Class – Case study 27B
Tracey Canada
33 unread replies.33 replies.
Instructions:
Please complete the following case study: Chapter 27 Patient with Pulmonary Embolism and Respiratory Failure; and submit your assignment here by the due date.
Answers to objectives must be in your own words, you will receive a zero for copy and pasting
Cite all references. References must be from a Medical Surgical Nursing Textbook
Please reply by evaluating 1 other students’ post; what you learned or add additional relative information
Overview
Pulmonary embolism (PE) is a thrombotic occlusion of the pulmonary arterial system resulting in complete or partial obstruction of the arterial blood flow to parts of the lung. The lung continues to be ventilated but is not perfused because of the obstruction. A PE may consist of a blood clot (thrombus), fat, air, or tumor tissue. Most pulmonary emboli arise from deep vein thrombosis (DVT) in the deep veins of the legs. Once dislodged, the thrombus is carried to the right side of the heart and into the pulmonary vasculature, where it becomes lodged in progressively smaller arteries. Venous thromboembolism (VTE) is the preferred terminology to describe the spectrum of pathology from DVT to PE.
Clinical manifestations of PE are dependent on the size and extent of emboli. Dyspnea is the most common presenting symptom. The goals of interprofessional care are to (1) prevent further growth or multiplication of thrombi in the lower extremities, (2) prevent embolization from the extremities to the pulmonary arteries, and (3) provide cardiopulmonary support if indicated.
Objectives
Prioritize nursing care of a patient displaying respiratory distress.
Evaluate diagnostic test results for a patient experiencing a pulmonary embolism.
Discuss interprofessional care of a patient with a pulmonary embolism.
Describe the pathophysiology underlying respiratory failure.
Formulate a nursing plan of care for a patient with endotracheal intubation and mechanical ventilation.
Evaluate laboratory results related to heparin therapy.
Identify relevant assessment data related to complications of pulmonary emboli.
Describe drug management of a patient with pulmonary hypertension.
Appropriately delegate care for a patient with a pulmonary embolism.
Case Study
M.W. is a 55-year-old interior decorator who suffered a stable fracture of the pelvis in a motor vehicle crash 4 days ago. Her past medical history is positive for osteopenia and hypothyroidism. She has multiple areas of soft tissue trauma to her legs, as evidenced by large hematomas over the entire left leg and right thigh. She also has several facial fractures from hitting the steering wheel during the crash. She is being treated by immobilization with bed rest. Her medication orders include enoxaparin 40 mg subcutaneously daily, levothyroxine 100 mcg daily, alendronate 70 mg PO weekly, oxycodone/acetaminophen 2 tablets q4hr prn, and psyllium (Metamucil) 2 tsp twice a day.
Your morning assessment findings include the following: blood pressure 128/82 mm Hg, heart rate 82 beats/min, respiratory rate 16 breaths/min, and temperature 98.2°F (36.8°C); awake, alert, and oriented ×3; swelling and ecchymoses noted on right side of face; lung sounds clear but decreased in lower lobes bilaterally; normal S1 and S2 heart sounds; bowel sounds active in all four quadrants; moves her lower extremities with difficulty; states pain is at an acceptable level but says her legs are very sore; pedal pulses 2+ bilaterally; 1+ edema around both ankles; legs warm and ecchymotic. She is eating a regular diet and drinks fluids well.
NOTE
Please the actual assignment is to answer all questions on the objectives. Please feel free to ask me any questions or clarifications.
