A patient with a confirmed deep vein thrombosis (DVT) is started on anticoagulant therapy. Which nursing intervention is the highest priority in the initial management of this patient?

B) Monitor the patient for signs of bleeding and adjust anticoagulant dosage accordingly.

A) Encourage the patient to perform vigorous leg exercises to improve circulation.

B) Monitor the patient for signs of bleeding and adjust anticoagulant dosage accordingly.

C) Teach the patient about the importance of wearing compression stockings.

D) Educate the patient on dietary restrictions related to anticoagulant therapy.

A patient with a confirmed deep vein thrombosis (DVT) in the popliteal vein has been started on low molecular weight heparin. Which nursing intervention is most important to include in the care plan to prevent further thromboembolic events?

B) Elevate the affected leg above heart level while the patient is resting.

A) Encourage the patient to perform daily deep breathing exercises.

B) Elevate the affected leg above heart level while the patient is resting.

C) Apply warm compresses to the affected leg to reduce swelling.

D) Administer an analgesic prior to physical therapy sessions.

A patient recovering from a fracture and receiving anticoagulant therapy develops mild shortness of breath with fluctuating oxygen saturation levels. The nurse notes her hemoglobin is 10.5 g/dL and white blood cell count is 12,000/mm³. What should be the nurse's priority intervention?

A) Increase the flow of supplemental oxygen to maintain adequate saturation levels.

B) Notify the healthcare provider about the potential need to adjust anticoagulant therapy.

C) Administer a blood transfusion to address the mild anemia.

D) Encourage the patient to perform deep breathing exercises and use an incentive spirometer.

A patient recovering from a fracture is on anticoagulant therapy and now presents with mild shortness of breath and fluctuating oxygen saturation levels. Her hemoglobin level has decreased to 10.5 g/dL, and her white blood cell count is elevated at 12,000/mm³. Which nursing intervention should be prioritized to address her respiratory status?

A) Increase the patient's supplemental oxygen to maintain saturation above 95%.

B) Initiate a blood transfusion to address her decreased hemoglobin level.

D) Prepare the patient for immediate surgical intervention for suspected infection.

A 67-year-old patient with a fractured femur and developing pneumonia has her anticoagulation regimen under reassessment due to mild anemia and new antibiotic therapy. Which nursing intervention is most appropriate to prioritize in this patient's care plan to prevent further respiratory complications?

B) Encouraging incentive spirometry every hour while awake to promote lung expansion

A) Administering prescribed anticoagulants promptly to prevent clot formation

B) Encouraging incentive spirometry every hour while awake to promote lung expansion

C) Monitoring hemoglobin and hematocrit levels daily to assess for anemia

D) Initiating intravenous fluid therapy to maintain hydration and support antibiotic efficacy

A 67-year-old patient with a fractured femur is showing signs of a developing pulmonary complication, possibly pneumonia, and is on broad-spectrum antibiotics. Considering her immobility and respiratory status, which nursing intervention is most critical to prevent further respiratory deterioration?

C) Implement a schedule for incentive spirometry and deep breathing exercises.

A) Encourage the patient to consume a high-protein diet to support immune function.

B) Monitor the patient's fluid balance and adjust intake to prevent fluid overload.

C) Implement a schedule for incentive spirometry and deep breathing exercises.

D) Increase the frequency of vital signs monitoring to detect changes in status early.

A patient with a fractured femur is showing modest improvement in respiratory status but continues to experience intermittent dyspnea. Her lab results indicate a decrease in white blood cell count and an elevated CRP. Her INR is 1.8, and her hemoglobin is 10.5 g/dL. Given these findings, which nursing intervention is most appropriate to prioritize at this time?

A) Increase the frequency of respiratory assessments and adjust oxygen therapy as needed.

B) Initiate a blood transfusion to address the hemoglobin drop.

C) Encourage more aggressive physical therapy despite pain to improve mobility.

D) Decrease the anticoagulation medication due to the elevated INR.

A patient with a fractured femur is being closely monitored for respiratory and coagulation changes. Her oxygen saturation is stable at 94%, with a respiratory rate of 20 breaths per minute. Lab results show a decrease in white blood cell count to 11,000/mm³ and an INR of 1.8. Based on these findings, which nursing intervention is most appropriate to prioritize at this time?

B) Encourage the patient to perform deep breathing exercises regularly.

A) Increase supplemental oxygen to maintain a higher oxygen saturation.

B) Encourage the patient to perform deep breathing exercises regularly.

C) Administer anticoagulants immediately to prevent thrombosis.

D) Withhold physical therapy until pain is fully controlled.

A patient under your care begins to exhibit signs of confusion and mild agitation, with an elevated heart rate and slight temperature increase. Upon reassessment, her pain score has risen and her current pain management plan is under review. What is the most appropriate nursing intervention to prioritize at this time?

D) Conduct a thorough neurological assessment to determine the extent of confusion and agitation.

A) Increase the dose of her current opioid analgesic to manage her pain more effectively.

B) Administer oxygen therapy to address potential hypoxia contributing to her confusion.

C) Prepare the patient for possible nerve block intervention as discussed by the interdisciplinary team.

D) Conduct a thorough neurological assessment to determine the extent of confusion and agitation.

A patient who has been stable is now exhibiting confusion, mild agitation, and an increase in pain levels. Vital signs show a slight increase in heart rate and temperature. Which of the following nursing interventions should be prioritized to address the patient's current condition?

B) Reassess the patient's pain management plan and consider non-opioid analgesics.

A) Administer a prescribed antipyretic to reduce temperature.

B) Reassess the patient's pain management plan and consider non-opioid analgesics.

C) Increase the frequency of neurological assessments to monitor for further changes.

D) Encourage early mobilization to decrease the risk of complications.

67 yearold female, osteoporosis, fall suffered fractured femur - Nursing Case Study

Pathophysiology

• Primary mechanism: Osteoporosis leads to decreased bone density and structural deterioration, primarily due to an imbalance between bone resorption and formation. In postmenopausal women, a decline in estrogen levels accelerates bone loss, making bones more fragile and susceptible to fractures.

• Secondary mechanism: The trabecular (spongy) bone, which is prevalent in the femur, undergoes significant thinning and loss of connectivity in osteoporosis. This structural compromise reduces the bone's ability to absorb energy from impacts, increasing the likelihood of fractures from falls.

• Key complication: A fractured femur in this context can lead to significant morbidity, including impaired mobility, increased risk of further falls, and potential complications such as deep vein thrombosis or pulmonary embolism due to reduced activity during recovery.

Patient Profile

Demographics:

67-year-old female, retired teacher

History:

• Key past medical history: Osteoporosis, hypertension

• Current medications: Alendronate, Calcium and Vitamin D supplements, Lisinopril

• Allergies: Penicillin

Current Presentation:

• Chief complaint: Fall resulting in fractured femur

• Key symptoms: Pain and swelling at the site of fracture, difficulty moving the affected leg, dizziness

• Vital signs: Blood pressure 145/90 mmHg, heart rate 98 bpm, respiratory rate 22 breaths/min, temperature 37.8°C, oxygen saturation 92% on room air

Section 1

New Complications:

A few days post-admission, the patient begins to exhibit signs of new complications. She reports increased pain and swelling in the affected leg, and the nursing staff note that her leg appears warmer to the touch compared to the previous days. Upon further assessment, the patient is found to have a low-grade fever of 38.2°C, and her oxygen saturation drops slightly to 90% on room air. Blood pressure remains elevated at 150/95 mmHg, and her heart rate has increased to 105 bpm. Given her recent immobility and the fracture, there is a heightened concern for a developing deep vein thrombosis (DVT).

A Doppler ultrasound is ordered to assess for the presence of a thrombus in the veins of the affected leg. The results confirm the presence of a thrombus in the popliteal vein. The presence of DVT presents a significant risk for pulmonary embolism, necessitating immediate intervention. The medical team initiates anticoagulant therapy, starting with low molecular weight heparin, and plans to transition the patient to an oral anticoagulant as her condition stabilizes.

This new complication requires careful monitoring and adjustment of the care plan. The nursing team must prioritize the prevention of additional thromboembolic events while managing the patient's pain and facilitating safe mobilization as tolerated. The patient is educated on the importance of adhering to anticoagulation therapy and is encouraged to perform gentle leg exercises to promote circulation. The healthcare team collaborates to ensure a comprehensive approach in managing both the fracture and the associated complications, setting the stage for the next steps in her recovery journey.

Section 2

As the patient continues her recovery, the nursing team diligently monitors her response to the initiated anticoagulant therapy. Over the next 48 hours, the patient shows signs of improvement in some areas, but new challenges arise. Her leg pain decreases slightly, and the warmth over the affected area lessens, suggesting a positive initial response to the anticoagulation. However, her respiratory status becomes a growing concern. The patient begins to experience mild shortness of breath, and her oxygen saturation fluctuates between 88% to 90% on room air, prompting the use of supplemental oxygen.

In addition to her respiratory difficulties, the patient's laboratory results reveal a hemoglobin level of 10.5 g/dL, which is lower than previous readings, indicating a potential mild anemia. Her white blood cell count has increased to 12,000/mm³, suggesting an inflammatory or infectious process that requires further investigation. The team suspects a low-grade infection from the fracture site or a possible reaction to immobility and decides to perform a chest X-ray and further blood cultures to identify any underlying issues.

The team’s focus shifts to stabilizing her respiratory status while managing these new findings. They emphasize the importance of maintaining adequate oxygenation and continue encouraging deep breathing exercises and the use of an incentive spirometer. Meanwhile, plans are made to adjust her anticoagulation therapy if necessary, based on her evolving clinical picture and lab results. The complexity of her condition underscores the need for an integrated, multidisciplinary approach to address both the fracture and its complications, keeping her on the path to recovery.

Section 3

Two days following the initial concerns with her respiratory status, the nursing team notes further changes in the 67-year-old patient’s condition. Her shortness of breath has progressively worsened, prompting an increase in supplemental oxygen to maintain her saturation levels above 92%. Despite these measures, she remains somewhat tachypneic with a respiratory rate of 24 breaths per minute. The chest X-ray results return, showing scattered infiltrates suggestive of a developing pulmonary complication, possibly pneumonia, which might be secondary to her immobility and compromised respiratory effort. This finding correlates with her elevated white blood cell count, reinforcing the suspicion of an infection.

In response to these developments, the medical team initiates broad-spectrum antibiotics to address the potential pneumonia, recognizing the critical need to manage this complication swiftly. Concurrently, they decide to reassess her anticoagulation regimen, carefully balancing the risk of clot formation against the potential for bleeding, given her mild anemia and new antibiotic therapy. Continuous close monitoring of her hemoglobin levels and coagulation parameters becomes imperative to anticipate and mitigate any adverse interactions.

In parallel, the team intensifies her pulmonary care, emphasizing the importance of mobilization and respiratory exercises to enhance lung expansion and prevent further deterioration. They also consult with a physical therapist to devise a tailored plan that accommodates her fractured femur while promoting improved respiratory function. As these interventions unfold, the team remains vigilant for any signs of clinical improvement or further complications, understanding that their coordinated efforts are crucial to optimizing her recovery trajectory.

Section 4

As the team implements the new interventions, they closely monitor the patient's response over the following 48 hours. Notably, her respiratory status shows a modest improvement: her oxygen saturation stabilizes at 94% with reduced supplemental oxygen requirements, and her respiratory rate decreases to 20 breaths per minute. However, the patient continues to experience intermittent episodes of dyspnea, prompting the team to maintain vigilant surveillance.

New lab results reveal a decrease in her white blood cell count to 11,000/mm³, suggesting a potential response to the antibiotic therapy. Despite this, her C-reactive protein (CRP) remains elevated, indicating ongoing inflammation. In terms of her coagulation profile, her INR is 1.8, which is within the therapeutic range, but her hemoglobin has dropped slightly to 10.5 g/dL, necessitating continued reassessment of her anticoagulation strategy to prevent bleeding risks while managing her clotting potential.

In terms of mobility, the patient engages with the physical therapist, who reports that although her movement is limited by pain from the fractured femur, she is able to perform gentle leg exercises from the bed, which is crucial for preventing further pulmonary complications. The team decides to continue the current plan, with a focus on optimizing her pain management to facilitate more effective participation in rehabilitation activities. As the patient navigates these complex challenges, the team remains poised to adjust care strategies as necessary, always anticipating the next step in her recovery journey.

Section 5

As the team continues to monitor the patient, they notice a change in her status. Over the next 24 hours, the patient begins to exhibit signs of confusion and mild agitation, which prompts a thorough reassessment. Her vital signs reveal a subtle increase in heart rate to 98 beats per minute and a slight temperature elevation to 37.9°C. Although her respiratory status remains relatively stable, her increased agitation raises concerns about possible hypoxia or an infectious process affecting her central nervous system. The team decides to order a repeat set of blood cultures and a urinalysis to rule out any new sources of infection, given her ongoing inflammation indicated by the elevated CRP level.

In addition to these changes, the patient's pain levels seem to be fluctuating, despite the current pain management regimen. The team notes that her pain score has risen from 4/10 to 6/10, which could be contributing to her confusion and agitation. This necessitates a reevaluation of her pain management strategy. The interdisciplinary team, including the pharmacist, discusses potential adjustments to her analgesic plan to optimize her comfort without compromising her safety, particularly considering her INR and hemoglobin levels. They consider the introduction of adjunctive therapies, such as nerve blocks or non-opioid analgesics, to better control her symptoms and enable improved participation in physical therapy.

These developments prompt the team to maintain close surveillance, as they anticipate further diagnostic results and explore additional interventions. The patient's evolving condition underscores the importance of vigilant monitoring and adaptive care strategies, ensuring that each aspect of her treatment plan is aligned with her changing needs. The team remains committed to addressing her multifaceted challenges, focusing on stabilizing her current symptoms while proactively preventing potential complications that could hinder her recovery.