Medical Surgical Pulmonary embolism #4

Question

The nurse has completed discharged planning with her client who was treated for a pulmonary embolism and will be on warfarin for a few more months. Which statement by the nurse indicates additional teaching is required?

Answers

  1. “I will replace my regular razor with an electric razor.”
    • Rationale:

      This answer is not correct because a client on anticoagulation therapy will be at increased risk for bleeding. An electric razor will assist in avoiding nicks and cuts.

  2. “While traveling, I will get up and move around frequently.”
    • Rationale:

      This answer is not correct because a client with a past history of pulmonary embolism needs to avoid prolonged sitting. Sedentary behavior increases the risk of a deep vein thrombosis which can break through and cause a pulmonary embolism.

  3. “I will contact my provider if I have trouble breathing or chest pain.”
    • Rationale:

      This answer is correct because anyone having trouble breathing and chest pain should call 9-1-1 or go to their nearest emergency department. The sooner the client is treated with a thrombolytic, the better potential for a positive outcome.

  4. “I will continue my regular diet of lean meats, potatoes, and dark leafy greens.”
    • Rationale:

      This answer is not correct because although vitamin K and warfarin have an inverse relationship, vitamin K is needed by our bodies for blood clotting, bone metabolism, and regulating calcium levels. The current trend for clients on warfarin is to no longer avoid foods with vitamin K like once advised. The reason being is that their dose of warfarin has been adjusted to their specific maintenance needs. With the client staying on their regular diet they are used to (no more, no less of vitamin K foods), their warfarin dose most likely will keep them in their target range.

Overview

A client being discharged after a diagnosis of pulmonary embolism may require anticoagulation therapy post-discharge. Education on risks for bleeding, diet, and exercise will be discussed with the client. It is important the client understands to call 9-1-1 or go to the nearest emergency department if they exhibit any signs of a pulmonary embolism.

Explanation

Learning Outcomes

A client being discharged after a diagnosis of pulmonary embolism will require lifestyle changes such as exercising daily, smoking cessation, maintaining a healthy weight, compliance with medications, and lab studies. If the client requires anticoagulation post-discharge, education on risks for bleeding and the necessity of a medical alert bracelet will be necessary. It is important the client understands to call 9-1-1 or go to the nearest emergency department if they exhibit any signs of a pulmonary embolism. This is a medical emergency that requires emergency care and their primary care provider cannot provide at their regular physician’s office. A client on anticoagulation therapy will need to monitor for bleeding and find ways to prevent injury that can cause bleeding. The client will be encouraged to avoid sedentary behavior and to help prevent deep vein thrombosis which is a risk factor for pulmonary embolism. In the past, clients on warfarin were taught to avoid foods high in vitamin K. The current trend is to have them continue their regular diets and eat no more or no less of what they usually eat with vitamin K foods since their dose of warfarin has been adjusted for their particular maintenance style.

Test Taking Tip

It is important to realize a person with shortness of breath and chest pain requires immediate care and not to call their provider, but go to the ER. “Time is muscle” with heart attacks and time is of the utmost importance if a client is experiencing a stroke. Especially a person with a past history of PE should go to the ER if they experience any signs of a PE.

Video Rationale