Pulmonary embolism care plan: Treatment explained

Hearing the words “pulmonary embolism” (PE) is scary. A blood clot in the lungs sounds like
something ripped straight from a medical drama complete with beeping monitors and very
serious doctors talking in acronyms. But behind the drama, there’s something incredibly
important: a clear, step-by-step pulmonary embolism care plan.

A PE is a blockage in one of the arteries in your lungs, usually caused by a blood clot that
traveled from the deep veins of your legs or pelvis. It’s a form of venous thromboembolism
(VTE) and is considered a medical emergency because it can limit blood flow, damage lung tissue,
strain the heart, and, in severe cases, be life-threatening. The good news? With prompt
treatment and a solid care plan, most people survive and can get back to everyday life.

This guide walks through what typically happens from the emergency room to long-term follow-up:
how pulmonary embolism is treated, what a nursing care plan might include, and how you can
actively participate in your own recovery and prevention of future clots.

What exactly is a pulmonary embolism?

A pulmonary embolism usually starts somewhere else in the body. Most of the time, a clot forms
in a deep vein in the leg, thigh, or pelvis that’s deep vein thrombosis (DVT). If part of
that clot breaks off and travels through the bloodstream to the lungs, it becomes a pulmonary
embolism. This combo of DVT and PE is called venous thromboembolism, or VTE.

PE can range from small clots that cause mild symptoms to large or multiple clots that block
major lung arteries and seriously strain the heart. High-risk PE (sometimes called “massive” PE)
can cause low blood pressure, shock, or even cardiac arrest. Milder forms may “only” cause
chest pain and shortness of breath but those still aren’t symptoms to ignore.

That’s why the very first part of any pulmonary embolism care plan is simple but crucial:
recognize the signs early and get medical help fast.

Step 1 of the care plan: Emergency evaluation and stabilization

When someone arrives at the emergency department with symptoms like sudden shortness of breath,
chest pain that worsens when breathing in, coughing (sometimes with blood), a racing heart, or
unexplained dizziness, PE is one of the big diagnoses doctors need to consider.

Initial assessment and risk stratification

The healthcare team will quickly:

• Check vital signs: heart rate, blood pressure, oxygen saturation, breathing rate, and temperature.
• Assess for red-flag symptoms like confusion, fainting, or signs of shock.
• Ask about recent surgery, trauma, immobility, pregnancy, hormone therapy, cancer, or a history of blood clots.
• Perform tests: ECG, blood work (including D-dimer, clotting tests, kidney function), and often CT pulmonary angiography.

Based on the results, the PE is usually classified into risk levels:

• High-risk (massive) PE: low blood pressure, shock, or need for life support.
• Intermediate-risk (submassive) PE: normal blood pressure but signs of heart strain on imaging or lab tests.
• Low-risk PE: stable vital signs and no heart dysfunction.

This risk level drives the next part of the pulmonary embolism treatment plan.

Oxygen and basic stabilization

For many patients, the first orders are straightforward:

• Oxygen by nasal cannula or mask to keep oxygen saturation in a safe range.
• IV access for fluids and medications.
• Pain relief and anxiety management (because trying to breathe while panicking is, frankly, not a winning combo).

In severe cases, people may need noninvasive ventilation, mechanical ventilation, or medications
to support blood pressure (vasopressors).

Cornerstone of PE treatment: Anticoagulation (“blood thinners”)

The key medication in almost every pulmonary embolism care plan is an anticoagulant. These
drugs don’t dissolve the existing clot, but they prevent it from getting larger and stop new
clots from forming while the body slowly breaks down the existing one.

Common anticoagulant strategies include:

• Direct oral anticoagulants (DOACs) such as apixaban or rivaroxaban, often used as
  first-line treatment if kidney function and bleeding risk allow.
• Low molecular weight heparin (LMWH) injections or unfractionated heparin IV infusions,
  especially when rapid adjustment or procedures may be needed.
• Transitioning to an oral medication like a DOAC or warfarin once the situation is stable.

Generally, guidelines recommend at least three months of therapeutic anticoagulation after an
acute PE, with longer or indefinite therapy considered for unprovoked clots or ongoing risk
factors. The exact length is personalized based on bleeding risk, age, other conditions, and
whether the clot was “provoked” (for example, by surgery) or not.

When is clot-busting or invasive treatment needed?

For high-risk PE, anticoagulation alone may not be enough. Some patients may need:

• Systemic thrombolysis (clot-busting drugs given through a vein) to rapidly dissolve the clot.
• Catheter-directed therapy where a catheter is threaded into the lung arteries to deliver
  low-dose thrombolytic medication or mechanically break up/remove the clot.
• Surgical embolectomy to physically remove large clots in life-threatening situations.

For people who cannot safely receive anticoagulation (for example, due to active major
bleeding or recent brain surgery), doctors may consider placing an inferior vena cava
(IVC) filter a small device in the body’s main vein that can catch clots before they reach
the lungs. These are typically reserved for specific situations and, when possible, removed
once anticoagulation can be restarted.

