Table of Contents
What is Pulmonary Embolism?
Pulmonary embolism (PE) is a critical condition that occurs when a blood clot, known as a thrombus, obstructs an artery in the lungs, impeding blood flow (Ouellette & Mosenifar, 2020). Frequently originating from deep vein thrombosis (DVT), where clots form in deep veins, typically in the legs, PE develops when a fragment of this clot breaks free and travels through the bloodstream to the pulmonary arteries. This blockage can have severe, even fatal, consequences, with the highest risk of mortality occurring within the initial hours following the event (Ouellette & Mosenifar, 2020).
The impact of a pulmonary artery obstruction, whether partial or complete, is significant. It results in ventilation-perfusion mismatch, where air reaches the alveoli, but blood flow is restricted, leading to impaired gas exchange. Furthermore, the body’s response to the clot involves the release of substances that cause vasoconstriction, elevating pulmonary vascular resistance. This, in turn, increases pulmonary arterial pressure, potentially leading to right ventricular failure, decreased cardiac output, and shock. It’s also noteworthy that atrial fibrillation can contribute to PE by promoting clot formation within the right atrium. A massive PE is characterized by hemodynamic instability, while smaller, multiple emboli can cause lung infarctions.
Pulmonary embolisms are clinically categorized based on several factors:
- Acute Pulmonary Embolism: This type is defined by its recent formation and location centrally within the vessel lumen or causing complete vessel occlusion. Acute PEs lead to distention of the affected blood vessel.
- Chronic Pulmonary Embolism: Chronic PEs are characterized by their eccentric position against the vessel wall, reducing arterial diameter by more than 50%, showing signs of recanalization within the thrombus, or the presence of arterial webs.
- Central Pulmonary Embolism: This involves the major pulmonary arteries, including the main pulmonary artery, left upper lobe trunk, right middle lobe artery, and right and left lower lobe arteries. A PE is classified as massive when it affects both pulmonary arteries or results in hemodynamic instability.
- Peripheral Pulmonary Embolism: This refers to emboli located in the segmental and subsegmental arteries of the lung lobes, indicating a blockage in the smaller, more distal vessels.
The presentation of clinical symptoms in PE varies widely depending on the embolus’s size and location. The classic triad of symptoms includes a sudden onset of pleuritic chest pain, dyspnea, and hypoxia. However, it is crucial to recognize that many individuals with PE may present with subtle or no obvious symptoms initially. Pulmonary embolism is not a primary disease but rather a complication of underlying venous thrombosis (Ouellette & Mosenifar, 2020).
A thorough assessment of risk factors is vital for diagnosis. Key risk factors include hypercoagulability, endothelial damage to vein walls, prolonged immobility, recent surgery, pre-existing deep vein thrombosis, the postpartum period, and underlying medical conditions such as polycythemia, heart failure, and trauma. Treatment strategies are tailored to the severity of cardiopulmonary compromise, ranging from thrombolytic therapy in acute, severe cases to anticoagulant therapy and supportive measures like oxygen therapy and compression stockings to optimize respiratory and vascular function.
Pulmonary embolism is a significant concern in hospitalized patients, representing a common hospital-acquired condition and a leading cause of death among this population. Therefore, preventive measures against thrombus formation are paramount and constitute a critical aspect of nursing care.
Pulmonary Embolism
Nursing Care Plans & Management
Nursing care planning and management for pulmonary embolism (PE) are focused on patient safety, optimizing gas exchange, preventing further complications, and providing crucial emotional support. This encompasses vigilant monitoring of vital signs, administering supplemental oxygen, effective pain management, implementing preventative measures against DVT, comprehensive patient education on medication compliance and necessary follow-up care, collaborative teamwork with the healthcare team, and continuous monitoring for any complications.
Nursing Problem Priorities
The immediate nursing priorities for patients with pulmonary embolism are:
- Minimizing the immediate and ongoing risk of pulmonary embolism.
- Thoroughly assessing for the potential of pulmonary embolism in at-risk individuals.
- Close monitoring during thrombolytic therapy administration.
- Proactive prevention of thrombus formation.
