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Plućna embolija treća je po učestalosti kardiovaskularnih bolesti. Incidencija plućne embolije je 90/10000 stanovnika. Venska tromboembolija je bolest koja obuhvaća duboku vensku trombozu i njenu najčešću komplikaciju – plućnu emboliju. Plućna embolija, odnosno točnije rečeno embolija plućne arterije, je začepljenje plućne arterije ili njezinih ogranaka solidnom, tekućom ili plinovitom masom. Embolusi u 99% slučajeva nastaju od tromba pa to nazivamo tromboembolijom. Do opstrukcije krvožilnog sustava dolazi trombom koji u 95% slučajeva potječe iz dubokih vena nogu. Manifestira se u različitim oblicima, od asimptomatskog oblika do masivne plućne embolije sa disfunkcijom desnog srca. U kliničkoj slici dominira dispneja. Također se javlja i u obliku hiperventilacije, arterijske hipotenzije, kao plućni infarkt, akutno plućno srce s razvitkom kardiogenog šoka ili kao akutna plućna hipertenzija s disfunkcijom desne klijetke. Većina plućnih embolija su često asimptomatske i fiziološki beznačajne. Veći embolusi uzrokuju akutnu dispneju i tahipneju, pleuralnu bol u prsima te rijetko kad kašalj i hemoptizu. Masivna plućna embolija nastupa naglo s tahikardijom, hipotenzijom, sinkopom ili zastojem srca. Dijagnoza se postavlja na temelju kliničke slike, anamneze, fizikalnog pregleda, RTG-a pluća, EKG-a, plućne angiografije te pulsne oksimetrije. Plućna embolija liječi se antikoagulantnom terapijom, trombolitičkom terapijom te kirurškom trombektomijom. U sprječavanju plućne embolije važnu ulogu imaju medicinske sestre. Dužnost medicinske sestre je poticati i/ili provoditi pasivne i aktivne vježbe donjih udova, poticati pacijenta na vježbe dubokog disanja, pravilan položaj te mijenanje položaja u krevetu, stavljati elastične zavoje i čarape te poticati pacijenta na što ranije ustajanje iz kreveta te šetnju. Pulmonary embolism is the third most common cardiovascular disease. The incidence of pulmonary embolism is 90/10000 inhabitants. Venous thromboembolism is a disease that includes deep vein thrombosis and its most common complication - pulmonary embolism. Pulmonary embolism, or more precisely pulmonary artery embolism, is the blockage of the pulmonary artery or its branches by a solid, liquid or gaseous mass. Embolus in 99% of cases is caused by a thrombus, so we call it thromboembolism. Obstruction of the vascular system occurs by a thrombus that in 95% of cases originates from the deep veins of the legs. It manifests in various forms, from asymptomatic form to massive pulmonary embolism with right heart dysfunction. The clinical picture is dominated by dyspnea. It also occurs in the form of hyperventilation, arterial hypotension, as a pulmonary infarction, acute pulmonary heart with the development of cardiogenic shock, or as acute pulmonary hypertension with right ventricular dysfunction. Most pulmonary emboli are often asymptomatic and physiologically insignificant. Larger emboli cause acute dyspnea and tachypnea, pleural chest pain, and rarely cough and hemoptysis. Massive pulmonary embolism occurs abruptly with tachycardia, hypotension, syncope, or cardiac arrest. Diagnosis is made based on clinical picture, medical history, physical examination, lung X-ray, ECG, pulmonary angiography, and pulse oximetry. Pulmonary embolism is treated with anticoagulant therapy, thrombolytic therapy and surgical thrombectomy. Nurses play an important role in preventing pulmonary embolism. The nurse's duty is to encourage and / or perform passive and active lower limb exercises, encourage the patient to do deep breathing exercises, correct posture and change position in bed, put on elastic bandages and socks and encourage the patient to get out of bed and walk as soon as possible. |
