What is the primary reason for administering supplemental oxygen to the patient in this scenario?

B) To ensure oxygen saturation remains above 95%

A) To reduce the patient's anxiety

B) To ensure oxygen saturation remains above 95%

C) To decrease the patient's respiratory rate

D) To prevent the development of cyanosis

A 56-year-old female patient with a history of deep vein thrombosis presents with mild shortness of breath and light-headedness. Her initial assessment reveals stable vital signs and an oxygen saturation of 96% on room air. What is the priority nursing intervention for this patient?

C) Administer supplemental oxygen to maintain saturation above 95%

A) Start the patient on a high-calorie diet

B) Encourage the patient to ambulate frequently

C) Administer supplemental oxygen to maintain saturation above 95%

D) Provide the patient with a warm blanket to reduce anxiety

A patient with a diagnosed pulmonary embolism is receiving anticoagulation therapy with low molecular weight heparin. Which assessment finding would be most concerning to the nurse?

A) Bruising at the injection site

D) Patient reports feeling anxious

Which of the following is the primary purpose of administering low molecular weight heparin to a patient diagnosed with a pulmonary embolism?

B) To prevent further clot formation

A) To dissolve the existing clot

B) To prevent further clot formation

C) To reduce inflammation in the lungs

What is the primary reason the nursing team advises the patient to monitor for signs of bleeding while on anticoagulation therapy?

B) To detect potential complications early

A) To ensure the patient avoids physical activity

B) To detect potential complications early

C) To encourage dietary changes

D) To maintain stable blood pressure

What is a key dietary consideration for a patient on anticoagulation therapy with warfarin?

B) Limit intake of foods high in vitamin K

A) Increase intake of green leafy vegetables

B) Limit intake of foods high in vitamin K

D) Limit intake of citrus fruits

What is the primary reason for monitoring the International Normalized Ratio (INR) in a patient on anticoagulation therapy?

D) To check for signs of infection

What is the primary purpose of monitoring the INR (International Normalized Ratio) in a patient on anticoagulation therapy?

C) To ensure proper blood clotting time

B) To evaluate liver enzyme levels

C) To ensure proper blood clotting time

D) To measure blood sugar levels

A patient on anticoagulation therapy presents with dizziness and an elevated INR of 3.2. Which action should the nurse prioritize to address the patient's condition?

B) Educate the patient on potential dietary and medication interactions

A) Administer vitamin K to reverse the effects of anticoagulation

B) Educate the patient on potential dietary and medication interactions

C) Encourage the patient to increase fluid intake to manage dizziness

D) Recommend the patient to rest in a supine position to alleviate symptoms

What is the most likely reason the patient's INR is elevated in this case?

A) Increased dietary intake of vitamin K

C) Incorrect anticoagulation dosage prescribed

D) Development of thrombocytopenia

Pulmonary embolism complication - Nursing Case Study

Pathophysiology

• Primary mechanism: A pulmonary embolism occurs when a blood clot, often originating from the deep veins of the legs (deep vein thrombosis), travels to the lungs, blocking a pulmonary artery. This obstruction impairs blood flow and decreases oxygen exchange, leading to low oxygen levels in the blood.

• Secondary mechanism: The blocked artery increases pressure in the right side of the heart, as it struggles to push blood through the obstructed pulmonary circulation. This can lead to right ventricular strain and potentially heart failure if not managed promptly.

• Key complication: Reduced oxygen delivery to vital organs can result in symptoms like shortness of breath, chest pain, and dizziness, potentially leading to tissue damage and other complications if untreated.