Nursing Assessment
The clinical presentation of pulmonary embolism (PE) is diverse, varying with the size of the clot and the extent of pulmonary artery obstruction. Dyspnea, or difficulty breathing, is the most frequently reported symptom, with its severity and duration reflecting the degree of embolism. Chest pain, often described as sudden and pleuritic in nature, is also common and can mimic cardiac conditions like angina or myocardial infarction. Additional symptoms can include anxiety, fever, tachycardia, cough, diaphoresis, coughing up blood (hemoptysis), and syncope. Tachypnea is the most prevalent clinical sign. While PE may sometimes present with minimal symptoms or resemble other cardiopulmonary disorders, severe cases can manifest with significant dyspnea, acute chest pain, a rapid and weak pulse, shock, syncope, and potentially sudden death.
Conduct a comprehensive assessment for the following subjective and objective data:
- Confusion and altered mental status
- Decreased PaO2 and increased PaCO2 levels on arterial blood gas analysis
- Desaturation (Oxygen saturation below 90%)
- Dyspnea and orthopnea
- Headache
- Hypercapnia
- Hypoxia
- Pallor or cyanosis
- Restlessness and agitation
- Tachypnea
- Abnormal arterial blood gasses (ABGs)
- Impaired chest excursion and asymmetric chest movement
- Apprehension and anxiety
- Tachycardia
- Use of accessory muscles for breathing
Assess for factors related to the underlying causes of pulmonary embolism:
- Reduced lung perfusion due to pulmonary arterial blood flow obstruction by the embolus
- Decreased bronchial airflow associated with bronchoconstriction
- Increased physiological shunting from alveolar collapse due to surfactant loss
- Increased alveolar dead space
- Psychological responses such as anxiety and fear related to respiratory distress
Nursing Diagnosis
Following a detailed assessment, a nursing diagnosis is formulated to specifically address the patient’s needs related to pulmonary embolism, guided by the nurse’s clinical judgment and comprehensive understanding of the patient’s health status. While nursing diagnoses provide a structured framework for care, their direct application can vary in clinical practice. In real-world settings, the specific use of diagnostic labels might be less emphasized than the overall care plan. The nurse’s expertise and clinical reasoning are paramount in shaping a care plan that is individualized and responsive to the patient’s unique health concerns and priorities, ensuring patient-centered care.
Nursing Goals
The overarching goals and expected outcomes for patients with pulmonary embolism include:
- The patient will maintain adequate gas exchange, evidenced by ABGs within normal limits, oxygen saturation of 90% or higher, alert and oriented mentation, and heart rate within the patient’s baseline.
- The patient will report or demonstrate a resolution or absence of respiratory distress symptoms.
- The patient will exhibit an effective breathing pattern, characterized by relaxed breathing at a normal rate and depth, and absence of dyspnea.
- The patient will verbalize understanding of essential information, including the importance of medications, signs of excessive anticoagulation, and methods to minimize the risk for bleeding and recurrence of emboli.
- The patient will actively participate in the learning process and adhere to the treatment plan.
Nursing Interventions and Actions
Therapeutic nursing interventions and actions for patients with pulmonary embolism are multifaceted and aimed at managing the acute event and preventing recurrence. Key interventions are outlined below:
1. Minimizing Pulmonary Embolism Risk
Nurses are instrumental in preventing venous thromboembolism (VTE) by implementing strategies focused on reducing venous stasis and hypercoagulability.
1. Monitor vital signs regularly. Continuous monitoring of vital signs, including blood pressure, heart rate, respiratory rate, and oxygen saturation, is crucial for early detection of hemodynamic instability or respiratory distress. Changes in vital signs can indicate worsening PE or complications.
2. Administer oxygen therapy as prescribed. Supplemental oxygen therapy is essential to correct hypoxemia and alleviate respiratory distress. Oxygen administration should be titrated to maintain optimal oxygen saturation levels.
3. Facilitate thrombolytic therapy administration. In cases of massive PE, nurses collaborate with the healthcare team to administer thrombolytic agents, which are potent medications designed to dissolve blood clots and restore pulmonary blood flow.
4. Support anticoagulant therapy. Anticoagulant medications, such as heparin or warfarin, are fundamental in preventing new clot formation and promoting the resolution of existing clots. Nurses manage the administration and monitoring of anticoagulant therapy, including laboratory monitoring.
5. Encourage mobility and ambulation. Promoting early mobilization and ambulation is vital to prevent venous stasis and improve blood flow, reducing the risk of DVT and subsequent PE.
6. Educate patients on medication adherence and potential side effects. Comprehensive patient education regarding prescribed medications, including adherence, side effects, and the importance of regular monitoring, is essential for effective management and patient safety.
