Nursing Interventions for Ineffective Breathing Pattern, Acute Pain, Impaired Gas Exchange, Activity Intolerance
Pulmonary embolism (PE) is a life-threatening cardiovascular emergency caused by the obstruction of the pulmonary artery or its branches by an embolus—most commonly a thrombus originating from deep vein thrombosis (DVT) in the lower extremities. Once a clot dislodges and travels to the lungs, it can impair gas exchange, obstruct blood flow, and lead to reduced cardiac output, respiratory distress, or sudden death.
According to global health data, untreated pulmonary embolism has a mortality rate of up to 30%, while proper treatment reduces mortality to 2–10%. Due to its high morbidity and prevalence, nurses must be competent in early recognition, emergency care, and ongoing management of PE. This article provides a complete, SEO-friendly nursing care plan including the four priority nursing diagnoses, detailed interventions, and rationales.
What Is Pulmonary Embolism?
Pulmonary embolism occurs when an embolus—either a blood clot, fat, air bubble, tumor fragment, or amniotic fluid—travels through the venous system and becomes lodged in the pulmonary artery. Thrombotic embolism is the most common type, accounting for more than 90% of cases.
Pathophysiology
When a thrombus obstructs the pulmonary artery:
- Blood flow to the lungs decreases
- Ventilation-perfusion (V/Q) mismatch occurs
- Gas exchange becomes impaired
- The right ventricle must work harder to pump blood
- Right ventricular failure may develop
Large or massive emboli can cause sudden hemodynamic collapse and cardiac arrest, while small or subsegmental emboli may cause mild symptoms or go unnoticed.
Risk Factors for Pulmonary Embolism
- Prolonged immobilization
- Advanced age
- History of DVT
- Long bone fractures
- Trauma or surgery
- Pregnancy and postpartum period
- Obesity
- Oral contraceptive use
- Congestive heart failure
- Malignancy
- Hypercoagulable disorders
- Smoking
According to studies, failure to treat PE can increase mortality tenfold compared to patients who receive appropriate therapy.
Clinical Manifestations
Symptoms vary depending on the size and location of the embolus. Some patients may have minimal symptoms, while others present with acute respiratory distress.
Common Symptoms
- Sudden chest pain (pleuritic or substernal)
- Dyspnea or shortness of breath
- Tachycardia
- Tachypnea
- Cough
- Anxiety or feeling of impending doom
- Diaphoresis
- Hemoptysis
- Syncope
Symptoms of Massive Pulmonary Embolism
- Severe dyspnea
- Weak, rapid pulse
- Hypotension and shock
- Right heart failure
- Sudden death
Silent or Small Recurrent Emboli
May mimic heart failure or pneumonia and result in multiple small lung infarcts.
Diagnostic Tests for Pulmonary Embolism
- Chest X-ray: May show atelectasis, infiltrates, pleural effusion, or enlarged pulmonary arteries.
- ECG: Sinus tachycardia, S1Q3T3 pattern, right ventricular strain.
- Impedance plethysmography: Detects deep vein thrombosis.
- Arterial Blood Gas (ABG): Shows hypoxemia and hypocapnia.
- D-Dimer: Increased levels indicate clot formation.
- CT Pulmonary Angiography (CTPA): Gold standard diagnostic test.
- V/Q Scan: Alternative for those allergic to contrast.
Goals of Pulmonary Embolism Management
- Relieve symptoms
- Prevent death
- Prevent chronic pulmonary hypertension
- Reduce the risk of recurrence
- Improve oxygenation and hemodynamic stability
Treatment usually includes anticoagulants, thrombolytics, oxygen therapy, and in severe cases, surgical or catheter embolectomy.
Priority Nursing Diagnoses for Pulmonary Embolism
The following four nursing diagnoses are most relevant to PE patients:
- Ineffective Breathing Pattern related to decreased lung expansion
- Acute Pain related to pulmonary infarction
- Impaired Gas Exchange related to ventilation-perfusion imbalance
- Activity Intolerance related to decreased oxygen delivery to tissues
Nursing Care Plan for Pulmonary Embolism
1. Ineffective Breathing Pattern
Goal:
The patient will demonstrate an effective breathing pattern.
