Stage 4 — Generate solutions. CT pulmonary angiography confirms acute PE in the right main and segmental pulmonary arteries, and the completed bedside echocardiogram shows mild right-ventricular dilation. After oxygen and initial support, BP is 102/64 without vasopressors or signs of shock. Which interventions are appropriate now? Select all that apply.
Select All That Apply
Choose your responses, then check the answer.
Explanation
Why choices 1, 3, and 6 are appropriate Confirmed acute PE with hypoxemia requires ongoing oxygen support and reassessment. Therapeutic anticoagulation is the treatment foundation; the specific agent and monitoring depend on renal function, bleeding risk, and whether rapid adjustment or advanced therapy may be needed. Right-ventricular dysfunction plus the initial low BP warrants hospitalization, close monitoring, and prompt multidisciplinary escalation.
Why choices 2, 4, and 5 are not appropriate Aspirin alone does not treat acute VTE. An IVC filter is not routine when anticoagulation can be given. Right-ventricular dilation without persistent hypotension, shock, or clinical deterioration does not by itself mandate immediate systemic thrombolysis.
Step 1 — Use completed data once CT pulmonary angiography has confirmed PE, and the echocardiogram has already shown right-ventricular dilation. Reordering the same echocardiogram is not a new solution.
Step 2 — Treat and monitor the current risk Continue oxygen according to the client's hypoxemia and work of breathing. Administer the selected therapeutic anticoagulant after baseline safety review. Because RV dysfunction and the initial low BP raise concern for deterioration, keep the client hospitalized in a monitored setting and involve the appropriate PE-response or critical-care team.
Step 3 — Avoid over-treatment and false exclusion Do not use aspirin as sole therapy, insert an IVC filter routinely, or give systemic thrombolysis solely for RV dilation while the client is currently stable. A single negative troponin and nonischemic ECG reduce but do not independently eliminate ACS; the confirmed PE and full clinical picture guide the immediate plan.
Key concept Generate solutions that match the client's present severity and completed workup.
Scenario (Stage 4 — Generate solutions)CT pulmonary angiography confirms acute PE, and the already completed echocardiogram shows mild RV dilation. BP has improved after initial support, with no persistent hypotension or shock.
BackgroundNCJMM Stage 4 — Select all appropriate treatment, surveillance, and escalation strategies without repeating completed tests.
Acute PE with right-ventricular dysfunction — Right-ventricular dilation increases concern for adverse outcomes and supports close inpatient monitoring. Reperfusion decisions also depend on hemodynamics, bleeding risk, and clinical deterioration.
Therapeutic anticoagulation — The agent is selected from patient factors and the care plan. Use institution-specific, agent-specific dosing and monitoring rather than assuming one universal aPTT target.
IVC filter — An inferior vena cava filter is generally reserved for selected situations such as an absolute contraindication to anticoagulation; it is not routine first-line treatment when therapeutic anticoagulation can be given.