Step 2: In-hospital pulmonary embolism care plan

After the emergency phase, the focus shifts to careful monitoring, preventing complications,
and setting up a sustainable treatment plan. This is where the nursing care plan for pulmonary
embolism really shines.

Key nursing assessments

Nurses are on the front line of PE management and will repeatedly:

• Monitor respiratory rate, oxygen saturation, and effort (looking for labored breathing or use of accessory muscles).
• Check heart rate and rhythm, blood pressure, and watch for signs of right-sided heart strain or shock.
• Assess pain level, especially chest pain and discomfort when breathing in.
• Evaluate mental status (confusion, anxiety, restlessness can signal worsening oxygenation).
• Look for swelling, warmth, or tenderness in the legs, suggesting persistent or new DVT.
• Monitor lab values such as clotting tests, kidney function, and hemoglobin to catch bleeding early.

These assessments feed directly into the care plan, guiding whether medications need adjusting,
whether additional oxygen or tests are required, and whether the patient is stable enough to
move more or eventually go home.

Priorities in the hospital care plan

A typical in-hospital pulmonary embolism care plan aims to:

• Optimize oxygenation: Maintain target oxygen saturation; adjust oxygen delivery; in
  severe cases, support breathing with devices.
• Support circulation: Monitor blood pressure, heart rate, urine output, and signs of
  heart strain; provide IV fluids or medications if needed.
• Prevent complications of immobility: Encourage safe early ambulation; use compression
  devices or stockings if appropriate; reposition regularly.
• Ensure anticoagulant safety: Verify correct dose and timing; watch for bruising,
  bleeding gums, blood in urine or stool, or a sudden drop in hemoglobin.
• Address pain and anxiety: Provide pain medications and relaxation strategies; explain
  what’s happening to reduce fear (because “mystery” is a terrible coping strategy).

Patient and family education in the hospital

Education isn’t an “optional extra” it’s an essential part of the pulmonary embolism care
plan. Before discharge, the team will usually explain:

• What a pulmonary embolism is and how it likely developed.
• The purpose of anticoagulant medications and how long they may be needed.
• Warning signs of bleeding (like black stools, severe headaches, coughing up blood).
• Signs of a new PE or DVT (new or worsening shortness of breath, chest pain, leg swelling).
• Practical details: how and when to take medications, when to get blood work, and which over-the-counter drugs to avoid (like NSAIDs unless cleared).

A written discharge plan is really helpful here; it’s hard to remember everything when you’re
exhausted and just want to sleep in your own bed.

Step 3: Long-term pulmonary embolism treatment plan

Once you’re home, the care plan doesn’t disappear it simply changes focus. The big goals now
are:

• Finish the full course of anticoagulation safely.
• Prevent new clots.
• Monitor for long-term complications.

Anticoagulation: How long do “blood thinners” last?

The length of treatment depends on the cause of the clot and your overall risk factors:

• PE caused by a major temporary risk factor (like recent major surgery or a long
  flight plus dehydration): often at least three months of treatment.
• Unprovoked PE or PE linked to ongoing risks (like certain cancers or chronic conditions):
  doctors may recommend extended or indefinite anticoagulation if the bleeding risk is acceptable.
• Recurrent PE: long-term or lifelong therapy is often recommended.

Regular follow-ups help fine-tune this plan, especially if you have risk factors for bleeding,
like prior gastrointestinal bleeding, kidney disease, or frequent falls.

Lifestyle and prevention strategies

Your long-term pulmonary embolism care plan almost always includes lifestyle strategies to lower
your chance of another clot:

• Stay as active as your doctor recommends; avoid long stretches of sitting or lying down.
• Take movement breaks during travel: stand up, stretch, and walk the aisle on long flights.
• Maintain a healthy weight and manage conditions like high blood pressure, diabetes, or high cholesterol.
• Avoid smoking or vaping, which can damage blood vessels and increase clot risk.
• Use compression stockings if recommended, especially if you’ve had DVT in a leg.

None of these things are magic on their own, but together they create a lower-risk environment
for your blood vessels kind of like baby-proofing your house, but for your circulation.

Follow-up testing and chronic complications

Some people recover fully and never look back. Others may notice ongoing shortness of breath,
reduced exercise tolerance, or fatigue. In a small percentage of patients, chronic clots and
scarring in the lungs can lead to chronic thromboembolic pulmonary hypertension (CTEPH), a
serious complication that may require specialized treatment or surgery.

That’s why follow-up visits may include:

• Physical exams focused on breathing and heart function.
• Repeat imaging or echocardiograms if symptoms don’t improve.
• Review of medication side effects and bleeding risk.

