# A nurse is caring for a patient with a confirmed pulmonary embolism who is stable on anticoagulation therapy. Which nursing intervention should be the highest priority?

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## 문제

A nurse is caring for a patient with a confirmed pulmonary embolism who is stable on anticoagulation therapy. Which nursing intervention should be the highest priority?

## 보기

1. Administer prescribed analgesics for chest pain relief
2. Position the patient in high Fowler's position and administer oxygen **✔ 정답**
3. Prepare the patient for immediate surgical embolectomy
4. Encourage deep breathing exercises and ambulation

**정답: 2**

## 해설

Positioning in high Fowler's and administering oxygen are the highest priority as they directly address life-threatening hypoxemia and optimize ventilation in pulmonary embolism. Other interventions like pain management or surgery are secondary or not immediate.

## 심화 해설

Understanding the Priority: Oxygenation and Positioning in Pulmonary Embolism

The correct answer is to position the patient in high Fowler's position and administer oxygen. For a patient with a confirmed pulmonary embolism (PE), the immediate physiological threat stems from a ventilation-perfusion (V/Q) mismatch. A clot obstructs blood flow to a portion of the lung, creating "dead space" where ventilation occurs but no gas exchange happens. This leads to hypoxemia, the most critical and immediate life-threatening consequence of a PE, even in a patient who appears stable.

The rationale for prioritizing this nursing intervention is rooted in the pathophysiology of PE. The primary goal is to optimize the patient's rapidly compromised oxygenation status. Placing the patient in high Fowler's position achieves this by maximizing lung expansion and reducing the work of breathing. Administering supplemental oxygen directly addresses the hypoxemia caused by the V/Q mismatch. This aligns with the clinical observation that a patient with PE can appear deceptively calm while their right ventricle struggles, and their condition can deteriorate quickly, especially if they are classified as intermediate-high-risk [4]. A stable blood pressure reading does not rule out significant cardiopulmonary strain. Therefore, supporting oxygenation is the foundational step to prevent rapid decompensation.

While the other options are relevant to the overall care of a patient with PE, they do not address the most immediate physiological need. Administering analgesics (Option 1) is important for comfort but is a secondary intervention. Pain and anxiety can increase oxygen consumption, so relief is beneficial, but it does not directly correct the underlying hypoxemia. Preparing for a surgical embolectomy (Option 3) is an invasive procedure reserved for massive, life-threatening PE with hemodynamic instability, not for a patient who is currently stable on anticoagulation. Encouraging deep breathing and ambulation (Option 4) is contraindicated in the acute phase of a PE. Ambulation could dislodge a clot, leading to a new or worsening embolic event, and deep breathing exercises are less of a priority than direct oxygen supplementation when the patient is already hypoxemic. The core of safe anticoagulation therapy, as noted in managing thrombotic complications, is to prevent clot propagation while the body's fibrinolytic system works, but this does not immediately fix the existing gas exchange problem .References (research sources)

- [4]Caught in Transit: Mobile Right Atrial Thrombus in Intermediate-High-Risk Pulmonary Embolism Treated With Half-Dose Alteplase.Research articleGomaa W, Sewify K, Abdelshafey EE, Alsaher A, Elmessery R, Alanazi F, Azmy A, Al Faraidy K. (2026) · DOI: 10.12659/ajcr.952646

## 임상 시나리오

Acute PE: Priority Nursing ActionOptimizing Oxygenation in Stable Patients
The immediate threat in a pulmonary embolism is hypoxemia from a V/Q mismatch. Even if the patient appears stable, prioritize interventions that maximize gas exchange. Position the patient in High Fowler's position to reduce the work of breathing and administer supplemental oxygen to target an SpO2 of ≥92%.

A stable blood pressure does not rule out significant right ventricular strain. Closely monitor for signs of decompensation, including a sudden drop in SpO2, increased dyspnea, or hypotension. Avoid activities that could dislodge the clot or increase cardiac workload, such as ambulation or strenuous deep breathing exercises in the acute phase.

CautionDo not delay oxygen therapy for pain medication. While analgesics are important, untreated hypoxemia can lead to rapid clinical deterioration and cardiac arrest.

## 핵심 개념

- **Ventilation-Perfusion (V/Q) Mismatch** — An imbalance in lung ventilation and blood flow; in PE, a clot blocks perfusion to ventilated alveoli, creating dead space and causing hypoxemia.
- **High Fowler's Position** — A sitting position with the head of the bed elevated to 90 degrees, which maximizes lung expansion and reduces the work of breathing.
- **Dead Space Ventilation** — Ventilation of lung areas that are not perfused with blood, preventing gas exchange and leading to ineffective breathing.

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