A postpartum client who delivered 5 days ago presents to the emergency department with sudden onset of chest p…

Question

A postpartum client who delivered 5 days ago presents to the emergency department with sudden onset of chest pain and shortness of breath. Which assessment finding would be most indicative of pulmonary embolism?

Accepted Answer

보기 4: Pleuritic chest pain with hemoptysis and anxiety

Pleuritic chest pain with hemoptysis and anxiety is the classic triad most specific for pulmonary embolism in postpartum clients. Other findings like hypotension, hypoxia, or leg swelling are less specific and can occur in other conditions.

Answer

보기 1: Blood pressure 90/60 mmHg with tachycardia at 120 bpm

Answer

보기 2: Oxygen saturation 88% on room air with cyanosis around the lips

Answer

보기 3: Unilateral leg swelling with positive Homan's sign

Concept	Key Points
Pulmonary Embolism (PE)	Life-threatening blockage of a pulmonary artery by a thrombus. Classic triad: Pleuritic chest pain, Hemoptysis, Dyspnea/Anxiety.
Postpartum Risk Factors	Hypercoagulable state, venous stasis, endothelial injury (Virchow's Triad). Increased risk with C-section, obesity, advanced maternal age, history of DVT/PE.
Deep Vein Thrombosis (DVT)	Clot formation in deep veins (often legs). Signs: Unilateral edema, pain, warmth, erythema. Homan's sign is unreliable and should not be elicited due to risk of dislodging clot.
Nursing Priority	Maintain oxygenation (administer O2), ensure IV access, prepare for anticoagulant therapy (e.g., Heparin), monitor for complications (right heart strain).

Postpartum Complication	Key Differentiating Symptoms	Nursing Focus
Pulmonary Embolism (PE)	Sudden dyspnea, pleuritic chest pain, hemoptysis, anxiety, tachycardia.	ABCs, oxygen therapy, anticoagulation, calm reassurance.
Postpartum Hemorrhage (PPH)	Excessive vaginal bleeding, uterine atony, tachycardia, hypotension, pallor.	Fundal massage, IV fluids/oxytocics, prepare for possible transfusion.
Amniotic Fluid Embolism (AFE)	Sudden onset of dyspnea, hypotension, coagulopathy (DIC), seizure/cardiac arrest. Often during/after delivery.	Full cardiopulmonary resuscitation (CPR), manage DIC, intensive life support.
Peripartum Cardiomyopathy	Progressive dyspnea, orthopnea, fatigue, peripheral edema, crackles in lungs.	Heart failure management (diuretics, afterload reduction), fluid restriction.

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A postpartum client who delivered 5 days ago presents to the emergency department with sudden onset of chest pain and shortness of breath. Which assessment finding would be most indicative of pulmonary embolism?

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