Patient Profile

Demographics:

56-year-old female, office administrator

History:

• Key past medical history: History of deep vein thrombosis (DVT) 3 years ago

• Current medications: Low-dose aspirin daily, oral contraceptive pill

• Allergies: Penicillin

Current Presentation:

• Chief complaint: Sudden onset of mild shortness of breath

• Key symptoms: Mild chest discomfort, slight cough, light-headedness

• Vital signs: Blood pressure 118/76 mmHg, heart rate 92 bpm, respiratory rate 20 breaths per minute, temperature 98.6°F, oxygen saturation 96% on room air

Section 1

Initial Assessment Findings:

Upon arrival at the hospital, the nursing team conducted a thorough assessment of the 56-year-old female patient who presented with mild shortness of breath. The initial evaluation focused on her respiratory and cardiovascular systems, given her history of deep vein thrombosis and the suspicion of a pulmonary embolism. The patient appeared alert and oriented, though slightly anxious, likely due to her difficulty in breathing. Her skin was warm and dry, and there were no signs of cyanosis. Lung auscultation revealed clear breath sounds with no wheezing or crackles, but there was a noticeable increase in her respiratory effort, consistent with her reported breathlessness. Cardiac examination showed a regular rhythm, with no murmurs or gallops detected.

The nursing team also noted the patient's recent symptoms of mild chest discomfort and light-headedness. Her vital signs remained relatively stable with a blood pressure of 118/76 mmHg, heart rate of 92 bpm, respiratory rate of 20 breaths per minute, and oxygen saturation of 96% on room air. Despite her stable vitals, the patient reported that her mild chest discomfort was constant but not worsening. Given her history of DVT and current symptoms, the nursing team prioritized obtaining further diagnostic tests, including a D-dimer test and a computed tomography pulmonary angiography (CTPA), to confirm the diagnosis of a pulmonary embolism and assess the extent of the clot.

These initial assessment findings prompted the nursing staff to implement immediate interventions, focusing on maintaining the patient's oxygenation and monitoring for any changes in her condition. The patient was placed on supplemental oxygen to ensure her oxygen saturation remained above 95%, and an intravenous line was established for potential medication administration. Additionally, the team educated the patient about the importance of reporting any changes in her symptoms, such as increased chest pain or worsening shortness of breath, as they awaited further diagnostic results to guide treatment. This careful monitoring and patient education aimed to prevent further complications and ensure prompt intervention if her condition were to change.

Section 2

Following the initial assessment, the nursing team received the results of the D-dimer test, which returned elevated levels, suggestive of the presence of a clot. This result, combined with the patient's clinical presentation and history of deep vein thrombosis, increased the suspicion of a pulmonary embolism. The subsequent computed tomography pulmonary angiography (CTPA) confirmed the diagnosis, revealing a small embolus lodged in a peripheral branch of the pulmonary artery. The finding of a small clot was reassuring in terms of severity, aligning with the patient's relatively stable condition and minor symptoms.

Given these diagnostic results, the nursing team continued to focus on maintaining the patient's stability while initiating treatment. Anticoagulation therapy was started promptly, with low molecular weight heparin administered subcutaneously to prevent further clot formation. The patient tolerated the treatment well, reporting no new symptoms, and her vital signs remained stable. Her blood pressure was 116/74 mmHg, heart rate 90 bpm, respiratory rate 18 breaths per minute, and oxygen saturation was maintained at 97% with supplemental oxygen. The nursing staff continued to monitor her closely for potential side effects of the anticoagulation therapy, such as bleeding or bruising.

The patient responded positively to the interventions, with a gradual improvement in her symptoms. Her anxiety decreased as she was reassured by the nursing staff about the effectiveness of the treatment plan and the mild nature of the embolism. Education was provided about the importance of medication adherence and lifestyle modifications to prevent future thrombotic events, such as staying active and maintaining hydration. As the patient's condition remained stable, plans were made for her safe transition to outpatient care with follow-up appointments to monitor her progress and adjust her anticoagulation regimen as needed. This transition marks a critical step in her recovery, emphasizing the importance of continuity of care and patient education in managing her condition.

Section 3

As the patient continued to respond well to the anticoagulation therapy, the nursing team observed a notable improvement in her respiratory status. Her breathing pattern became more regular, and she reported a decrease in the mild chest discomfort she initially experienced. The supplemental oxygen was gradually reduced, and the patient maintained an oxygen saturation level of 98% on room air. Her vital signs remained stable: blood pressure at 114/72 mmHg, heart rate at 88 bpm, and respiratory rate at 16 breaths per minute. The patient expressed relief and optimism about her recovery, which was supported by her improving clinical status.

