Nursing care for clients with pulmonary embolism (PE) and infarction focuses on stabilizing cardiorespiratory status, managing pain and anxiety, preventing further clot formation, and providing comprehensive education to prevent recurrence. 

Acute Phase Nursing Interventions

Immediate care addresses life-threatening symptoms and focuses on supportive measures and prompt treatment. 

• Respiratory Support:
• Administer supplemental oxygen immediately to maintain oxygen saturation levels above 90%. Unstable patients may require mechanical ventilation.
• Position the patient in a semi-Fowler's or high-Fowler's position to facilitate lung expansion and ease breathing.
• Monitor respiratory rate, depth, and effort continuously, and auscultate lung sounds regularly for abnormalities like crackles or decreased ventilation.
• Encourage and assist with deep breathing exercises and the use of an incentive spirometer to prevent atelectasis and improve gas exchange.
• Hemodynamic Monitoring:
• Monitor vital signs frequently, including blood pressure, heart rate, and respiratory rate. Tachycardia and hypotension can indicate right ventricular strain or cardiogenic shock.
• Assess for signs of shock (cool, clammy skin, decreased urinary output, decreased blood pressure) and right-sided heart failure (peripheral edema, distended neck veins).
• Monitor lab results, including arterial blood gases (ABGs), D-dimer, partial thromboplastin time (PTT), and international normalized ratio (INR).
• Medication Administration and Monitoring:
• Administer anticoagulant therapy (e.g., heparin) as prescribed to prevent the growth of existing clots and formation of new ones.
• Closely monitor for signs of bleeding, which is a primary complication of anticoagulant and thrombolytic therapies (e.g., bruising, bloody stools, hematuria, bleeding gums).
• Administer analgesic medications for pleuritic chest pain as ordered, and monitor their effectiveness.
• Pain and Anxiety Management:
• Assess pain levels frequently; pleuritic chest pain is a common symptom, especially in patients with pulmonary infarction.
• Provide emotional support and reassurance, as a PE is an acute and frightening event. Stay with the client during acute episodes of respiratory distress. 

Ongoing Care and Prevention

Once the patient is stable, nursing care shifts to preventing complications, promoting recovery, and educating the patient for self-management. 

• Promote Mobility:
• Encourage early and progressive ambulation as tolerated to enhance blood flow and prevent venous stasis.
• For bedridden patients, ensure active and passive leg exercises are performed and that anti-embolism stockings or sequential compression devices are used.
• Patient Education and Discharge Planning:
• Educate the patient and family on the importance of adhering to the prescribed anticoagulant regimen, which may continue long-term.
• Instruct on lifestyle modifications to reduce the risk of recurrence:
• Staying well-hydrated, avoiding dehydration.
• Quitting smoking.
• Maintaining a healthy weight.
• Engaging in regular physical activity.
• Teach the signs and symptoms of DVT (calf pain, swelling) and PE (sudden chest pain, shortness of breath, hemoptysis), and when to seek immediate medical attention.
• Emphasize the importance of follow-up appointments for monitoring coagulation tests and overall recovery.