Nursing Care Plan for Pulmonary Embolism (NCP for PE)

Pulmonary embolism (PE) is a life-threatening condition in which a blood clot blocks one or more arteries in the lungs. It is considered a medical emergency requiring rapid diagnosis, aggressive treatment, and close nursing monitoring. 

What Is Pulmonary Embolism?

Pulmonary embolism occurs when a thrombus—usually originating from a deep vein in the leg—travels to the pulmonary artery, obstructing blood flow and impairing oxygen exchange.

Common Causes

• Deep vein thrombosis (DVT)
• Prolonged immobility or long flights
• Recent surgery (especially orthopedic surgery)
• Trauma or fractures
• Pregnancy or postpartum period
• Smoking
• Hormonal contraceptives

Signs and Symptoms

• Sudden shortness of breath
• Chest pain (usually sharp and pleuritic)
• Tachypnea and tachycardia
• Cough, possibly with hemoptysis
• Low oxygen saturation (SpO₂)
• Anxiety or feeling of impending doom

Nursing Assessment for Pulmonary Embolism

Comprehensive assessment is essential for early detection and preventing complications.

Subjective Data

• “I can’t breathe” or sudden shortness of breath
• Chest pain that worsens with inspiration
• Anxiety or restlessness

Objective Data

• RR > 20 breaths/min
• HR > 100 beats/min
• SpO₂ < 92% on room air
• Cyanosis
• Cough with or without blood
• Abnormal ABG (e.g., respiratory alkalosis)
• ECG: sinus tachycardia

Nursing Care Plan (NANDA–NIC–NOC)

NANDA #1: Impaired Gas Exchange

NOC Outcomes

• Respiratory Status: Gas Exchange
• SpO₂ ≥ 95% with supplemental oxygen
• Improved breath sounds
• Normal ABG levels

NIC Interventions

• Monitor respiratory status every 1–2 hours (RR, depth, lung sounds).
• Monitor SpO₂ continuously and provide oxygen as ordered.
• Place patient in a semi-Fowler or high Fowler position to maximize lung expansion.
• Administer anticoagulants (heparin, enoxaparin, warfarin) as prescribed.
• Prepare for thrombolytic therapy (e.g., alteplase) if ordered.
• Monitor ABG for changes in oxygenation and acid-base balance.
• Assess for signs of bleeding due to anticoagulant therapy.

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NANDA #2: Decreased Cardiac Output

NOC Outcomes

• Stable blood pressure within normal limits
• HR 60–100 beats/min
• Warm extremities and normal skin color

NIC Interventions

• Monitor vital signs every 1 hour or as indicated.
• Assess for signs of decreased perfusion (cool skin, delayed capillary refill).
• Maintain IV access for emergency medications.
• Administer vasopressors if ordered in cases of shock.
• Monitor ECG continuously for dysrhythmias.

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NANDA #3: Anxiety

NOC Outcomes

• Patient verbalizes reduced anxiety
• Demonstrates relaxed breathing
• Stable vital signs

NIC Interventions

• Provide reassurance and stay with the patient during acute distress.
• Teach slow, deep breathing techniques.
• Explain all procedures to reduce fear.
• Provide a calm environment.

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Example of a Complete Nursing Care Plan Table

Nursing Diagnosis (NANDA)	Goals/Outcomes (NOC)	Interventions (NIC)	Rationale
Impaired Gas Exchange related to pulmonary circulation disruption.	SpO₂ ≥ 95% Normal respiratory rate Clear lung sounds	Monitor respiratory status Administer oxygen therapy Place in semi-Fowler position Administer anticoagulants	To detect early deterioration Improves oxygenation Promotes lung expansion Prevents further clot formation

Patient Education

Teaching is a crucial part of nursing care to prevent recurrence.

• Encourage early ambulation after surgery.
• Teach proper use of compression stockings.
• Educate about anticoagulant therapy and bleeding risks.
• Advise smoking cessation.
• Promote hydration to prevent blood thickening.

Complications of Pulmonary Embolism

• Pulmonary hypertension
• Right-sided heart failure
• Recurrent PE
• Cardiac arrest (severe cases)

Conclusion

Pulmonary embolism is a critical and potentially fatal condition requiring rapid assessment, early intervention, and continuous monitoring. This Nursing Care Plan (NCP) provides a structured approach using NANDA, NIC, and NOC to guide nursing students and healthcare professionals in managing patients effectively. Implementing evidence-based interventions can significantly improve patient outcomes and prevent complications.

References

• American Heart Association. (2024). Pulmonary Embolism Guidelines.
• Lewis, S. L., et al. (2023). Medical-Surgical Nursing. Elsevier.
• Ignatavicius, D. (2023). Patient-Centered Collaborative Care.
• National Institutes of Health (NIH). Pulmonary Embolism Overview.
• NANDA International. (2024). NANDA-I Nursing Diagnoses: Definitions & Classification.

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