7. Implement deep breathing and coughing exercises. These exercises help to maintain effective gas exchange by expanding alveoli and mobilizing secretions, preventing respiratory complications like atelectasis and pneumonia.
8. Provide emotional support and reassurance. PE can be a frightening and stressful experience. Providing psychological support, addressing anxiety and fear, and offering emotional reassurance are integral components of nursing care.
2. Managing Effective Gas Exchange & Oxygen Therapy
Optimizing gas exchange is a primary goal in the nursing care of patients with PE. This involves careful assessment, monitoring, and interventions to ensure adequate oxygenation and ventilation.
1. Assess skin color, nail beds, and mucous membranes. Changes in color, such as pallor or cyanosis, can indicate hypoxemia. Cyanosis, particularly in warm tissues, is a late sign of severe oxygen deprivation.
2. Monitor vital signs for changes. Initially, hypoxia and hypercapnia may cause increased respiratory rate, heart rate, and blood pressure. Deterioration can lead to hypotension, continued tachycardia with potential dysrhythmias, and ultimately respiratory failure.
3. Assess for signs and symptoms of hypoxia. Hypoxia can manifest as confusion, headache, diaphoresis, restlessness, tachycardia, and pallor. These signs indicate inadequate oxygenation and the need for intervention.
4. Auscultate lung sounds. Adventitious lung sounds like crackles may indicate fluid in the lungs, while decreased or absent breath sounds may suggest areas of poor ventilation.
5. Assess for signs and symptoms of pulmonary infarction. Pulmonary infarction, resulting from significant emboli, can present with fever, cough, bronchial breath sounds, hemoptysis, pleuritic pain, pleural friction rub, and consolidation on chest X-ray.
6. Assess for calf tenderness, redness, swelling, and hardened areas. These signs can indicate DVT, the primary source of most PEs. Identifying DVT is crucial for comprehensive management.
7. Monitor arterial blood gases (ABGs). ABG analysis typically reveals hypoxemia, hypocapnia, and respiratory alkalosis in PE patients. These values provide objective measures of gas exchange effectiveness.
8. Monitor oxygen saturation as indicated. Pulse oximetry provides continuous, non-invasive monitoring of oxygen saturation, ensuring that oxygen therapy is effective in maintaining adequate oxygenation levels (above 90%).
9. Assess level of consciousness and mentation changes. Hypoxemia can lead to neurological changes, ranging from restlessness and irritability to decreased mentation and syncope.
10. Assess activity intolerance. Monitor for reports of weakness and fatigue, vital sign changes, or increased dyspnea with exertion to gauge the patient’s tolerance to activity and guide activity progression.
11. Maintain bed rest initially, gradually increasing activity. Bed rest reduces oxygen demand during acute respiratory distress. Activity should be resumed gradually as tolerated, with early ambulation encouraged when stable.
12. Position the client to facilitate ventilation-perfusion matching. Upright or sitting positions optimize diaphragmatic movement and lung perfusion. Elevate the head of the bed to enhance chest expansion and patient comfort.
13. Maintain patent airways. Implement interventions to maintain airway patency, including deep breathing exercises, coughing, and suctioning to remove secretions and prevent airway obstruction.
14. Address fear and anxiety. Provide support and reassurance to alleviate fear and anxiety associated with dyspnea. Encourage expression of feelings to help patients regain a sense of control.
15. Provide continuous monitoring and ensure someone stays with the client. Close monitoring ensures prompt detection of changes and readily available assistance. Provide clear explanations of procedures and expected outcomes to reduce anxiety.
16. Ensure proper application of compression stockings. For patients with proximal DVT, elastic compression stockings can help prevent postphlebitic syndrome. Gradient compression stockings are effective in thromboembolism prophylaxis and preventing clot progression.
17. Prepare the client for a lung scan. A lung scan can identify ventilation-perfusion mismatches, confirming PE diagnosis and assessing the extent of obstruction.
18. Administer IV fluids or oral fluids as indicated. Fluid administration may help reduce blood hyperviscosity, but cautious administration is necessary, especially in hypotensive patients, to avoid fluid overload.
19. Administer oxygen as indicated. Supplemental oxygen is crucial for maintaining oxygenation, reducing the work of breathing, relieving dyspnea, and promoting comfort. Mechanical ventilation may be required for severe respiratory compromise.
