IN-CLASS CASE STUDY

Patient Profile
D.R. is a 74-year-old obese Hispanic woman who is in the third postoperative day after an open
reduction internal fixation (ORIF), for repair of a left femoral neck fracture after a fall at home.

Subjective Data
● States pain in her left hip is a 4 to 5 on a 1-to-10 scale
● States pain in her left calf area is a 3 on a 1-to-10 scale

Objective Data
Physical Examination
● Vital signs: blood pressure 140/68, pulse 64, temperature 98.7° F, respirations 20
● Oxygen saturation 93% on room air
● Lungs clear all lobes
● Bowel sounds are present in all four quadrants
● Apical pulse: 64, irregular

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● Alert and oriented to person, place, and time

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● Skin warm to touch bilateral lower extremities, slight erythema left lower extremity

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● No edema right lower extremity, 2+ left lower extremity
● Pedal pulses 3+ right lower extremity, 1+ left lower extremity

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● Calf circumference: right, 8 cm; left, 10 cm
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● Left hip wound has staples; no signs or symptoms of infection
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● Last bowel movement was four days ago
Interprofessional Care
Medication Administration Record
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● Morphine sulfate 2 mg IVP every two hours as needed for pain scale 6-10
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● Lisinopril 20 mg PO daily
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● Bisacodyl 10 mg PO daily

Discussion Questions
1. What do you suspect is occurring with D.R.? What data were used to make this determination?
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leg).
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Deep Vein thrombosis.

Patient recently had surgery on her left hip area. The patient has unilateral swelling to left calf
distal to the surgery site. The patient is experiencing pain, redness and warmth of the leg. The
patient oxygen saturation level is 93% which is not critical, but it is lower. Could be experiencing
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a pulmonary embolus.
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2. What are the priority nursing interventions at this time?

Elevate the foot of the bed and place compression stockings on the patient. Call the physician.
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3. Using SBAR, what would you report to the provider?

Report the symptoms the patient is experiencing, such as pain levels and feeling of numbness, report
the background history of recent surgery repair and what the admitting diagnosis is for the patient,
report the assessment, such as the unilateral edema, warmth, O2 levels, vital signs, and medications

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 patient is currently on, suggest recommendations for the patient such as placing them on
anticoagulant therapy.

4. What diagnostic studies would be used to determine the existence, location, and extent of a
DVT?
Use a venous duplex scanning device uses high-frequency sound waves to provide a picture of the blood
flow through a blood vessel, and a doppler flow study can be used to produce an audible sound when
venous circulation is normal and little or no sound when veins are thrombosed.

5. What risk factors for development of a DVT does D. R. have?

The patient is 74 years old, recently had surgery, is female, and she had a recent fall.

6. What measures can be taken to prevent a DVT in an at-risk patient?

Place EPC cuffs on the patient postoperatively, utilize range of motion exercises, apply compression
stockings, elevate the foot of the bed, and change positions often. The patient may be placed on

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anticoagulant therapy as well.

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Case Study Progression

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D.R. is diagnosed with a DVT in the left lower extremity.
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7. What treatment do you anticipate for D.R.?
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D.R. will be placed on heparin therapy and warfarin therapy. They will be done simultaneously until
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warfarin has reached therapeutic levels, which takes 2-5 days.

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8. What is the most serious complication of a DVT and how would you monitor D.R. for this
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complication?
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The most serious complication is a pulmonary embolism which occurs when the clot breaks off and
travels to the lungs. Monitor for manifestations such as dyspnea, pleuritic chest pain, restlessness,
feelings of impending doom, cough, crackles, pleural friction rub, low grade fever, petechiae over the
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chest, and a decreased arterial oxygen saturation. Monitor for this by having a D-dimer test completed.
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