Physiological Adaptation Q 178
A nurse calls a physician with the concern that a patient has developed a pulmonary embolism. Which of the following symptoms has the nurse most likely observed?
A. The patient is somnolent with decreased response to the family.
B. The patient suddenly complains of chest pain and shortness of breath.
C. The patient has developed a wet cough and the nurse hears crackles on auscultation of the lungs.
D. The patient has a fever, chills, and loss of appetite.
Correct Answer: B. The patient suddenly complains of chest pain and shortness of breath.
Typical symptoms of pulmonary embolism include chest pain, shortness of breath, and severe anxiety. The physician should be notified immediately. Pulmonary embolism (PE) occurs when there is a disruption to the flow of blood in the pulmonary artery or its branches by a thrombus that originated somewhere else. Chest pain is a frequent symptom and is usually caused by pleural irritation due to distal emboli causing pulmonary infarction. In central PE, chest pain may be from underlying right ventricular (RV) ischemia and needs to be differentiated from an acute coronary syndrome or aortic dissection.
Option A: The most common symptoms of PE include the following: dyspnea, pleuritic chest pain, cough, hemoptysis, presyncope, or syncope. Dyspnea may be acute and severe in central PE, whereas it is often mild and transient in small peripheral PE.
Option C: A patient with pulmonary embolism will not be sleepy or have a cough with crackles on exam. On examination, patients with PE might have tachypnea and tachycardia, which are common but nonspecific findings. Other examination findings include calf swelling, tenderness, erythema, palpable cords, pedal edema, rales, decreased breath sounds, signs of pulmonary hypertension such as elevated neck veins, loud P2 component of second heart sound, a right-sided gallop, and a right ventricular parasternal lift might be present on examination.
Option D: A patient with fever, chills, and loss of appetite may be developing pneumonia. A massive PE leads to an acute right ventricular failure, which presents as jugular venous distension, parasternal lift, third heart sound, cyanosis, and shock. If a patient with PE who has tachycardia on presentation develops sudden bradycardia or develops a new broad complex tachycardia (with right bundle branch block), providers should look for signs of right ventricular strain and possible impending shock. PE should be suspected in anyone who has hypotension with jugular venous distension wherein acute myocardial infarction, pericardial tamponade, or tension pneumothorax has been ruled out.