Nursing care
Nursing care plan for pulmonary embolism: priority problems, goals and rationales
Written and reviewed by Rachel Goldberg, MSN, RN, CEN · 5 min read · Updated November 2026
Short answer
In a nursing care plan for pulmonary embolism, the priority nursing diagnosis is impaired gas exchange, because a clot blocking pulmonary blood flow causes hypoxemia and sudden dyspnea. Risk for decreased cardiac output from right heart strain comes next, then risk for bleeding from anticoagulation, acute pain from pleuritic chest pain, and anxiety, each with measurable goals.
Five PE problems, ranked for a postoperative patient
The plan uses a hypothetical 67-year-old, four days after hip surgery, with sudden dyspnea, sharp chest pain on inspiration, heart rate 122 and saturation 88 percent on room air. Anticoagulant choice, thrombolytics and oxygen orders belong to the prescriber; the rows describe nursing actions.
| Nursing diagnosis or problem | Goal or outcome | Interventions | Rationale |
|---|---|---|---|
| 1. Impaired gas exchange | Saturation at or above the ordered target within an hour; respiratory rate trending down | Raise head of bed, give oxygen as ordered, continuous pulse oximetry, monitor mental status and work of breathing | The clot creates lung areas that are ventilated but not perfused, so oxygenation falls |
| 2. Risk for decreased cardiac output | Systolic pressure stays at baseline; any drop or syncope reported at once | Frequent blood pressure and heart rate, watch for light-headedness, distended neck veins, cool skin, low urine output | A large clot strains the right ventricle and can cause shock, which defines high-risk PE |
| 3. Risk for bleeding | No bleeding events; bleeding signs reported within the shift they appear | Check gums, urine, stool, IV sites and incision; avoid IM injections when possible; follow anticoagulation protocol labs; report headache or confusion | Bleeding is the main complication of anticoagulant therapy, especially after recent surgery |
| 4. Acute pain | Pain rated at or below an agreed number and able to take deeper breaths | Assess pain on inspiration, give ordered analgesia, splint the chest with a pillow | Pleuritic pain causes shallow breathing that worsens oxygenation |
| 5. Anxiety | Patient states fear is reduced and follows breathing instructions | Stay with the patient, explain procedures briefly, calm environment | Sudden air hunger produces fear, and fear raises oxygen demand |
Notice that the bleeding row depends on the treatment, not the disease. Students often leave it off because the clot feels like the whole story, yet MSD Manuals calls bleeding the primary complication of anticoagulation.
The pressure numbers that turn a stable PE into a crisis
MSD Manuals defines high-risk PE as systolic blood pressure under 90 mm Hg, or a fall of 40 mm Hg or more from baseline lasting at least 15 minutes. That gives the cardiac output row a concrete reporting trigger. It also lists hypotension, tachycardia, presyncope, syncope and cardiac arrest as presentations of massive emboli.
Once those cues appear, cardiac output moves above gas exchange because circulation is now failing, not only oxygenation. MSD Manuals also notes that older adults sometimes present first with altered mental status. A new confusion in a postoperative patient is a cue to check saturation and pressure, not to assume delirium.
Bleeding watch on anticoagulants: what to check each shift
NHLBI explains that blood thinners stop clots growing and new clots forming, and warns that they can cause bleeding, especially with other blood-thinning medicines such as aspirin. The care plan turns that into nursing checks: gums, urine and stool color, wound drainage, bruising, and neurologic changes that might signal intracranial bleeding.
Teaching continues the same row after discharge. The patient should know which over-the-counter products add bleeding risk, to use a soft toothbrush and electric razor, and to report black stools or a sudden severe headache. The linked heparin and DVT comparison pages cover drug specifics so this plan does not repeat them.
Statement, SMART goals and checking whether the plan worked
For the hypothetical patient: Impaired gas exchange related to ventilation and perfusion mismatch from pulmonary arterial obstruction as evidenced by saturation 88 percent on room air, respiratory rate 30, dyspnea at rest and restlessness. A matching goal: saturation at or above the ordered target and respiratory rate under 24 within 2 hours of treatment.
Evaluate by the numbers. Falling heart rate, calmer breathing and stable pressure show the plan is working. MSD Manuals lists early mobilization, anticoagulants and mechanical compression devices for prevention in hospitalized patients, so once treated, the plan should also show the nurse rechecking new clot risk, including calf pain or swelling.
Hypothetical question: four findings after a PE diagnosis
Hypothetical scenario, not a real NCLEX item: a patient on IV anticoagulation for PE has a small bruise at an old IV site, pleuritic pain rated 4, blood pressure that has fallen from 132/80 to 86/54 over 20 minutes, and asks to call family.
The blood pressure drop comes first: it meets the MSD Manuals definition of high-risk PE and suggests the right heart is failing. The bruise is expected on anticoagulants and needs only monitoring. Pain rated 4 can be treated after the prescriber is called, and the phone call can wait a few minutes.
Sources and further reading
Pulmonary Embolism (PE) - Pulmonology - MSD Manual Professional Edition. Acute dyspnea and pleuritic chest pain; altered mental status in older adults; massive PE with hypotension, tachycardia, presyncope, syncope; high-risk PE defined as systolic under 90 mm Hg or a 40 mm Hg drop for 15 minutes; oxygen for hypoxemia; bleeding as the primary anticoagulation complication; early mobilization and compression devices for prevention.
Venous Thromboembolism - Treatment | NHLBI, NIH. Blood thinners keep clots from growing and stop new clots; bleeding risk especially with other medicines such as aspirin; thrombolytics, catheter removal and vena cava filters for selected cases.
The next step on this is the same as on everything else here: answer questions and read the rationales. Our respiratory practice questions are the closest set to what this page covers.
Common questions
What is the priority nursing diagnosis for pulmonary embolism?
Impaired gas exchange, because the clot blocks blood flow to ventilated lung and causes hypoxemia. If blood pressure falls below 90 systolic or drops sharply from baseline, risk for decreased cardiac output takes over as the top problem.
What are nursing interventions for pulmonary embolism?
Raise the head of the bed, give oxygen and anticoagulants as ordered, monitor saturation, heart rate and blood pressure closely, watch for bleeding and neurologic changes, treat pleuritic pain, reduce anxiety, and teach bleeding precautions and clot prevention.
What are SMART goals for a patient with pulmonary embolism?
Examples: saturation at or above the ordered target within 2 hours of oxygen, respiratory rate under 24 by end of shift, no bleeding events during anticoagulation, and the patient naming three bleeding warning signs before discharge.