Question

Case Study-Deep Vein Thrombosis

Melody Smith is a 57-year old, 1 ½ pack per day (PPD) smoker. She works as a secretary in a legal office. When Melody woke this morning she noticed that she was experiencing right calf pain and some slight swelling. She also noticed that her calf was warm to the touch. Melody decided to go to her primary healthcare provider’s office for advice.

Data obtained from the nursing assessment includes the following information:

• Vital signs: B/P 130/78, HR 94, RR 20, Temp. 100.8 F
• Lungs sound clear
• Heart sounds S1, S2, present, clear, & audible
• ECG shows an atrial fibrillation

Melody’s provider orders a PTT, PT, and INR; WBC, platelet count, and an ultrasound of the right lower leg.

It is confirmed that she has a deep vein thrombosis and she is admitted to the hospital.

After 3 days in the hospital receiving heparin IV, the provider orders oral warfarin (Coumadin) for discharge and a weekly PT and INR test.

QUESTIONS

1. What are the contributing factors that led to the development of Ms. Smith’s DVT?
2. What is the significance of the weekly blood work?
3. What are possible complications if the DVT is not treated?
4. What patient education will need to be done?

Answer 1

Contributing factors

In these case clearly explained that smith is a "chronic smoker".Smoking is a main risk factor for developing DVT.In case of smokers the blood is more "sticker" which can easily develop DVT.That may developed symptoms like calf muscle pain, swelling, unable to stand prolonged period, twitching sensation.

Other isk factor are heredity, prolonged bed stay, paralysis patient, pregnancy, over weight.

Blood investigation :

Weekly blood investigation like PT, INR, APTT will gives idea regarding dose adjustments of oral Warfarin. And also how the oral blood thinners effective. Could be maintain INR level in a normal parameters other wise patient chance to high risk for bleeding. If the client must check and inform the concern certified doctors.

Complications of DVT:

Main complications are;

Pulmonary embolism :

The blood clots are dislodge and travel toblung and block a major blood vessel that may leads to pulmonary embolism. Patient may occur sudden breathing difficulty, chest pain, sweating. It's a major complication of DVT.

Venous insufficiency and post traumatic syndrome :

It can occur when the lower limb veins are damaged and unable toto fuction normally. Which can leads to slowdown venous return, and that may leads to pooling of blood there itself. Leads to pain, swelling. In post tramatic syndrome persist may leads to ulcer & wound.

Patient education :

* Explain detaily about the importance of blood thinners. Continue oral warfarin daily as per doctors order. Don't skip the medication unless doctors order. The blood thinners not been break the clots and it's prevent development of new clots and reduce risk for reoccurrence.

* Stockings :lower limb stockings are available could reduce the chance to develope new clots.

* Early ambulatiion promoted. Bt not being done strained activities.

* Explain the risk for bleeding. Because of the use of blood thinners. In case any sign of bleeding like oral bleeding, nose bleeding should inform to the doctors.

* If the client slip & fall or took treatment for any other secondary disease should inform the concern doctor regarding she is regularly taken warfarin.

* Done daily activities as much as possible.

* proper followup with the health care providers.

* weekly blood test must be done to prevent further complications associated with oral warfarin.