Acute Pulmonary Thromboembolism with Systemic Lupus Erythematous

Shalini¹, Baranika²

¹Non Critical Ward Senior Staff Nurse, Kauvery Heartcity, Trichy, India

²Non Critical Ward Junior Staff Nurse, Kauvery Heartcity, Trichy, India

Case Presentation

Present History

Patient had complaints of dyspnea since two days; also giddiness. Initially went to a hospital, assessed as pulmonary thromboembolism and referred to Heart City

Past Medical History

The Patient was known to have systemic lupus erythematosus (2011), lupus nephritis and was on treatment with :

Tab.Cellcept 1gm BD

Tab.WYsolone 10mg OD

Tab.Shellcal 500mg OD

Tab.Folvite 5mg OD

Past Surgical History

Past surgical history of umbilical hernioplasty (2019)

Menstrual History

The patient had regular menstrual cycle 2 to 3 days with severe abdomen pain and body pain presented.

Acute Pulmonary Embolism

An acute pulmonary embolism or embolus is a blockage of a pulmonary artery most often. The condition result from a blood clot that forms in the lungs or another part of the body (Deep Vein Thrombosis) DVT and travels to the lungs.

Usual Causes

Book Picture

Patient Picture

Slow bloodflow from

Inmobilization

Genetic and family history
Infection
Injury to a vein and bone fracture or surgery

Complication of SLE / systemic lupus erythematosus and side effects of medicine

Usual signs and Symptoms

May have	Our patient had
Rapid or irregular heart beat Light headness or dizziness Excessive sweating Fever Leg swelling and pain	Dizziness Sweating Leg swelling and body pain

Investigations done

ECG done
Chest X-ray
Echo cardiogram done (Moderate PAH, fair LV function)
USG abdomen
Lupus anticoagulant
Anti phospholipid Antibody (IgG & IgM)
CT pulmonary angiogram done (Thrombus)
Both lower limb verous doppler done
No deep vein thrombus
Ultrasonogram abdomen pelvis done

ECG

ECHO Report

RA & RV dilated; Moderate PAH

USG abdomen Report:

Lupus Anticoagulant report:

Anti Phospholipid antibody IgM Report:

Anti Phospholipid antibody IgG Report

Anti Nuclear Antibody Report

CA 125 Report

Venous Doppler Report Right & Left Leg

Right Leg:

Left Leg:

CT pulmonary Angio Report

Management

The main treatment for a pulmonary thrombo embolism is an anticoagulant (blood thinner) depending on the severity of the clot and its effect on other organs such as the heart . Patient may also undergo thrombolytic therapy surgery or interventional preoceduce to improve blood flow in thepulmonary arteries.

The patient rece ived

Inj.Alteplase lysed 100mg over two hours.

Inj.Clexane 60mg BD

Tab. Acitrom 1mg or if INR value in correction dose given to the patient.

Regular blood tests evaluation was done and continued the anticoagulant medicine, the most important for Tab. Acitrom in (if INR value in atternative dose given to the patient). Monitored the patient for any bleeding present and preventede any injuries. The managment of diet was very clearly explained to patient and relatives.

Maintained and monitored the vital signs.

Nursing Management

Monitored vital signs, maintained provided the comfortable position, and provided the safety measures.
To administered the medication correct time and correct dose given to the patient
To maintained the intake and output chart and weight monitoring daily.
To monitored the patient any allergic reaction in medicine side effects.
Diet pattern explained to patient and patient relative (No vitamin K diet).
Semi fowler position with pillow supported to prevent the breathing difficulty.
Health remote the patient and regular monitored the blood tests.
Explained to patient to avoid the heavy work and stain.
To provide the psychological support
To educate the regular follow-up care and continue the take rest.
To maintain personal hygiene, avoid to air pollution.
Advised to take regular follow up care.

Outcome

We received the good outcome because of our effective treatment and also received the great blessings from the patient with his smiling face as the patient happily returns back to his home.

Ms. Shalini

Senior Staff Nurse

Ms. Baranika

Junior Staff Nurse

Acute Pulmonary Thromboembolism with Systemic Lupus Erythematous