The client with a massive pulmonary embolism is receiving alteplase (Activase). What is the priority nursing diagnosis or collaborative problem for this client?
A. Risk for Impaired Adjustment
B. Ineffective Breathing Pattern
C. Potential for Anaphylaxis
D. Risk for Injury (Bleeding)
D
Alteplase is a fibrinolytic agent that dissolves formed clots. The dose of fibrinolytic agents for PE is far higher than the dose used to treat clots in a coronary artery. The drug has an impact on clots outside of the pulmonary embolism and the client is at great risk for hemorrhage and shock. The client with a PE already has an impaired breathing pattern and the alteplase will not worsen this problem. Alteplase, unlike urokinase, is a totally synthetic drug and does not stimulate aller-gic or anaphylactic reactions. The client may be concerned about his or her family and profes-sional roles but at this time, the risk for bleeding has a higher priority than this psychosocial issue.
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