Pulmonary Embolism Case History and Initial Assessment

History Taking and Initial Care 👀 Pyelonephritis – Check for fever and urination pain and monitor body temperature rise 👀 FEMORAL FRACTURE – Check accident progress and pain area, check blood pressure and pain score 👀 Pulmonic embolism – Check for shortness of breath and oxygen saturation 👀 Pneumonia – Cough, phlegm color change, body temperature, respiratory rate check 👀 Congestion heart failure (CHF) – Check swelling and shortness of breath, monitor weight change 👀 Myocardial infarction (MI) – Check the location and duration of chest pain, check blood pressure and heart rate 👀 Stroke – Check the time and speech impairment of symptoms, observe blood pressure 👀 Diabetic ketoacidosis (DKA) – Check thirst and frequency of urination, check respiratory rate (Kussmaul breathing) 👀 Sepsis – Check fever, history of infection, monitor changes in body temperature and heart rate

 

 

 

 

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Comprehensive Simulation Scenario for Nurse Training: Pulmonary Embolism Case History and Initial Assessment

 

Scenario Title: Structured Case History, Vital Sign Assessment, and Early Intervention for Suspected Pulmonary Embolism

Setting: Emergency Department

Characters:

• Nurse (RN) – Emergency triage nurse conducting initial assessment
• Mr. Sanghoon Lee (Patient) – 46-year-old male presenting with acute respiratory symptoms

 

 

 

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Phase 1: Patient Identification and Communication

Nurse: Good morning, Mr. Lee. I’m the nurse assigned to assist you today. Could you please confirm your name and date of birth?

 

Patient: Good morning. My name is Sanghoon Lee, and my date of birth is January 15, 1978.

 

Nurse: Thank you, Mr. Lee. I’ll ask you a series of questions to better understand your current condition. Please let me know if you feel uncomfortable at any time. Everything you share will remain confidential and help us provide the best possible care.

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Phase 2: History of Present Illness (HPI)

Nurse: When did you first start feeling short of breath? Was it sudden or gradual?

 

Patient: It started suddenly this morning.

 

Nurse: How would you describe your chest pain—sharp, crushing, or more like pressure?

 

Patient: It’s sharp, especially when I take deep breaths.

 

Nurse: On a scale of 0 to 10, how would you rate your chest pain and your difficulty breathing?

 

Patient: The chest pain is a 7, and the shortness of breath is around 8.

 

Nurse: Have you noticed any blood in your cough? Any leg pain, tenderness, or swelling?

 

Patient: Yes, I coughed up a little blood, and my right leg has been swollen for a few days.

 

Nurse: Do any positions or activities make your symptoms better or worse?

 

Patient: Lying down and deep breathing make it worse. Sitting up helps a bit.

 

Nurse: Have you felt dizzy, faint, or experienced a racing heart?

 

Patient: Yes, I’ve been feeling lightheaded and my heart feels like it’s racing.

 

 

 

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Phase 3: Past Medical History (PMH)

Nurse: Have you ever been diagnosed with cardiovascular or lung conditions like heart disease, asthma, or COPD?

 

Patient: No, I haven’t had anything like that before.

 

Nurse: Have you had any recent surgeries, hospitalizations, or periods of prolonged immobility?

 

Patient: Yes, I had knee surgery two weeks ago and was mostly in bed recovering.

 

Nurse: Have you previously experienced any blood clots or been told you were at risk for clotting disorders?

 

Patient: No, this is the first time anything like this has happened.

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Phase 4: Family History (FH)

Nurse: Does anyone in your family have a history of blood clots, pulmonary embolism, or cardiovascular disease?

 

Patient: My father had a pulmonary embolism a few years ago.

 

Nurse: That’s important to note. Family history can increase risk.

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Phase 5: Social History (SH)

Nurse: Do you smoke or consume alcohol?

 

Patient: I quit smoking five years ago. I drink socially—once a week or so.

 

Nurse: What do you do for work? Does it involve sitting for long periods?

