Question

Michael Wolverton, a 55-year-old patient and a pipefitter, has arrived at the emergency department, where you practice nursing, with a leg ulcer. Upon assessment, Mr. Wolverton reports medial left thigh pain (8 on 0-to-10 scale), bilateral lower extremity edema and hyperpigmentation, and shortness of breath. (Learning Objectives 5 and 10)

a. What are your priorities in care?

b. What could be causing his symptoms?

c. Why is Mr. Wolverton’s shortness of breath problematic?

d. What is anticoagulant therapy? Give examples of two medicaitons used as anticoagulant medicatons

a.

b.

Answer 1

a) First priority should be given to address the shortness of breath. Here patient is experiencing shortness of breath, and it can be due to a pulmonary embolism ,which occured as a complication due to patients disease condition ,that is chronic venous insufficiency. Pulmonary embolism is treated by thrombolytic and anticoagulant therapy.

Important interventions are the following:

1.Prevent venous stasis by encouraging ambulation and active and passive leg excercises.

2.Monitor thrombolytic and anticoagulant therapy by monitoring INR and PTT

3. Manage oxygen therapy by assessing signs of hypoxia and spo2 levels.

Second priority should be given for pain management.

Important interventions are the following:

1.Assess the pain of the patient.

2.Provide comfortable position and encourage use of elastic stockings.

3. Provide appropriate wound care for the ulcer.

4. Administer analgesics according to the physicians order.

b)Patient's symptoms are due to chronic venous insufficiency.It is a vascular condition that affects the legs.Sometimes the valves in the legs does not work properly ,and blood flows backwards and pools in the leg. Gradually this can lead to swelling,discoloration and venous leg ulcers. Reduced blood flow triggers formation of blood clots and can cause DVT-deep vein thromposis.This can lead to pulmonary embolism ,when the thrombus breaks and travels to lungs.One of the symptom of pulmonary embolism is shortness of breath.

c)Shortness of breath is problematic,because it may be due to pulmonary embolism.Pulmonary embolism is due to the blockage of the one or more arteries of the lung by blood clots. It damages lung tissue due to decreased blood flow.Also it decreases oxygen level in the blood and can damage other organs as well.Prompt treatment with thrombolytics and anticoagulants can reduce the mortality.(what causes pulmonary embolism in venous insufficiency is explained in the previous answer)

d)Anticoagulant therapy includes drugs which are used for the treatment or the prevention of thrombus (  blood clots )in the blood vessels,

example for anticoagulants:heparin,warfarin