Mrs. Ramirez was admitted to the hospital for wrist surgery secondary to rheumatoid arthritis. Postoperatively, she is stabilized and transferred to the general surgery unit. Mrs. Gonzalaez’s medications include digoxin, Lasix, captopril, Synthyroid, aspirin, Protonix, and prednisone. When administering morning medications, Mrs. Ramirez refuses her aspirin and prednisone, and the nurse holds the medications. Over the next 3 days, Mrs. Gonzalez continues to refuse the prednisone, and the medication is not administered. On the third postoperative day, Mrs. Ramirez becomes hypotensive, tachycardic, and has a decrease in level of consciousness. STAT labs are sent for a complete blood cell count and chemistry panel, and the physician is notified of the change in patient status. On review of the patient’s record, the physician notes that Mrs. Ramirez has not received her prednisone for 4 days. Mrs. Ramirez has been on Prednisone for the past 5 years for her rheumatoid arthritis, and the physician begins to treat the patient for acute adrenal insufficiency.
b. what risk factors does the patient have for a pulmonary embolism?
c. what measures are appropriate to manage a pulmonary embolism?
d. what measures are appropriate to help the patient in this case study to prevent the reoccurrence of a pulmonary embolism
ANSWER
b. Risk factors patient have for a pulmonary embolism.
* Pulmonary embolism can occur after surgical procedure.
* Refuse to take aspirin (Antiplatelet drug help to prevent formation of
blood clots).
* Immobility of the patient.
* Heart problems.
c. Measures to manage a pulmonary embolism.
* Administration of oxygen to relieve symptoms like dyspnea,
tachypnea,central cyanosis occur due to pulmonary embolism.
* Slow infusion of drug dobutamine which has a dilating effect on
the pulmonary vessels and bronchi.
* Continue ECG monitoring to identify dyarhythmias and right ventricular
failure which occur due to pulmonary embolism.
* Anticoagulant therapy with drugs like aspirin,warfarin to manage pulmonary
embolism.
* Thrombolytic therapy with drugs like streptokinase,alteplase to remove blood
clots.
* Surgical embolectomy if patient has massive pulmonary embolism.
d. Measures useful for this patient to prevent reoccurance of pulmonary embolism.
* Ambulation and regular exercises to prevent clot formation.
* Application of compression devices.
* Avoid prolonged sitting,standing and immobility.
* Avoid constrictive clothings.
* Avoid crossing legs and place feet on floor or chair.
Mrs. Ramirez was admitted to the hospital for wrist surgery secondary to rheumatoid arthritis. Postoperatively, she is s...
Mrs. Ramirez was admitted to the hospital for wrist surgery secondary to rheumatoid arthritis. Postoperatively, she is stabilized and transferred to the general surgery unit. Mrs. Gonzalaez’s medications include digoxin, Lasix, captopril, Synthyroid, aspirin, Protonix, and prednisone. When administering morning medications, Mrs. Ramirez refuses her aspirin and prednisone, and the nurse holds the medications. Over the next 3 days, Mrs. Gonzalez continues to refuse the prednisone, and the medication is not administered. On the third postoperative day, Mrs. Ramirez becomes...
Mrs. ramirez was admitted to the hospital for wrist surgery secondary to rheumatoid arthritis. postoperatively, she is stabilized and transferred to the general surgery unit. mrs. ramirez's medications include digoxin, lasix, captopril, synthroid, aspirin, protonix, and prednisone. when administering morning medications, mrs. ramirez refuses her aspirin and prednisone, and the nurse holds the medications. over the next 3 days, Mrs. Ramirez continues to refuse the prednisone, and the medication is not administered. on the third postoperative day, Mrs. Ramirez becomes...