20. Anticipate anticoagulant and thrombolytic therapy. Anticoagulants like heparin or enoxaparin are used to prevent recurrent emboli. Thrombolytics are reserved for massive PE with hemodynamic instability to dissolve clots directly.
21. Assist with chest physiotherapy techniques. Techniques like postural drainage, percussion, blow bottles, and incentive spirometry facilitate deeper breathing and secretion drainage.
22. Assist in surgical interventions as indicated. In recurrent PE despite anticoagulation, vena caval ligation or intracaval umbrella insertion may be necessary. Embolectomy may be considered for massive PE with contraindications to fibrinolysis.
Oxygen therapy is a crucial intervention in managing patients with pulmonary embolism to improve oxygenation and alleviate respiratory distress.
3. Maintaining Patent Airway Clearance and Effective Breathing Pattern
Ensuring a patent airway and effective breathing pattern is paramount in managing patients with PE. Nursing interventions focus on optimizing respiratory function and preventing respiratory compromise.
1. Assess the client’s anxiety level. Anxiety is a common response to PE and can exacerbate respiratory distress. Assess anxiety levels and implement appropriate interventions to manage it.
2. Assess respiratory rate, rhythm, and depth. Tachypnea, changes in rhythm, and increased work of breathing are early indicators of respiratory distress. Hypoventilation can signal impending respiratory failure.
3. Assess pain characteristics, especially with the respiratory cycle. Pleuritic chest pain, worsened by deep breathing or coughing, is common in PE and can lead to shallow breathing, further impairing gas exchange.
4. Monitor arterial blood gases (ABGs). ABGs typically show hypoxemia and respiratory alkalosis. Monitor for trends and changes in ABG values.
5. Monitor D-dimer results as indicated. Elevated D-dimer levels support the diagnosis of PE. A negative D-dimer, in low-risk patients, can help rule out PE.
6. Monitor vital signs continuously. Changes in vital signs, especially tachycardia and hypotension, can indicate hypoxia, right ventricular strain, and impending shock.
7. Provide reassurance and allay anxiety during respiratory distress. Presence and reassurance from a trusted person can help alleviate anxiety during acute episodes.
8. Position the client in a sitting position, and change position regularly. Sitting positions promote lung expansion. Repositioning every 2 hours aids in secretion drainage and prevents atelectasis.
9. Encourage deep breathing and coughing exercises. Suction as needed. These measures promote airway clearance and secretion removal. Suctioning is necessary when patients cannot effectively cough.
10. Reinforce chest splinting with pillows during coughing. Splinting reduces pleuritic pain and allows for deeper, more effective coughing.
11. Instruct and assist with incentive spirometry. Incentive spirometry maximizes lung inflation, prevents atelectasis, and improves respiratory function.
12. Prepare the client for diagnostic studies. Prepare patients for chest X-rays, CT scans, ventilation-perfusion scans, and pulmonary arteriograms to confirm PE diagnosis and rule out other conditions.
13. Administer oxygen as indicated. Supplemental oxygen is vital to maintain adequate oxygenation and reduce respiratory distress.
14. Anticipate the need for intubation and mechanical ventilation. In severe cases, intubation and mechanical ventilation may be necessary to stabilize breathing and prevent respiratory decompensation.
4. Managing Bleeding Risk & Thrombolytic Therapy
Managing bleeding risks is crucial, especially with anticoagulant and thrombolytic therapies. Nurses play a key role in monitoring for bleeding and implementing preventive measures.
1. Assess for history of high-risk bleeding conditions. Conditions like liver disease, kidney disease, hypertension, tuberculosis, endocarditis, and heparin-induced thrombocytopenia increase bleeding risk.
2. Assess for signs and symptoms of bleeding. Monitor for bleeding from insertion sites, mucous membranes, decreased hematocrit/hemoglobin, GI/GU bleeding, hematoma, petechiae, purpura, and respiratory tract bleeding.
3. Monitor vital signs and compare to baseline. Hypotension and tachycardia can indicate significant blood loss. Monitor for postural hypotension.
4. Monitor platelets in heparin-induced thrombocytopenia (HIT). HIT is a serious complication of heparin therapy. Monitor platelet counts regularly and suspect HIT if platelet count drops below 100,000/µL or 50% of baseline.
