Question

Scenario 2: You are assigned to care for L.J., a 70-yr old retired bus driver who has just been admitted to your medical floor with right leg deep vein thrombosis (DVT). LJ. has a 48-pack-yr smoking history, although he states he quit 2 yrs ago. He has had pneumonia several times, and frequent episodes of atrial fibrillation (A-fib). He has had 2 previous episodes of DVT and was diagnosed with rheumatoid arthritis 3 yrs ago. Two months ago, he began experiencing shortness of breath (SOB) on exertion and noticed swelling of his right foreleg (lower leg) that became progressively worse until it extended up to his groin. His wife brought him to the hospital when he complained of increasingly severe pain in his leg. A Doppler study indicated a probable thrombus in his lower leg, and he was admitted for bed rest and to initiate heparin therapy. His significant lab values were: PT 12.4 sec, INR 1.11, PTT 25 sec, Hgb 13.3 g/dl, Hct 38.9%, and cholesterol 206 mg/dl. 1. List six risk factors for DVT. Identify at least 5 risk factors that LJ. has in his history that represent his personal risk factors. 2. What is the most serious complication of DVT? 3. What is the difference between thrombus, embolus, and thromboembolus? 4. Keeping in mind LJ.'s health history and diagnosis of DVT, what are the most important recommendations you can make for L.J. after treatment of his DVT?

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Answer 1

1) The six risk factors for Deep vein thrombosis (DVT) are :-

• Previous history of DVT
• Age over 40 years
• Sitting or staying still for long periods of time
• Heart disease, lung disease, cancer, and inflammatory bowel diseases.
• Smoking, use of hormonal birth control methods, pregnancy and postpartum phase.
• Obesity and overweight

Out of the above risk factors, L.j had previous episodes of DVT. He had the lung disease Pneumonia several times. He also had frequent attacks of atrial fibrillation (heart disease). He has a smoking history. His age is more than 40 yrs ( i.e 70 yrs). He has a habit of sitting for long periods of time since he was a bus driver. These are the risk factors that L.j has in his history that represent his personal risk factors.

2) The most serious complication of DVT is Pulmonary embolism.

3) Thrombus is a hard mass of blood clot developed within the circulatory system as the final product of blood coagulation step in hemostasis.

Embolus is a mass of blood clot that moves through the blood vessels.

Thromboembolus is the mass of blood clot which can be dislodged from its site of formation and could cause serious conditions in the body by obstructing the blood flow in the blood vessels.

4) The most important recommendations which can be made for L.j after treatment of his DVT are :-

• Do not stay still for long periods of time.
• Wear loose clothes and drink lots of water
• Exercise
• Do not smoke
• Anticoagulant may be used as a precautionary measure.
• Have a control over his weight
• Use compression stockings to prevent leg swelling.
• Do not eat cholesterol rich foods and check blood pressure at regular intervals.

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