Which of the following interventions is most appropriate for a nurse to implement to prevent further clotting in a patient suspected of having deep vein thrombosis (DVT)?

B) Promote hydration and mobility

C) Apply cold compresses to the affected leg

D) Administer aspirin immediately

Based on the initial assessment findings, which intervention should the nurse prioritize for a patient suspected of having deep vein thrombosis (DVT)?

C) Elevate the affected leg above heart level

A) Encourage the patient to ambulate frequently

B) Apply a warm compress to the affected leg

C) Elevate the affected leg above heart level

D) Massage the affected leg gently to relieve pain

What is the primary purpose of initiating anticoagulation therapy in a patient diagnosed with deep vein thrombosis (DVT)?

B) To prevent the thrombus from growing and causing complications

A) To dissolve the existing thrombus

B) To prevent the thrombus from growing and causing complications

C) To improve circulation in the affected leg

D) To immediately relieve the patient's pain and swelling

What is the primary purpose of administering low molecular weight heparin (LMWH) to a patient diagnosed with deep vein thrombosis (DVT)?

B) To prevent the formation of new clots

A) To dissolve the existing thrombus

B) To prevent the formation of new clots

C) To enhance platelet aggregation

Which of the following indicates a positive response to anticoagulation therapy in a patient with deep vein thrombosis (DVT)?

B) Decrease in swelling and pain

A) Increase in leg circumference

B) Decrease in swelling and pain

C) Development of unusual bruising

Which of the following actions should the nurse prioritize when educating the patient about transitioning to oral anticoagulants for long-term management?

B) Instruct the patient to monitor for signs of bleeding

A) Emphasize the importance of regular physical exercise

B) Instruct the patient to monitor for signs of bleeding

C) Advise the patient to increase dietary intake of vitamin K-rich foods

D) Recommend discontinuing anticoagulant therapy if side effects occur

Which of the following is a primary responsibility of the nurse when a patient is transitioning from intravenous to oral anticoagulation therapy?

A) Educating the patient on potential side effects of oral anticoagulants

B) Ensuring the patient receives a flu vaccine before discharge

C) Scheduling the patient's follow-up MRI scan

D) Providing the patient with a list of local pharmacies

Which of the following findings in the patient's assessment most strongly indicates that the oral anticoagulant therapy is effective?

B) Therapeutic INR level of 2.5

A) Blood pressure of 120/78 mmHg

B) Therapeutic INR level of 2.5

C) Heart rate of 76 beats per minute

D) Oxygen saturation of 98% on room air

blood clots in legs and lungs - Nursing Case Study

Pathophysiology

• Primary mechanism: Blood clots in the legs, known as deep vein thrombosis (DVT), often form due to sluggish blood flow, which can occur during prolonged immobility. This slow flow increases the likelihood of clot formation.

• Secondary mechanism: Injury to the blood vessel walls, or hypercoagulability (an increased tendency for blood to clot), can further promote clot development. This might be due to surgical procedures, certain medications, or genetic factors.

• Key complication: If a clot from the leg travels to the lungs, it can cause a pulmonary embolism (PE), blocking blood flow in the lungs. This can lead to symptoms like shortness of breath and chest pain, and requires prompt medical attention to prevent severe complications.

Patient Profile

Demographics:

45-year-old female, office worker

History:

• Key past medical history: Varicose veins, occasional migraines

• Current medications: Oral contraceptive pill, ibuprofen as needed for migraines

• Allergies: Penicillin

Current Presentation:

• Chief complaint: Swelling and discomfort in the left leg

• Key symptoms: Mild leg pain, shortness of breath on exertion, slight cough

• Vital signs: Blood pressure 120/80 mmHg, heart rate 82 bpm, respiratory rate 18 breaths/min, temperature 98.6°F, oxygen saturation 97% on room air

Section 1

Initial Assessment Findings:

Upon further assessment, the nurse observes that the patient's left leg is visibly more swollen compared to the right, with mild erythema and warmth to touch. The calf is tender upon palpation, which aligns with the suspicion of deep vein thrombosis (DVT). The patient reports the leg pain as a 4 out of 10 on the pain scale, indicating mild discomfort that increases with movement. Her respiratory assessment reveals that while resting, she maintains an oxygen saturation of 97% on room air, but experiences mild dyspnea upon exertion, such as walking across the room. Heart and lung auscultation are unremarkable, with no abnormal heart sounds or wheezes noted. The nurse records these findings to inform the physician and guide further diagnostic testing, such as a Doppler ultrasound to confirm DVT and a D-dimer test to assess for any elevated clotting activity.

In considering the patient's history of varicose veins and use of oral contraceptives, the nurse recognizes these as risk factors that may have contributed to her current condition. The patient’s overall stability, reflected in her vital signs and mild symptom presentation, suggests an early-stage DVT without severe complications. The nursing team focuses on educating the patient about the importance of mobility and hydration to prevent further clotting, while preparing her for potential anticoagulation therapy to dissolve the existing clot and prevent pulmonary embolism.

These initial findings and interventions set the stage for monitoring the patient’s response and any changes in her condition, while ensuring she understands the significance of adhering to prescribed treatments and lifestyle modifications to reduce the risk of future clots.

Section 2

New Diagnostic Results:

The physician orders a Doppler ultrasound to confirm the presence of deep vein thrombosis (DVT) in the patient's left leg. The results reveal a thrombus in the proximal segment of the left popliteal vein, confirming the nurse’s initial suspicion. Alongside the ultrasound, a D-dimer test is conducted, returning a significantly elevated value of 1,200 ng/mL (normal range: less than 500 ng/mL), indicating increased clotting activity. These findings verify the presence of a clot and suggest that the patient's condition requires prompt management to prevent further complications such as pulmonary embolism.