 

Patient: I work in an office, so I’m sitting most of the day.

 

Nurse: Do you exercise regularly?

 

Patient: I used to go for walks, but I’ve been inactive since the knee surgery.

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Phase 6: Medication History and Allergies

 

Nurse: Are you currently taking any medications, including pain relievers, supplements, or prescriptions?

 

Patient: I’ve been taking painkillers after my surgery, but nothing else. No blood thinners.

 

Nurse: Do you have any allergies to medications, food, or latex?

 

Patient: No known allergies.

 

 

 

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Phase 7: Vital Signs Assessment

Nurse: I’ll now check your vital signs. Let me know if you feel uncomfortable at any point.

7.1 Temperature

Nurse: I’ll begin by measuring your temperature using a tympanic thermometer. Please remain still.

(Performs hand hygiene, places cover on thermometer, gently pulls ear back, inserts probe.)

 

Nurse: Your temperature is 37.9°C, slightly elevated. This could suggest an inflammatory response.

 

7.2 Blood Pressure

 

Nurse: Now I’ll take your blood pressure. Please relax your arm on this cushion.

(Wraps cuff, inflates, uses stethoscope on brachial artery.)

 

Nurse: Your blood pressure is 140/90 mmHg. That’s slightly high and could be due to anxiety, pain, or underlying complications.

 

7.3 Pulse

 

Nurse: Next, I’ll check your pulse at your wrist.

(Finds radial artery, counts for one minute.)

 

Nurse: Your pulse rate is 110 beats per minute. That’s elevated, which is consistent with your symptoms.

 

7.4 Respiratory Rate

 

Nurse: Finally, I’ll observe your breathing.

(Counts chest rise for one minute discreetly.)

 

Nurse: Your respiratory rate is 24 breaths per minute—above normal. That aligns with your shortness of breath.

 

 

 

 

 

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Phase 8: Clinical Summary and Initial Management

Nurse: To summarize:

• Your temperature is mildly elevated.
• Your blood pressure is slightly high.
• Your pulse and respiratory rate are significantly elevated.

These findings, along with your symptoms, suggest a possible pulmonary embolism. We’ll need to act quickly to confirm the diagnosis and begin treatment.

Initial management will include:

1. Blood Tests – To measure D-dimer and assess clotting risk.
2. Chest CT Angiography – To visualize blood clots in the lungs.
3. Lower Limb Ultrasound – To detect any deep vein thrombosis (DVT), especially in the right leg.
4. Oxygen Support – Depending on your oxygen saturation, we may begin supplemental oxygen.
5. Monitoring and Bed Rest – You should avoid unnecessary movement to prevent dislodging any clots.

Please let us know immediately if you feel chest tightness, dizziness, or increased difficulty breathing.

Patient: Thank you for being so clear and detailed.

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Phase 9: Education and Closing

 

Nurse: Mr. Lee, based on your history and assessment, pulmonary embolism is strongly suspected. We’ll begin the necessary diagnostic tests now. Early detection and treatment are key.

In the meantime:

• Stay still as much as possible to avoid clot migration.
• Notify us if symptoms worsen.
• Avoid anything that increases your breathing effort, like talking excessively or changing positions quickly.

Once test results are confirmed, the doctor will discuss next steps, which may include blood thinners or hospitalization.

 

Patient: I appreciate you explaining everything.

 

Nurse: You’re very welcome. We’ll begin your tests now and monitor you closely. Don’t hesitate to call for assistance.

 

 

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Learning Objectives for Nurse Trainees

• Conduct a focused and complete pulmonary embolism case history
• Identify key risk factors such as surgery, immobility, and family history
• Recognize clinical red flags including hemoptysis, unilateral leg swelling, and pleuritic chest pain
• Accurately assess vital signs and relate them to systemic responses
• Provide early education, reassurance, and immediate coordination for diagnostic testing and care escalation

End of Scenario

 

 

 

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Pulmonary Embolism Case History and Initial Assessment