Question

Due: Aug 1, 2018 at 23:59

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.

1) Please provide two nursing differential diagnoses for this presentation

2) Design a short term nursing protocol

3) Design a long term care protocol to adress this patient situation.

Answer 1

1.Two nursing differential diagnoses are
1)Deep vein thrombosis
2)coronary heart disease

2.short term nursing protocol includes
-provide comfort
-oxygen supply as per ABG report
-continuous vital monitoring
-compression therapy
-positioning and excercise
-regular medication
-intake and output charting

3.Long term protocol for this patient includes
-regular medication and follow ups
-avoid alcohol to prevent the anticoagulant effectiveness
-regular exercises and elevating legs to promote circulation