Question

I. Read Chapter 37 from your Text Book

II. NCLEX Review Questions Chapter 37 from Evolve Resources

III. Case Study:  Deep Vein Thrombosis

Patient Profile

D.R. is a 74-year-old obese Hispanic woman who is in the third postoperative day after an open reduction internal fixation (ORIF), for repair of a left femoral neck fracture after a fall at home.

Subjective Data

States pain in her left hip is a 4 to 5 on a 1-to-10 scale

States pain in her left calf area is a 3 on a 1-to-10 scale

Objective Data

Physical Examination

Vital signs: blood pressure 140/68, pulse 64, temperature 98.7° F, respirations 20

Oxygen saturation 93% on room air

Lungs clear all lobes

Bowel sounds arepresent in all four quadrants

Apical pulse: 64, irregular

Alert and oriented to person, place, and time

Skin warm to touch bilateral lower extremities, slight erythema left lower extremity

No edema right lower extremity, 2+ left lower extremity

Pedal pulses 3+ right lower extremity, 1+ left lower extremity

Calf circumference: right, 8 cm; left, 10 cm

Left hip wound has staples; no signs or symptoms of infection

Last bowel movement was four days ago

Interprofessional Care

Medication Administration Record

Morphine sulfate 2 mg IVP every two hours as needed for pain scale 6-10

Lisinopril 20 mg PO daily

Bisacodyl 10 mg PO daily

Discussion Questions

What do you suspect is occurring with D.R.? What data were used to make this determination?

What are the priority nursing interventions at this time?

Using SBAR, what would you report to the provider?

What diagnostic studies would be used to determine the existence, location, and extent of a DVT?

What risk factors for development of a DVT does D. R. have?

What measures can be taken to prevent a DVT in an at-risk patient?

Answer 1

fAT EMBOLISM is suspected. This suspection is based on the following data:

Apical pulse: 64, irregular

Alert and oriented to person, place, and time

Skin warm to touch bilateral lower extremities, slight erythema left lower extremity

2+ left lower extremity edema

1+ left lower extremity pedal pulses

Interventions

the person should be admitted into intensive care unit (ICU), preferably with central venous pressure (CVP) monitoring. CVP monitoring would be helpful to guide the volume resuscitation.^[5] Supportive treatment is the only proven treatment method. Supplemental oxygen can be given if a person has mild respiratory distress.^[6] However, if a person has severe respiratory distress, either continuous positive pressure ventilation (CPAP), or mechanical ventilation using positive end-expiratory pressure (PEEP)^[5] may be indicated. Fluid replacement is required to prevent shock.^[6] Volume resuscitation with human albumin is recommended because it can restore blood volume in the circulatory system while also binds to free fatty acids in order to reduce lung injuries.^[5][8] In severe cases, dobutamine should be used to support the right ventricular failure. Frequent Glasgow coma scale (GCS) charting is required to assess the neurological progression of a person with FES. A placement of intracranial pressure monitor may be helpful to direct the treatment of cerebral odema.