Expected Outcomes:
- Normal respiratory rate and depth
- Normal ABG results
- No cyanosis or signs of hypoxia
Interventions and Rationales:
- Identify the cause or trigger factors.
Rationale: Helps guide appropriate treatment. - Assess respiratory function (rate, depth, cyanosis, vital signs).
Rationale: Detects early signs of respiratory compromise. - Auscultate breath sounds.
Rationale: Identifies crackles, wheezing, or diminished breath sounds. - Observe chest wall movement and tracheal position.
Rationale: Helps detect uneven lung expansion or obstruction. - Position the patient in high Fowler's.
Rationale: Promotes lung expansion and reduces the work of breathing. - Administer oxygen therapy as prescribed.
Rationale: Improves oxygenation and reduces hypoxemia.
2. Acute Pain (Chest)
Goal:
The patient will report reduced or controlled chest pain.
Expected Outcomes:
- Verbalizes pain relief
- Appears relaxed and comfortable
Interventions and Rationales:
- Assess pain characteristics and intensity using a pain scale.
Rationale: Enables appropriate pain management. - Teach relaxation and distraction techniques.
Rationale: Helps reduce perception of pain. - Monitor for changes in pain quality.
Rationale: Sudden changes may indicate worsening embolism. - Administer prescribed analgesics.
Rationale: Relieves pain and improves comfort.
3. Impaired Gas Exchange
Goal:
The patient will demonstrate improved gas exchange.
Expected Outcomes:
- Normal ABG values
- Oxygen saturation > 95%
- Pink skin color
Interventions and Rationales:
- Assess respiratory rate, rhythm, and depth.
Rationale: Determines the severity of respiratory impairment. - Administer oxygen therapy.
Rationale: Restores oxygen balance and reduces hypoxia. - Monitor oxygen saturation frequently.
Rationale: Ensures adequate oxygen delivery. - Correct acid–base imbalance as needed.
Rationale: Indicates whether gas exchange is improving. - Position the patient to maximize lung expansion (e.g., semi-Fowler’s).
Rationale: Enhances ventilation. - Encourage deep breathing and coughing exercises.
Rationale: Helps remove secretions and improve ventilation.
4. Activity Intolerance
Goal:
The patient will tolerate increased activity levels.
Expected Outcomes:
- Participates in necessary daily activities
- Shows reduced signs of physiological stress
Interventions and Rationales:
- Assess the patient’s response to activity.
Rationale: Determines baseline tolerance. - Encourage energy-saving techniques.
Rationale: Helps prevent fatigue. - Assist in gradual activity increase as tolerated.
Rationale: Promotes independence while preventing overexertion.
Clinical Example
A 55-year-old postoperative patient presents with sudden pleuritic pain and shortness of breath. CT angiography confirms pulmonary embolism. The nurse implements oxygen therapy, continuous monitoring, pain management, and early anticoagulant therapy. Over several days, respiratory symptoms improve and the patient begins mobilizing with assistance.
Conclusion
Pulmonary embolism is a critical medical emergency requiring rapid diagnosis and prompt nursing interventions. Through careful monitoring, oxygen therapy, pain control, patient education, and collaboration with the healthcare team, nurses play a vital role in improving patient outcomes and preventing complications. Using NANDA, NOC, and NIC frameworks ensures structured, evidence-based, and effective nursing care.
References
- Brunner & Suddarth. (2001). Textbook of Medical-Surgical Nursing.
- Goldhaber, S. (1998). Pulmonary embolism pathophysiology.
- Lee, A. (2005). Management of venous thromboembolism.
- Sharma, S. (2005). Pulmonary embolism review.
- Torbicki, A. (2000). Management of acute pulmonary embolism.
- Riedel, M. (2004). Clinical approach to PE.
- Fedullo, P. (2003). Evaluation of pulmonary embolism.