In preparation for her transition to outpatient care, the nursing team focused on reinforcing patient education about anticoagulation therapy. The patient was informed about the importance of recognizing signs of bleeding, such as unusual bruising or prolonged bleeding from minor cuts, and was advised to report these symptoms promptly. The team also reviewed lifestyle modifications, emphasizing exercises like walking, which could be incorporated into her daily routine to improve circulation and reduce the risk of future thrombotic events. Additionally, dietary considerations were discussed, particularly regarding vitamin K intake, to ensure therapeutic levels of anticoagulation were maintained.

With these educational components in place, the patient felt confident about managing her condition at home. A follow-up appointment was scheduled to reassess her progress and make any necessary adjustments to her treatment plan. This planned follow-up ensures continuity of care and provides an opportunity for the healthcare team to evaluate her response to the outpatient regimen, reinforcing the critical role of ongoing monitoring in preventing further complications. The patient was discharged with clear instructions and contact information for any concerns, marking a positive step forward in her recovery journey.

Section 4

A few weeks after the patient was discharged, she returned for her scheduled follow-up appointment. During the initial assessment, the nursing team noted that the patient was in good spirits and reported feeling much better overall. She had been adhering to her anticoagulation therapy without any major issues and had successfully integrated the recommended lifestyle changes, including regular walking and monitoring her diet for vitamin K intake. Upon examination, her vital signs remained stable, with a blood pressure of 116/74 mmHg, heart rate of 82 bpm, and a respiratory rate of 18 breaths per minute. Her oxygen saturation was consistently at 98% on room air. The patient had no complaints of chest discomfort, and her breathing pattern continued to be regular and unlabored.

Lab results from her visit revealed that her INR (International Normalized Ratio) was within the therapeutic range at 2.5, confirming effective anticoagulation management. There were no signs of bleeding or adverse reactions to her medication. The nursing team took this opportunity to reinforce the importance of routine INR monitoring and maintaining her current regimen to prevent potential complications.

As the patient prepared to leave, the healthcare team ensured she had a clear understanding of her current health status and the need for continued vigilance in recognizing any signs of bleeding or other complications. They reminded her to keep all follow-up appointments and maintain open communication with her healthcare providers. With her recovery progressing well, the patient felt reassured and empowered to continue managing her condition effectively at home. This successful follow-up visit marked another positive milestone in her journey, highlighting the critical role of patient education and adherence in achieving favorable outcomes in managing pulmonary embolism.

Section 5

Two weeks later, the patient returned for another routine follow-up appointment. During the initial assessment, the nursing team observed that the patient appeared slightly anxious compared to her previous visit. She reported experiencing some mild, occasional dizziness over the past few days, particularly when standing up too quickly. However, she denied any chest pain, shortness of breath, or changes in her usual level of activity. Her vital signs remained stable, with a blood pressure of 112/70 mmHg, heart rate of 78 bpm, and respiratory rate of 18 breaths per minute. Her oxygen saturation was still at 98% on room air, and her breathing pattern was regular and unlabored.

Given these new symptoms, the healthcare team ordered a complete blood count (CBC) and a repeat INR test. The lab results showed that her INR was slightly elevated at 3.2, which could explain the episodes of dizziness. Her hemoglobin and hematocrit levels were within normal limits, indicating no significant blood loss or anemia, and her platelet count was normal, ruling out thrombocytopenia. The nursing team suspected that the recent increase in INR might be due to a temporary dietary change or an interaction with a new over-the-counter medication, which the patient confirmed she had started taking for a mild cold.

In response to these findings, the healthcare team provided additional education on potential interactions with her anticoagulation therapy and emphasized the importance of consulting her healthcare provider before starting any new medications. They adjusted her anticoagulation dose slightly to bring her INR back within the target range and arranged for more frequent INR monitoring until her levels stabilized. Reassured by the clear guidance and support from her healthcare team, the patient felt confident in managing her condition and promptly scheduled her next follow-up visit to ensure continued monitoring and adjustment of her treatment plan.