DVT: A Case Study Essay

HISTORY OF PRESENT ILLNESS: Mr. Barua is a 42-year-old gentleman from Bangladesh who presents with chest tightness, shortness of breath, and tachycardia. Dr. J.K. McClain of cardiology is evaluating his heart condition. The patient has had the recent onset of hemoptysis. He was treated for tuberculosis in Bangladesh 15

other intense tests can be done to make the diagnosis much clearer such as Doppler echocardiogram, this uses sound waves to show the function of the right ventricle to measure the blood flow through the heart valves, and then calculate the systolic pulmonary artery pressure. There is also an X-ray, this is done on the chest. This can show any increase or decrease in size of the right ventricle and arteries. A simpler test such as the 6-minute walk test, this controls exercise patience level and blood oxygen saturation level during exercise. There is also a Pulmonary function test, this seeks for other lung conditions such as chronic obstructive pulmonary disease and idiopathic pulmonary fibrosis compared to others. Also there is a 'Polysomnogram or overnight oximetry', this monitors sleep apnea (results in low oxygen levels at night). Also a right heart catheterization, this measures various heart pressures ( inside the pulmonary arteries, coming from the left side of the heart), the rate at which the heart is able to pump blood, and finds any leaks between the right and left sides of the heart.

PHYSICAL EXAM: Temperature 98.6, Blood pressure 140/90. Pulse 110. Respirations 26. Her lungs are clear, showing mild signs of distress. Heart sounds are normal, irregular rhythm and bradycardia noted. No edema noted in extremities. Patient skin is cool to touch, slightly clammy. EEG shows prolonged QRS wave, with ischemic ST changes and PVCs. Chest radiograph clear.

With suspicion of a DVT or PE, I would order the D-dimer with other baseline labs such as CBC and CMP. I would verify with the physician or CT tech that imaging needed to be done with contrast to be of value. I am aware that in some hospitals, the physicians aren’t as involved with the nurses, and discourage the nurses to order or even suggest things to them. But if it was my patient, and I knew the patient wasn’t getting the attention they deserved, it would be my job to advocate for them. If my suggestions to the physician were ignored, I would document thoroughly and inform a supervisor of the

DVTs usually occur within the deep veins of the lower leg. The DVTs that remain in the lower leg and calf tend to be asymptomatic and do not become clinically significant. A DVT is most likely to present symptoms when the proximal leg veins are involved and also when the DVT obstructs venous outflow resulting in inflammation of the vein wall (Bonner and Johnson, 2014). Warmth, redness, pain and swelling in the affected limb are common symptoms of a DVT. If a patient presents with these symptoms, a physical examination of the whole limb should be undertaken by a nurse or physician to observe for signs suggestive of a DVT. Suggestive symptoms of DVTs include superficial venous dilation, tenderness along the course of the vein, unilateral leg oedema, cyanosis, warmth and erythema (Bonner and Johnson, 2014). On examination of the limb, these are the symptoms that the nurse or physician should be looking out for, however, diagnosis on clinical presentation alone is extremely difficult as these symptoms are not specific to DVT and can be present in numerous other conditions. To improve accuracy when determining the probability of a DVT, nurses are advised to use the two level DVT Wells score. Each clinical feature is accompanied with a score. If a patient presents with a score that is two points or higher, it is likely that a DVT is present and

Shortness of breath and sudden chest pain are the primary symptoms. The chest pain is typically localized to the affected side. Tiredness may also be a symptom.

The physician will complete a thorough exam. He/she will listen to the heart and lungs looking for signs of heart failure. Gallops, rapid heartbeats, and murmurs of the heart valves may be heard. The physician will palpate the abdomen to feel if the liver is enlarged. He/she will also check the skin and nail beds on fingers and

Symptoms of pulmonary hypertension do not usually occur until the condition has progressed. The first symptom of pulmonary hypertension is shortness of breath with everyday activities, such as climbing stairs. Fatigue, dizziness, and fainting spells can also be symptoms. Swelling in the abdomen, ankles or legs, bluish lips and skin, and chest pain may occur as strain on the heart increases. Symptoms range

tissue can be removed and examined, or an x-ray to examine for pulmonary edema, fluid

Deep Vein Thrombosis, often referred to as DVT, is the formation of a solid blood clot in a vein or artery, similar to a normal blood clot, which occurs due to external injury or skin abrasion near the surface of the skin. There are significantly greater risk factors with a DVT than an external clot as the internal clot can stop the flow of blood to organs and extremities. Severe cases can cause clots to break off and travel through the blood stream to the heart, lungs or brain where it can cause permanent damage or death. “The diagnosis of DVT in children is complicated by the widely diverse locations in which clots occur, the small size of the patients, the variety of underlying disorders, and the lack

Deep vein thrombosis (DVT) is a disorder that occurs when a blood clot forms in a vein that is deep inside the body. It is mainly associated with veins in the legs, usually in the lower leg and thigh, but may occur in other parts of the body. About half of the people who have DVT show no symptoms, but people who sit for long periods, are over 60 and smoke are at higher risk, and should be aware of possible signs of a problem.

A: Janie is a 60 year old Female with PMH of A-Fib, COPD, Hypothyroidism, HTN, Lung Cancer and recently diagnosed Pulmonary Embolism. Janie presents to ER for evaluation on SOB, cough with greenish sputum, sore thoart, hoarseness and generalized weakness. Janie lives at home with her husband, use to smoke ½ pack per week, but quit many years ago, denies alcohol or drugs. Family history is non-contributory. Allergies: NKDA. Differential diagnosis includes worsening Lung Ca, PE, COPD and CHF. Janie uses home O2 at 4 L/NC. V/S: T=98.7, HR=89, R=16, B/P=132/56, O2 sats=100% on 4L/NC, Pain=6/10. Labs: WBC=7.6, H&H=8.5/27, Na=141, Troponin=0.08/0.06, BNP=495, INR=4.2, UA=3+ protein, 1+ blood and 6-10 RBC. CXR: Impression:1). COPD with nonspecific coarsening of the basilar interstitium. 2). Mild cardiomegaly with borderline cardiac compensation. 3). Right

Most common presenting signs are dyspnea at rest, pleuritic pain, cough and orthopnea. Upon initial presentation of PE hemodynamic status should be assessed based and patients should be strafed into low risk, moderate or high risk. Majority of patients with PE are hemodynamically stable. Roughly 8% of the patient’s present with hemodynamic instability and circulatory collapse. These patient have either systolic blood pressure 15 minutes, hypotension requiring vasopressors or clear evidence of shock. However, there are a few patients who are hemodynamically stable but have significant ventricular dysfunction and borderline SBP due to extensive clot burden – these patients are characterized as intermediate risk or

Blood tests will be done to assess troponin I, troponin T, creatine kinase (CK) and myoglobin which are classified as cardiac serum markers (Cardiac Emergencies, n.d.).

The types diagnostic that maybe ordered by the provider are x-ray to see the occultation of fluid noted in the lower lobes of the lungs and check the size of the heart.