Following the diagnostic results, the healthcare team initiates anticoagulation therapy with low molecular weight heparin to start addressing the clot. The patient is educated on the potential side effects of anticoagulants, such as bleeding, and is instructed to report any unusual bruising or bleeding immediately. The nurse emphasizes the importance of adhering to the treatment plan and discusses lifestyle modifications, such as avoiding prolonged immobility and staying hydrated, to reduce the risk of additional clot formation. The patient's vitals remain stable, with a blood pressure of 118/76 mmHg, pulse of 78 bpm, and temperature of 98.6°F, indicating her current stability and readiness to manage her condition with appropriate interventions.

These results and subsequent actions set the stage for monitoring the patient's response to the anticoagulation therapy. The nursing team will continue to assess for signs of improvement in her symptoms, such as reduced leg swelling and discomfort, while remaining vigilant for any new signs of complications. This approach underscores the importance of ongoing evaluation and patient education in managing early-stage DVT effectively.

Section 3

As the nursing team continues to monitor the patient, they observe her response to the anticoagulation therapy. Within the first 48 hours, the patient reports a noticeable decrease in the swelling and discomfort in her left leg, suggesting a positive response to the treatment. The nurse conducts an assessment and notes that the circumference of the patient's left calf has reduced by 2 cm compared to the initial measurement, indicating a reduction in edema. The patient also confirms she is experiencing less pain and is able to ambulate with more ease than before.

Vital signs are reassessed to ensure the patient's stability during the course of treatment. Her blood pressure remains stable at 116/74 mmHg, pulse at 76 bpm, and temperature at 98.7°F. The nurse checks for any signs of bleeding, such as unusual bruising or bleeding gums, which could indicate complications from the anticoagulation therapy. No such signs are observed, and the patient reports no unusual bleeding. The nurse reviews the patient's prothrombin time (PT) and international normalized ratio (INR), which are within the therapeutic range, further confirming the effectiveness of the anticoagulation therapy without excessive risk of bleeding.

The nursing team continues to reinforce the importance of lifestyle modifications, such as regular ambulation and adequate hydration, to prevent further clot formation. The patient expresses understanding and commitment to following the care plan. With signs of improvement and stability, the team prepares to evaluate the next steps in her treatment plan, including transitioning to oral anticoagulants for long-term management once her condition is deemed stable enough. This ongoing assessment and adaptation of the care plan are crucial as the patient progresses through her recovery from DVT.

Section 4

As the nursing team continues to monitor the patient, they decide to conduct a follow-up Doppler ultrasound to assess the status of the blood clot in her left leg. The results indicate that the clot has reduced in size, a promising sign that the anticoagulation therapy is effectively breaking down the thrombus. The team also orders a chest X-ray to evaluate the condition of the patient's lungs, given her initial presentation of a suspected pulmonary embolism (PE). The X-ray reveals no new infiltrates, and the patient reports improved respiratory comfort, with no shortness of breath or chest pain, suggesting the absence of significant pulmonary complications.

To ensure the patient’s continued stability and address any potential for new complications, the nursing team closely monitors her oxygen saturation levels, which remain steady at 98% on room air. Her respiratory rate is a regular 18 breaths per minute, further supporting the absence of respiratory distress. Blood tests show that her D-dimer levels are decreasing, indicating a reduction in clot activity and the effectiveness of the ongoing treatment. Throughout this phase, the patient is encouraged to report any new symptoms, such as sudden pain or difficulty breathing, which could signal complications like re-thrombosis or PE reoccurrence.

In light of the positive diagnostic results and the patient's stable condition, the medical team discusses transitioning her to oral anticoagulants for long-term management. This change is aimed at maintaining therapeutic anticoagulation while allowing her to recover at home. The patient is educated on the importance of medication adherence, recognizing signs of bleeding, and maintaining follow-up appointments to monitor INR levels. As she prepares for discharge, the nursing team ensures she is equipped with the knowledge and resources needed to continue her recovery safely, setting the stage for her next steps in managing her condition.

Section 5

A few days after the transition to oral anticoagulants, the patient returns for a follow-up appointment, where the nursing team conducts a thorough initial assessment to evaluate her current status. Upon arrival, the patient appears alert and oriented, with no signs of acute distress. Her vital signs are stable: blood pressure is 120/78 mmHg, heart rate is 76 beats per minute, respiratory rate remains at 18 breaths per minute, and her oxygen saturation is consistently at 98% on room air. She reports feeling well and is pleased with the absence of leg pain and the improvement in her breathing. During the physical examination, the nurse notes that there is no swelling or tenderness in the left leg, suggesting continued resolution of the deep vein thrombosis. The patient's lungs are clear upon auscultation, further supporting the absence of respiratory complications.

The nursing team reviews the results of her recent lab work, which indicate a therapeutic INR level of 2.5, confirming that the oral anticoagulants are effectively maintaining anticoagulation. Her hemoglobin and hematocrit are within normal limits, and platelet count is steady, showing no signs of bleeding or platelet abnormalities. The patient demonstrates understanding of her medication regimen and the importance of adhering to it to prevent clot recurrence. She is also able to articulate the warning signs of potential complications, such as sudden leg swelling, chest pain, or significant changes in her respiratory status.

With these encouraging findings, the nursing team feels confident in the patient's ability to manage her condition at home. They reinforce the need for regular INR monitoring to ensure her safety while on anticoagulants. The patient is encouraged to maintain an active lifestyle, with guidance to avoid prolonged immobility and to stay hydrated, which can further reduce her risk of clot formation. The nursing team schedules her next follow-up appointment and provides contact information for any questions or concerns that may arise. With a solid plan in place, the patient is well-prepared to continue her recovery journey successfully.