Question

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

#The patient is suspected to have Deep vein thrombosis

#The following data can be used to determine this condition

• Pain in calf muscle
• Edema in pectorals lower extremities
• Pedal pulse is 1+ which means the pulse is light or faint
• Increased calf circumference (inflammation )

#The priority nursing intervention for this patient are

• To administer anticoagulants as per order to relieve any blood clots
• To apply DVT stockings
• Ensure the patient is mobilised out of bed. This is the best way to prevent DVT in post operative patient as DVT is a complication after surgery due to immobilisation

#Using SBAR ,the following has to be reported to the provider

Situation :Good morning Dr. I'm nurse XX calling from post operative ward regarding your patient D. R who is complaining of pain in her left leg.

Background :D.R is a 74yr/F undergone ORIF for left femoral neck fracture on post operative day 3.She is on Morphine ( analgesics ),Lisinopril (antihypertensive) and Bisacodyl $laxative )

Assessment :The patient vitals are T:98.7,RR:20,P:64 and BP:140/68

She is having pain in her left calf muscle grading 3 in a pain scale of 1-10, Edema +, pedal pulse1+

Wound dressing intact

Last bowel movement happened before four days

Recommendation :I would recommend the patient be started on DVT prophylaxis and early mobilisation

#The diagnostic studies which can be used to study the existence ,location and intensity are

• D dimer test
• Ultrasound leg
• Venography to rule out the presence of any clothes I'd first two options fails

#The risk factors which D. R had to develop DVT are

• Post operative state
• Immobilisation due to surgery

#The measure which can be taken to prevent DVT in at risk patient are

• Early mobilisation in post operative patient
• Physiotherapy
• Passive exercise
• Blood thinners in post-op patient who has undergone limb surgery
• In case of obesity weight has to be brought into normal
• Encourage clients to avoid smoking which is a greater risk factor to get DVT.