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. 2) Design a short term nursing protocol

Answer 1

Ans) Nursing protocol:

Based on symptoms and laboratory investigations,patient is suffering from pulmonary embolism.pulmonary embolism is a blockage of an artery in the lungs.By a substance that has moved from elsewhere in the body through the blood stream.(embolism).so,it can lead to 90% of emboli are from proximal leg deep vein thrombosis or pelvic vein thrombosis.

assessment:complete assessment of the patient.it includes subjective data: patient complaints are chest pain,shortnessbreath , severe leg pain ,fever,weakness.

Objective data: observation by the nurse.hypoxia,mild fever,hypotension,tachycardia,swelling of legs.

Nursing diagnosis:1)chest pain relarelated to disease condition i.e , pulmonary embolism as evidenced by lab investigations.

2)mild fever is related to infection in the lungs as evidenced by vital signs.

3) altered tissue perfusion is related to immobilisation.

4) hypoxia is related to disease process as evidenced by ABG analysis.

5) decrease heart rate is related to increase venous pressure as evidenced by laboratory investigations.

6) altered ventilation is related to clot in pulmonary artery in right lungs.

treatment :administration of anticoagulant therapy: heparin ,low molecular weight heparin.,warfarin.

Administration of antipyretics.

Administration of oxygen to prevent hypoxia.

Catheter directed thrombosis(CDT)is a new technique found to be relatively safe and effective for mass PEs.

Surgical management: pulmonary thromboendartectomy.(surgical management of acute pulmonary embolism).

interventions:to assess the patient condition.

To check the vital signs every hourly.

To administration of oxygen.

To maintain personal hygiene.

To provide Psychological support.

To administer antipyretics and anticoagulant therapy.

Change the position of the patient.

Provide post operative care to the patient.

Evaluation: patient should free from symptoms