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A 57- year old man undergoes total knee replacement for severe degenerative joint disease. Four days after surgery, he develops acute onset of shortness of breath and right-sided pleuritic pain. He is now in moderate respiratory distress with a respiratory rate of 28/min, heart rate of 120, and blood pressure of 110/70 mm Hg. Oxygen saturation is 90% on room air. Lung examination is normal. Cardiac examination reveals tachycardia, but is otherwise unremarkable. The right lower extremity is postsurgical, healing well, with 2+ edema, calf tenderness, , and warmth, the left leg is normal. He has a positive Homan’s sign on the right. Acute pulmonary embolism is suspected.

1.    Where did the pulmonary embolism probably arise from?

2.    What are the patients risks factors for thromboembolism?erythema

3.    What are the hemodynamic changes seen in acute pulmonary embolism?

4.    What changes might be expected in the ventilation/perfusion relationships? What might you expect this patient’s A-a Po2 gradient to be?

SCIENCE
HEALTH SCIENCE
NURSING
NUR 641

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