Building a personalized pulmonary embolism care plan

While the overall framework is similar, a good PE care plan is personalized. Here’s what it
might look like when written out in plain language:

• Diagnosis summary: “You had a moderate-risk pulmonary embolism likely triggered by
  recent knee replacement surgery and a long period of immobility.”
• Medication plan: “You’ll take apixaban twice daily for at least three months. We’ll
  reassess at that point. Avoid starting new medications without checking with your doctor.”
• Monitoring plan: “Call if you notice signs of bleeding, unusual bruises, severe
  headaches, black stools, or blood in your urine. Go to the ER immediately for new or
  worsening shortness of breath or chest pain.”
• Activity plan: “Walk daily, slowly increasing your distance. Avoid heavy lifting until
  cleared. Take a short walk every hour you’re awake.”
• Travel and work: “You can return to office work in X weeks assuming your symptoms are
  stable. For flights longer than four hours, wear compression stockings and walk the aisle
  regularly.”
• Follow-up: “Schedule follow-up visits at one month and three months. We may order
  additional tests if symptoms persist.”

Writing this out (in a notebook or phone note) is incredibly helpful. It turns a complicated
diagnosis into a concrete plan you can actually follow.

Real-world experiences: Living with a pulmonary embolism care plan

Medical guidelines are great, but real life is rarely as neat as an algorithm. Here are some
common experiences and practical lessons people often discover while living through pulmonary
embolism treatment.

1. The “I’m afraid to move” stage

It’s very common to feel scared to move after you’ve been told you have a blood clot. Many
patients worry that walking will “shake the clot loose” and cause another embolism. In reality,
once you’re on therapeutic anticoagulation and your team has cleared you to mobilize, gentle
movement is usually part of the treatment not a threat to it.

One practical tip: start small. Walk to the bathroom and back. Then to the end of the hall.
Use a smartwatch or phone step counter if that helps you see progress. Celebrate small wins:
“Yesterday I walked for five minutes. Today I made it to eight.” You’re not training for a
marathon; you’re rebuilding confidence in your body.

2. Getting used to anticoagulants in daily life

The first weeks on blood thinners can feel like a crash course in medication safety. You may
notice bruises more easily or see a little extra bleeding with shaving or toothbrushing. That
doesn’t necessarily mean something is wrong, but it does mean you should be more mindful.

People often find it helpful to:

• Set phone alarms or use a pillbox to avoid missing doses.
• Carry a medication card or note in their wallet listing their anticoagulant and dose.
• Tell dentists and other providers they’re on a blood thinner before procedures.
• Keep a running note of any unusual bleeding episodes to share at follow-up visits.

Over time, taking the medication becomes just another part of the routine like brushing your
teeth, but with more pharmacology involved.

3. The emotional side of PE: Fear, anxiety, and “what if it happens again?”

Even after physical recovery, many people describe a lingering fear that another clot will
suddenly appear. It’s not unusual to feel a spike of anxiety every time you get a twinge of
chest pain or breathe a little harder walking up stairs.

Helpful strategies can include:

• Asking your doctor which symptoms truly require urgent care versus what’s expected during recovery.
• Practicing simple breathing exercises or mindfulness to help distinguish anxiety from physical symptoms.
• Talking openly with family or friends so you’re not carrying the worry alone.
• Seeking therapy or counseling if fear of recurrence is interfering with sleep or daily life.

Remember, surviving a pulmonary embolism is a big deal. It’s okay if your brain needs time to
catch up with your body’s recovery.

4. Working with your healthcare team as a partner

A PE care plan works best when you see yourself as an active member of the team, not just a
passive recipient of orders. That means asking questions like:

• “Why did my clot happen now? Was it provoked or unprovoked?”
• “How did you choose this blood thinner for me?”
• “What would make you decide to stop or extend anticoagulation at three months?”
• “What signs should make me call the clinic versus go straight to the ER?”

Taking notes (or having a friend or family member do it) during appointments helps you remember
the answers later. Over time, these conversations fine-tune your pulmonary embolism care plan
to fit your life, not just your lab results.

5. Planning for travel, surgery, and big life events

At some point after a PE, real life shows up with its usual requests: vacations, long flights,
weddings, maybe another surgery, or a pregnancy plan. Each of these can affect your clot risk.

Experiences from many patients highlight a few recurring themes:

• Always loop your healthcare team in before long trips or planned surgeries.
• Ask if you need dose adjustments, injections (like LMWH) around procedures, or special precautions for flights.
• If pregnancy is on the horizon, discuss this well ahead of time some medications are not safe during pregnancy, but alternatives exist.

Thinking ahead reduces last-minute stress and helps keep your risk of another PE as low as possible.

Bringing it all together

A pulmonary embolism isn’t just a frightening event; it’s also a turning point. The immediate
treatment focuses on saving your life and stabilizing your lungs and heart. The short-term care
plan in the hospital keeps oxygen, circulation, and anticoagulation on track. The long-term plan
is about preventing new clots, protecting you from bleeding, and helping you safely return to
the life you care about.

No two pulmonary embolism care plans look exactly the same, but the building blocks are very
similar: prompt diagnosis, appropriate use of anticoagulants and (if needed) advanced
interventions, close monitoring, patient education, lifestyle changes, and ongoing follow-up.
When all of these pieces come together, the story shifts from “I had a blood clot in my lungs”
to “I have a plan and I know how to follow it.”