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Case Study History
John Solinger is being readmitted after being discharged from the hospital 6 days ago. He sustained a left femur fracture and open reduction internal fixation with intramedullary rod was performed. He tolerated the procedure well, and his hospital course was uneventful. He was discharged home on postoperative day 2. He was seen in the office today for a follow-up appointment. He has been experiencing redness and swelling of surgical area and left lower leg pain. He has not ambulated at home since discharge. The provider assessed Mr. Solinger upon admission and documented patient care orders.
NOTE TO STUDENT:
You have 20 minutes to complete this phase.
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Upon assuming care of Mr. Solinger after his admission to the medical-surgical unit, you complete a nursing assessment.
Neurological: The patient is alert and oriented to person, place, and time. Pupils are equal at 5 mm with brisk reaction to light.
Gastrointestinal: The abdomen is soft with active bowel sounds x 4 quadrants.
Pain: He complains of left lower leg pain that he rates as 8/10. He grimaces with any movement and states the pain is worse with repositioning. He states he has not been able to relieve the pain.
Cardiovascular: The patient's apical pulse is regular; no murmur is auscultated. Radial, dorsalis pedis, and posterior tibial pulses are 2-plus and regular. Capillary refill is greater than 3 seconds to left foot and less than 3 seconds to right foot and both hands. No edema is noted.
Respiratory: Respirations are even and effortless. Breath sounds are clear throughout all lobes.
Safety: Bed in low, locked position; call light and bedside table within reach; and patient instructed to call nurse when he needs assistance. ID and falls risk bracelet on. All universal precaution measures in place.
Temperature: 100.8 degrees Fahrenheit (38.2 degrees Celsius), tympanic...
Heart rate: 94, radial...
Blood pressure: 128/74 mmHg, left arm, lying...
Oxygen saturation: spot check pulse oximetry to finger with 98% on room air...
[STUDENT ACTION: Review the admission orders. Review the Medication Reconciliation record, and document your assessment findings.]
After completing the admission assessment, you administer the ordered pain medication. While administering the medications using the 6 rights of medication administration, you take the opportunity to explain the procedure that will soon be performed by the ultrasound technician and provide information regarding pain management. You apply a warm compress to the left lower leg as ordered and start an IV to intermittent lock in the left forearm (median vein) with a 20-gauge angiocath.
[STUDENT ACTION: Document medication administration, patient teaching, and basic nursing interventions.]
When you have completed the above tasks, click Complete this Phase.
Which is a factor that would place a patient at risk for developing DVT?
Prolonged immobility or hospitalization
Trauma to veins or surgery
All of the above
All three factors such as prolonged immobility or hospitalization, Trauma to veins or surgery and obesity would cause DVT. But in the above scenario weight of the patient is not mentioned, surgery was performed well.
So the correct answer for Mr. Solinger would be first option Prolonged immobility or hospitalization.
Description: Patient got discharge after 2nd post operative day and was not moving the legs at home that suggest prolonged immobility as a risk factor for DVT.
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