5. Monitor coagulation test results. Regularly monitor INR, PT, aPTT, hemoglobin, and hematocrit to assess anticoagulation levels and adjust therapy as needed.
6. Monitor IV dosage and delivery system. Use electronic infusion pumps for IV anticoagulants to ensure accurate dosing and prevent over- or under-coagulation.
7. Administer anticoagulant therapy as prescribed. Administer heparin, low-molecular-weight heparin, or oral anticoagulants as ordered to prevent further thrombus formation.
8. Stop heparin products if HIPA positive and consult hematologist. Heparin should be discontinued in HIT-positive patients, and alternative anticoagulants should be initiated.
9. Implement measures if bleeding occurs while on heparin. Stop heparin if bleeding occurs. Vitamin K and clotting factors may be needed to reverse anticoagulation effects in severe bleeding.
10. Provide stool softeners as indicated. Prevent straining during bowel movements to reduce bleeding risk, especially in patients with hepatic issues.
11. Convert from IV to oral anticoagulation as appropriate. Overlap IV and oral anticoagulation (e.g., heparin and warfarin) for several days until INR is therapeutic before discontinuing heparin.
12. Administer thrombolytic therapy as prescribed. Thrombolytics are used for massive PE. Be aware of contraindications like recent surgery, pregnancy, stroke, or active bleeding.
13. Institute precautionary measures for thrombolytic therapy. Minimize bleeding risk by using compressible IV sites, applying prolonged pressure after punctures, limiting patient manipulation, and avoiding IM injections.
14. Avoid prophylactic vitamin K administration. Vitamin K is not routinely needed and can mask anticoagulant effects. Administer only if PT is elevated.
15. Administer blood and blood products if active bleeding occurs. Blood products and clotting factors (e.g., prothrombin complex concentrate) may be necessary for active, serious bleeding.
16. Administer appropriate antidotes as indicated. Activated charcoal may be used for DOAC overdose. Vitamin K1 is the antidote for warfarin overdose.
Anticoagulant therapy is a cornerstone of pulmonary embolism management to prevent clot progression and recurrence.
5. Monitoring Diagnostic and Laboratory Procedures
Continuous monitoring of diagnostic and laboratory results is vital for assessing PE severity, guiding treatment, and detecting complications.
1. Computed Tomography Pulmonary Angiography (CTPA). CTPA is the gold standard for PE diagnosis, visualizing pulmonary arteries and detecting clots using contrast dye and CT scanning.
2. Ventilation-Perfusion (V/Q) Scan. V/Q scans assess airflow and blood flow in the lungs, identifying ventilation-perfusion mismatches indicative of PE.
3. D-Dimer Test. D-dimer blood tests measure a protein fragment elevated when clots break down. A negative test can help rule out PE, but a positive test requires further imaging.
4. Chest X-ray. Chest X-rays, while not diagnostic for PE, can exclude other conditions and reveal related findings like right ventricular enlargement.
5. Echocardiography. Echocardiography assesses heart structure and function, identifying right ventricular strain or dysfunction associated with PE.
6. Blood Gas Analysis. ABG analysis measures oxygen and carbon dioxide levels, assessing gas exchange and acid-base balance to determine respiratory compromise severity.
7. Electrocardiogram (ECG). ECGs record heart electrical activity and can show changes suggestive of PE, such as right bundle branch block or right ventricular strain.
8. Lower Extremity Venous Doppler Ultrasonography. Doppler ultrasound assesses leg vein blood flow, detecting DVT, a common PE precursor.
6. Administering Medications and Pharmacological Support
Pharmacological management is central to PE treatment, focusing on anticoagulation, thrombolysis, pain relief, and supportive therapies.
1. Anticoagulants. Anticoagulants like heparin, warfarin, and direct oral anticoagulants (DOACs) are the primary treatment, preventing new clots and extension of existing ones.
2. Thrombolytics. Thrombolytics (e.g., alteplase, reteplase) are used in severe PE to rapidly dissolve clots and are reserved for hemodynamically unstable patients.
3. Nonsteroidal Anti-inflammatory Drugs (NSAIDs). NSAIDs like ibuprofen or naproxen can manage pain and inflammation associated with PE, improving patient comfort.
4. Analgesics. Pain medications, including opioids and non-opioids (acetaminophen), alleviate chest pain and discomfort, enhancing breathing and quality of life.
