy

⮚ Managing pain

⮚ Managing oxygen therapy

⮚ Relieving anxiety

⮚ Monitoring for complications

⮚ Providing post operative nursing

care
⮚ Promoting home and community
based care.

SUMMARY
Till now we have discussed about
various aspects of pulmonary
embolism and its medical, surgical
 and nursing management.

Discuss the RECAPITULATION

nursing
management of ● What is pulmonary embolism?
pulmonary
embolism ● What are the risk factors of
pulmonary embolism?
● What are the etiology of
pulmonary embolism?
● What are the clinical
manifestation of pulmonary
embolism?
11 10 mt Discuss Contributes
● What are the complications of points
pulmonary embolism?
● What are the medical and
surgical management of
pulmonary embolism? Listening

CONCLUSION
Pulmonary embolism is the result of a
clot in the pulmonary artery or one of
its branches. If untreated pulmonary
embolism can result in death. The
main aim is clot resolution and
decrease the risk of reoccurrence.
 RECENT RESEARCHES

● Ultrasound assisted
thrombolysis for a giant right
atrial thrombus and pulmonary
embolism in a patients with
12 covid-19. 1 mt Summarizing
the topic
● Incidence of venous
thromboembolism in patients
with non-hematological cancer
admitted for covid-19 at a third
level hospital in Madrid.
● Safety profile of enhanced
thromboprophylaxis strategies Go through the
13 1 mt
for critically ill covid-19 headings
patients during the first wave
of pendamic: observational
report from 28 European
intensive care unit.

BIBLIOGRAPHY

● Mrinalini mani, Chintamani

lewis’s medical surgical
nursing.Second south asian
 edition:Elsevier publishers (p)
Ltd; 2015. volume-2, page no:
577-579
● Janice L Hinkle, Kerry H
Cheever. Brunner and
Suddarth’s textbook of
medical-surgical nursing. 13th
south Asian edition: Wolters
Kluwer (p) Ltd, New Delhi;
2014.volume-1, page no: 600-
14 604
● http://www.ncbi.nlm.nih.gov/
articles

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