Medical Surgical Pulmonary embolism #5

Question

Which client is at the highest risk for a pulmonary embolism?

Answers

  1. A 67-year old client with exacerbation of congestive heart failure.
    • Rationale:

      This answer is not correct because the client only has two risk factors. Advanced age and CHF are risks of a pulmonary embolism due to the risk of clots. CHF causes the heart not to be able to pump as effectively and blood flow slows, creating clots.

  2. A 30-year old pregnant client at 30-weeks gestation.
    • Rationale:

      This answer is not correct because the client only has one risk factor and that is pregnancy. During pregnancy, blood volume thickens, the enlarged uterus puts pressure on the veins in the abdomen and hormones decrease venous tone, which can cause clots to form.

  3. A 59-year-old client status post-femur fracture.
    • Rationale:

      This answer is correct because this client has three risk factors for pulmonary embolism. The client is at an advanced age, has a fracture of a long bone, and is immobile. Fracture of a long bone, such as the femur can produce a fat emboli. That coupled with the fact that the client is immobile due to the leg fracture, puts the client at higher risk for pulmonary embolism.

  4. A 45-year-old on hormone replacement therapy.
    • Rationale:

      This answer is not correct because this client only has one risk factor, hormone replacement therapy. Estrogen increases the level of clotting factors in the blood which contributes to pulmonary embolism.

Overview

A pulmonary embolism (PE) is a blockage of one of the pulmonary arteries from a deep vein thrombosis that has broken off from a vein, usually in the leg. Risk factors include advanced age, congestive heart failure (CHF), pregnancy, fracture of a long bone, immobilization, and hormone replacement therapy.

Explanation

Learning Outcomes

A pulmonary embolism (PE) is a blockage of one of the pulmonary arteries from a deep vein thrombosis that has broken off from a vein, usually in the leg. Smoking highly increases the risk for pulmonary embolism because it changes the surface of platelets, damages the blood vessels, and causes vasoconstriction. Older age is the main risk for PE due to the change in coagulation; as we age and because the other risk factors for DVT are most common in the older population. CHF causes circulation to slow down, and this creates clots. In pregnancy, blood volume thickens in the enlarging uterus and decreases venous tone can cause clots to form. Estrogen also places a factor in clot formation. Fractures of long bones can produce fat emboli due to fat tissue from the bone marrow leaking into the blood. Prolonged immobilization raises the risk of PE because venous blood flow is reduced.

Test Taking Tip

Having a good understanding of blood circulation, the different things that affect it, and how that relates to clot formation will help the student answer this question.

Video Rationale