5. Oxygen Therapy. Oxygen supplementation corrects hypoxemia, relieves dyspnea, and supports respiratory function.
6. Prophylactic Medications. Prophylactic anticoagulants (low molecular weight heparin, fondaparinux) prevent clot formation in high-risk individuals, such as post-surgical or immobile patients.
7. Pain Medications. Non-opioid analgesics like acetaminophen can effectively manage mild to moderate pain associated with PE.
7. Providing Patient Education & Health Teachings
Patient education is crucial for empowering patients to manage their condition, adhere to treatment, and prevent recurrence.
1. Assess the client’s knowledge of pulmonary embolism. Determine the patient’s understanding of PE severity, prognosis, risk factors, and treatment to tailor education effectively.
2. Assess knowledge about anticoagulant therapy and complications. Evaluate the patient’s understanding of anticoagulant medications, adherence, and potential complications to address knowledge gaps.
3. Provide information on the cause, risk factors, and effects of PE. Educate patients about PE etiology, risk factors, and physiological impacts to promote informed decision-making and preventive behaviors.
4. Explain activity restrictions and the balance between activity and rest. Guide patients on appropriate activity levels, emphasizing rest during acute phases and gradual activity increase during recovery.
5. Problem-solve solutions to predisposing factors. Collaborate with patients to identify and address modifiable risk factors like prolonged sitting, restrictive clothing, oral contraceptive use, obesity, immobility, and dehydration.
6. Instruct the client to avoid sitting cross-legged. Advise against crossing legs to prevent popliteal pressure and potential thrombus dislodgement.
7. Review and demonstrate anti-embolic hose application. Educate on proper use of anti-embolic stockings to enhance therapy adherence and effectiveness.
8. Instruct in meticulous skin care of lower extremities. Educate on skin care to prevent venous congestion complications and stasis ulcers, especially in patients with chronic venous insufficiency.
9. Inform about routine laboratory testing for oral anticoagulation. Emphasize the importance of regular INR/PT monitoring to ensure therapeutic anticoagulation and prevent complications.
10. Instruct the client about medications. Provide detailed education on medication names, actions, dosages, side effects, and duration of therapy.
11. Discuss the use of a medical alert bracelet. Recommend medical alert bracelets to inform healthcare providers about anticoagulation history in emergencies.
12. Discuss drug, herb, alcohol, and food interactions with anticoagulants. Educate on potential interactions with medications, herbal supplements, alcohol, and vitamin K-rich foods.
13. Educate about signs and symptoms of anticoagulant toxicity. Instruct patients to recognize and report signs of bleeding, such as nosebleeds, black stools, hematuria, joint pain, hemoptysis, and severe headaches.
14. Identify safety precautions to prevent bleeding. Educate on safety measures like using soft toothbrushes, electric razors, avoiding sharp objects, and wearing gloves for gardening.
15. If HIPA positive, instruct about avoiding heparin. Educate HIT-positive patients to strictly avoid heparin products due to the risk of antibody formation and thrombocytopenia.
16. Explain the need for a vena cava filter if clotting is chronic. Explain the purpose of vena cava filters in preventing recurrent PE in high-risk patients when anticoagulation is insufficient or contraindicated.
Recommended Resources
Recommended resources for further learning and practice in pulmonary embolism nursing care.
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Ackley and Ladwig’s Nursing Diagnosis Handbook: An Evidence-Based Guide to Planning Care This handbook offers an evidence-based approach to nursing interventions and care planning.
Nursing Care Plans – Nursing Diagnosis & Intervention (10th Edition) Features over 200 care plans incorporating the latest evidence-based guidelines, including new content on ICNP diagnoses and LGBTQ health.
Nurse’s Pocket Guide: Diagnoses, Prioritized Interventions, and Rationales A quick-reference guide for accurate diagnoses and efficient care planning, updated with the most recent nursing diagnoses and interventions.
Nursing Diagnosis Manual: Planning, Individualizing, and Documenting Client Care Provides detailed interventions for over 800 diseases and disorders, aiding in individualized patient care planning and documentation.
All-in-One Nursing Care Planning Resource – E-Book: Medical-Surgical, Pediatric, Maternity, and Psychiatric-Mental Health Includes over 100 care plans across various specialties, emphasizing interprofessional patient problems.
See Also
Additional resources on our site related to respiratory system disorders:
References and Sources
Key resources used to develop this nursing care plan for pulmonary embolism:
