NURS2100 ACUTE CARE NURSING 1: CASE STUDY
Deep vein thrombosis is a serious health condition often associated with fatal
consequences. The patient presents with many risk factors that increase her chances of
developing DVT. The patient has had a re-current DVT condition which could be an
indicator that she has an inheriting blood clot disorder. This disorder makes the patient’s
blood clot with ease. This inherited condition does not cause health complication, unless it is
facilitated by other associated risk factors (Aubry, Etheridge, & Couturier, 2012).
Disease pathophysiology and treatment
DVT occurs when a thrombus (blood clot) forms in one of the patients deep veins in
their body- normally in the legs. The disease pathophysiology indicates that the disease
could be arising from a triad of possible alterations in the venous system. This includes the
injury of the vessel wall, changes in blood flow patterns (venous status) and changes in blood
constituency (hypercoagulability). These changes occur due to various factors such as
pathologies, treatments and therapies. Blood vessel injury can occur due to trauma, invasive
treatments of surgery (Aubry, Etheridge, & Couturier, 2012).
Venous stasis is mainly common in patients on prolonged bed rest which causes
changes in blood circulation. Patient medication can alter the coagulation of the blood. The
most causative agent for this patient is venous stasis and hypercoagulability. Venous stasis is
suspected because the patient is old and presents with multiple comorbidities that make her
remain at rest for a long time. Hypercoagulability is suspected because the patient is under
many medications that could be interacting, affecting coaguability of blood. Additionally, the
patient smokes and uses alcohol, additional factors associated with the alterations of her
blood constituencies (Songwathana, Promlek & Naka, 2011).
Treatment of deep vein thrombosis aimed at preventing blood clotting from becoming
bigger and also to ensure that the clot does not break loose causing further complications
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such as pulmonary embolism. After this, the next goal is to ensure that risk factors that could
lead to re-current DVT are addressed. The main treatment includes blood thinners/
anticoagulant which help in decreasing the ability of the blood to clot (Dunphy et al., 2012).
The medication helps reduce risks of developing additional clots. In this case, the
patient is given an infusion of heparin (appropriate doasage) for few days. Upon discharge,
the patient is given warfarin. The patient is also given compression stockings which helps
prevent edema associated with DVT. Other treatments such as use of filters and clot-busters
will be considered if the aforementioned medication regimen fails to improve patient
condition (Kibbe, Pearce, & Yao, 2010).
Patient’s rick factors
In this regard, the patient is at high risk of recurrent DVT because of the following
risk factors. To start with, the patient has osteoporosis complication on her RT knee. This
implies that her normal lifestyle comprises of prolonged rest. When patient legs remain still
for a prolonged duration, the calf muscles fails to contract effectively to facilitate blood
circulation, this increases the likely hood of re-current DVT (Songwathana, Promlek & Naka,
2010). The patient is smokes which increases her risk of DVT. Smoking by products affects
the blood clotting and circulation, which further increases her risk for recurrent DVT.
Cardiovascular disease complications increase the risk for DVT. This is attributable to the
fact that she already has limited heart function, which exacerbates even with minor symptoms
of DVT. The age also increases risk factors for DVT. The patient is 74 years (above 60
years) which increases risk for DVT (Kibbe, Pearce, & Yao, 2010).
The patient should be educated on common indicators of the onset of DVT.
Generally, the patient experiences general body weakness. This symptom is nonspecific as
many health conditions make the patient to be generally weak (Bagot & Tait, 2012).
However, if the patient experiences oedema in the affected extremity and feels a bumpy
NURS2100 ACUTE CARE NURSING 1: CASE STUDY 3
knotty vein, she should seek medical attention immediately. The patient is likely to
experience throbbing aching pain on the affected extremity especially during movement
(Dunphy et al., 2012).
Nursing Care plans (Songwathana, Promlek & Naka, 2011);
a) Maintain tissue perfusion to manage the thrombus
b) Minimize patient paint to promote maximum patient comfort
c) Prevention of further complication
d) Providing patient education on the disease process and treatment regimen
DISCHARGE PLANS
Discharge the patient when:
a) Tissue perfusion improved in the limb affected
b) Pain and discomfort is resolved
c) Further complication is prevented
d) Disease prognosis and therapeutic needs is well understood
e) Care plan is put in place to meet further needs after discharge
Discharge item Procedure steps suggested RN
Initials
once
completed
Reconciliation
of medication
RN discusses with the patient/caregiver the post discharge
medication including the interaction and side effects.
Patient understands the alternative medications and their
consequences
Patient/caregiver given list of post-discharge medication-
pharmacists involved if necessary. Patient should call in for
any new prescriptions
Confirms medication are available in the pharmacy and
covered by patients medical cover post discharge
RN describes the benefits for medication adherence
NURS2100 ACUTE CARE NURSING 1: CASE STUDY 4
Transition
record
RN completes written transition/discharge summary
Discharge plan reconciled with the transition record and
care plan clinical guidelines
Patient
instructions
Patient/caregiver provided with simple instructions for
primary language of the patient and the care provider. The
format is individualised in a manner that patient and
caregiver understands, no use of clinical abbreviations
Patient advised not to stop or introduce new treatment
without talking to the physician
Patient/care giver is educated on the vital signs and
symptoms for recurrent DVT
Follow up Patient appointment for follow-up care is done
Patient provided with name, address, phone number of
healthcare provider, date and time is indicated. Reason for
the visit is written in a way that the patient and caregiver
understands
Patient/caregiver is encouraged to carry with them the
medication list to healthcare provider involved in delivery of
their care
Patient counselling for DVT and anti-coagulant therapy
The healthcare provider should review the disease pathophysiology describing
possible complications and their clinical manifestation. The patient is taught about the
symptoms that they should do if they experience pain, swelling tenderness, redness or other
discolouration of the affected leg, rapid pulse, shortness of breath, chest pains, coughing up
of blood and raid pulse (Schulman, 2014). These adverse reactions should be checked when
taking anticoagulants. The patient should contact her healthcare provider immediately
(Davies, Lumsden, & Vykoukal, 2011). This increases the patient/care giver knowledge base
from which they can make informed choices.
The patient should be advised to balance between activity and rest. Rest is important
as it reduces oxygen demands and nutrients demands of the compromised tissues. The risks
NURS2100 ACUTE CARE NURSING 1: CASE STUDY 5
for fragmentation of thrombus are reduced significantly. Attaining the balance is important as
it prevents further exhaustion. However, prolonged rest is dangerous too. The patient is
referred to a physiotherapist to identify the most appropriate individualized activity program
(Nyamekye & Merker, 2012).
The RN role is not only treating the disease, but to ensure that the patient obtains holistic
healing. This implies that the RN should explore the predisposing factors that could be
promoting re-current for DVT. The patient should be given more information on prescription
assistance programs if RN identifies concerns of medication cost (Moneta, 2011).
Additionally, the patient should be encouraged to stop smoking and should be enrolled in
smoking cessation programs. The patient health status requires her to sit for a prolonged time.
Therefore, RN should discuss with the patient on measures that can be used to promote blood
flow in the extremities. This includes stretching or short walking distances after every three
to four hours. The initiation of this new lifestyle will help change behaviors and will prevent
DVT re-current (Dunphy et al., 2012).
The patient/care giver should be educated on the importance of adhering to
anticoagulant medication to full treatment regimen. This helps in reducing risk factors for re-
current DVT. The patient discussion is tailored to the mode of administration. This includes
ensuring that the patient is comfortable with the parenteral agent. For oral anticoagulant that
requires monitoring of INR, the patient or care giver must be educated on monitoring
schedule and requirements. If on the course of the treatment the dosage regimen will change,
the schedule is reviewed with the patient to ensure that they understand it (Huether &
McCance, 2012). Understanding of these processes is important as it promotes cooperation of
the prescribed therapy and reduces the chances of ineffective or improper use of therapeutic
measures. This helps in promoting her safety by minimizing risks of deleterious side effects
due to inadequate therapeutic responses (Dunphy et al., 2012).
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Once the patient is discharged, they need to take steps that will help improve their
quality of life. This includes activities such as checking regular medication and treatments.
For instance, the patient under warfarin medications needs to have regular blood test to check
blood clotting (Ghanny & Crowther, 2011). Their diets should be monitored because foods
rich in vitamin K (green leafy vegetables, multivitamins, and bananas) interact with warfarin
medication by increasing prothrombin activity. The blood thinners should be taken as
directed. The patient should look out for excessive bleeding, normally a side effect for blood
thinners medications. Patient safety must be maintained to avoid activities that will cause
blood injuries. Other measures such as use of compression stockings should be used to
minimize blood clots (Carlson & Pfadt, 2012).
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References
Aubry,, F., Etheridge, F., & Couturier, Y.,(2012). Facilitating Change Among Nursing
Assistants in Long Term Care. The Online Journal Of Issues In Nursing, 18(6).
Minneapolis: Cardiotext Pub.
Dunphy, L. M., Winland-Brown, J. E., Porter, B. O., & Thomas, D. J. (2011). Primary care:
the art and science of advanced practice nursing (3rd ed.). Philadelphia, PA: F.A. Davis
Company.
Ghanny, S., & Crowther, M. (2011). Management of deep vein thrombosis diagnosed during
active labour. Thrombosis Research, 127(2), 170.
Moneta, G. (2011). Symptomatic perioperative venous thromboembolism is a frequent
complication in patients with a history of deep vein thrombosis. Yearbook Of Vascular
Surgery, 2011, 83-84
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guideline for preventing deep vein thrombosis in critically ill trauma patients.
Australasian Emergency Nursing Journal, 13(4), 148.