A nurse is taking care of a patient with DVT and she must be aware that venous emboli will be lodged in

JIPMER Nursing Officer-2017

Medical & Surgical Nursing

Medium

Appeared in: JIPMER Nursing Officer-2017

Explanation

A blood clot (thrombus) that dislodges from a deep vein, typically in the legs (DVT), becomes a venous embolus.
This embolus travels with the flow of venous blood towards the heart.
The path is: Deep Veins → Inferior Vena Cava → Right Atrium → Right Ventricle → Pulmonary Artery.
The pulmonary circulation in the lungs is the first capillary bed the embolus encounters.
The embolus is too large to pass through these small vessels and becomes lodged, causing a blockage known as a Pulmonary Embolism (PE).

Option A: The embolus passes through the right-sided chambers of the heart but does not typically lodge there, as the chambers and valves are large enough to allow it to pass into the pulmonary artery.
Option C: The venous return from the lower extremities via the inferior vena cava bypasses the liver's primary circulation (portal vein and hepatic artery).
Option D: The kidneys are supplied by the systemic arterial circulation. An embolus lodging here would be an arterial embolus, typically originating from the left side of the heart (e.g., in atrial fibrillation).

Clinical Relevance

Nursing practice connection: Use the key finding related to Pathophysiology of Venous Thromboembolism (VTE) to guide bedside assessment, documentation, and the next nursing action.
Recognizing that a patient with DVT is at high risk for a PE is a critical nursing responsibility. A PE is a medical emergency that can lead to sudden death.
Nurses must vigilantly monitor for signs and symptoms of PE in at-risk patients, including sudden onset of shortness of breath, sharp chest pain, tachypnea, and hypoxia.
Primary prevention of DVT through early ambulation, mechanical compression devices, and prescribed anticoagulants is the most effective strategy to prevent PE.

How to Approach the Question

First, identify the source of the problem: The question specifies a 'venous emboli' originating from 'DVT'. This tells you the clot starts in the deep venous system, usually the legs.
Next, trace the path of blood flow from the systemic veins. Remember that all venous blood returns to the right side of the heart.
Follow the path through the heart: Venous blood enters the right atrium, goes to the right ventricle, and is then pumped out.
Determine the next destination: The right ventricle pumps blood exclusively to the lungs via the pulmonary artery to get oxygenated.
Conclude the final lodging point: The pulmonary artery branches into progressively smaller vessels. The embolus will get stuck in the first vascular bed it encounters that is too narrow for it to pass, which is the capillary network of the lungs.

Concept Tested & Keywords

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E6 Pathology- ROBBINS & COTRAN PATHOLOGIC BASIS OF DISEASE 10TH Ed p. 139-141

E6 Pathology-Textbook of PATHOLOGYHarsh Mohan Part 1 (1-214) p. 205-207

E6 Nursing Brunner Adult Health 3SA Vol 1 Part 2 p. 12-14