Question

A 70 y/o female who had undergone right total hip replacement presents on the 5th postoperative day with central chest pain and acute-onset dypsnea. HPI. She has been immobile since the surgery PE. VS: low-grade fever; tachycardia; hypotension. central cyanosis; elevated Jugular venous pressure (JVP); right ventricullar gallop rythm with widely split S2 Labs. Arterial Blood Gas (ABGs); hypoxia and hypercapnia (type 2 respiratory failure). patient had sinus tachycardia on ECG Imaging. Doppler Ultrasound shot clot in the right common femoral vein. CXR, showed right lower lobe atelectasis. V/Q scan demonstrated three areas of ventilation-perfusion mismatch in right lung. Angio-pulmonary: confirmatory; (not rrequired if V/Q scan is high probability). Gross pathology. Large thrombus seen in pulmonary artery Micro pathology. Large occlusive thrombus seen in pulmonary artery with variable degree of recanalization. 3) Design a long term care protocol to adress this patient situation.

Answer 1

1. She needs  provision of care, therapy and treatment.
2. She needs better coordinated care;
3. To recover she will be in need of increased continuity of care;
4. Reduce ambulance transport rates to the Emergency department
5. She needs  24-hour nursing care and personal support
6. Appropriate pharmacotherapy is needed for her.
7. She needs help for performing activities of daily living
8. The Long term care should have provisions for ventilator and a respiratory physician and oxygen administration , as she is at risk of hypoxia.
9. As she is diagnosed with pulmonary embolism , stockings should be applied in lower limbs , She may experience long term limitations for physical activity and that this may have a negative impact on quality of life. So counselling and recreational activities are neccesary within long term care facility.
10. The nursing staffs and other healthcare providers in the facility should have evidence based trainings to take of patients with PE,hip replacement and type 2 respiratory failure to prevent any harm to the patients. Because those staffs without knowledge may allow patient to move or do any physical activity which may pose threat to her life.
11. The facility should be near to the family and also emergency department
12. Frequent assessment of the patient by healthcare physicians should be needed.
13. Protocols are required to efficiently orient new or part-time staff to personal communication protocols.
14. Avoid multi-purpose rooms for residents associated with the household or neighbourhood.
15. There should be oppurtunities for socialization
16. Afford for personalization of rooms
17. A “home” environment encourages the patient
18. Patient should have access to therapeutic baths and the beds should have rails for safety of patient.
19. Advance care planning should be formulated by the health care providers in the facility.