DVT: A Medical Case Study

One afternoon a 67 year-old man presented to the emergency department of a small, rural hospital complaining of severe left leg and hip pain following a fall at home. The patient had no past history of falls. He had a history of impaired glucose intolerance, prostate cancer, hypercholesterolemia and hyperlipidemia. The patient’s current medications were atorvastatin and oxycodone for chronic back pain. The patient stated his pain was ten out of ten on a scale of one to ten with ten being the worst. The left leg appeared shorter than the right, edema was present in the calf, as was ecchymosis and he had limited range of motion. After an evaluation in triage by a registered nurse and a subsequent examination by the emergency department physician, a plan was established to sedate the patient using moderation sedation protocol and perform a manual reduction of the hip.

HISTORY OF PRESENT ILLNESS: David Lockman is a 44-year-old male who injured his right knee on July 21, 2015 when a circular saw came into contact with his medial right knee. He was taken to the operative suite by Dr. Lin for an emergent irrigation and debridement. He tolerated this very well. He was admitted overnight for antibiotic coverage, and discharged with instructions to weight bear as tolerated with the use of a hinged knee brace and walker. He was doing well but presents today with ongoing pain of 6-7/10. His biggest concern was that the swelling, redness, and edema was now extensive down the leg and into the ankle and foot causing him some ankle pain, as well. He has been using Norco for control of his pain. He is not taking any antibiotics currently. He is set up for

The patient is a 72 year old female. She has been experiencing progressively worse pain and stiffness in her joints. She is reports that she is having decreased range of motion, redness, and swelling in her joints. She is reports symptoms occur in the same joints on both sides of her body. She is also reporting the symptoms are worse when she first wakes up in the morning.

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

Anticoagulant therapy will started according to facility protocol. This therapy will decrease the blood’s ability to clot, and help to prevent the formation of new clots. Anticoagulants used will be warfarin, heparin, or coumadin. In facility therapy will be initiated via IV push according to facility protocol, with continuous monitoring of patient condition.

Based on the latest medical report dated 03/08/16 by Dr. Tenuta, the patient presents for his right knee pain. He was seen for back pain approximately a year ago. He has had persistent issues with that. He feels that he has been favoring his knees. He has been having problems going up and down steps. On examination, he has crepitus with patellofemoral range of motion. As of this

Hypertension is one of the leading risks for heart disease and stroke. Your physician may advise dietary or lifestyle changes, or specific medications to lower your blood pressure.

Based on the medical report dated 03/30/16, the patient has had pain in the right lower leg, numbness and tingling on the left side as well, rated as 8-9/10.

The key pathophysiological mechanism that influence complications associated with PVD is impaired perfusion in the lower limbs that causes limb ischaemia. PVD can be asymptomatic; however, symptomatic PVD includes intermittent claudication (IC) and critical limb ischemia (CLI). IC is the symptom of pain in the lower limbs on exertion which is alleviated by resting. CLI is the most progressed form of PVD, and is distinguished by rest pain, ischaemic ulceration, and foot gangrene. CLI patient has a high risk of limb loss and death. Mr. Guzys was diagnosed with acute arterial embolism in his right popliteal artery that resulted in acute limb ischaemia (ALI). ALI is the sudden interruption in limb perfusion, caused by thrombosis or embolism,

Hypertension is an indication of an increased risk for stroke. According to Verdecchia et al. (2015), there is a linear relationship between hypertension and increased stroke risk. The risk of stroke can be reduced with a decrease in systolic and diastolic blood pressure readings. In patients with a previous history of coronary artery disease, the ideal blood pressure is a baseline of 118/68 mmHg and a systolic of less than 140 mmHg (Verdecchia et al., 2015). Because of the evidence that associates hypertension with stroke risk, we offered and performed blood pressure screenings to the general public for our community intervention.

01/26/16 Progress Report documented a follow-up visit for left knee pain. The patient has attended 13 visits of PT and his knee is more painful now. He is currently having daily medial sided knee pain. He cannot run, walks with a limp, and has swelling and limited range of motion. The Worker’s compensation denied his MRI. He has been having pain in his knee since 09/03/15. The patient has a PMH significant for LKS with ACL reconstruction by FAB, 1.5 years ago. He reported swelling, catching,

The incidence of DVT & PE is continuously increasing in hospitalized patients especially those admitted after trauma. Major trauma leads to a state of hyper-coagulation by augmenting the components of Virchow’s triad. Acute injury to spine increases this risk of VTE even further. Without thromboprophylaxis, the reported incidence of DVT in these patients ranges from 50-80% and PE is the 3rd most common cause of death with an incidence of 5%[11, 12, 22]. The mechanism underlying increased rates of VTE is multifactorial and it involves immobility and venous stasis secondary to hospitalization, direct endothelial injury, upregulation of coagulation cascade, release of tissue factor and depletion of endogenous anticoagulants secondary to

Symptoms of a deep venous thrombosis (DVT) include pain in the affected extremity, swelling, and redness. It is important to remember that sometimes a DVT can occur without any symptoms (“Deep Vein,” n.d.). A pulmonary embolism can have different signs and symptoms and include sudden shortness of breath, discomfort that worsens when taking a deep breath, dizzy or fainting, rapid pulse, and coughing up blood (“Deep Vein,” n.d.). Two other potential diagnoses for her condition could be pulmonary artery hypertension or lung cancer. Pulmonary artery hypertension resembles a pulmonary embolism in that one may have fatigue, chest discomfort, palpitations, tachycardia and even a cough (McCance & Huether, 2014). There are several different types of

Patient attends with complaints of leg pain for a period of about 1-1/2 weeks. Pain is so severe that he has to keep active, the more active he is the less the discomfort bothers him. He finds that sleeping at night really is uncomfortable because of the cramping in his legs, the cramps start in the base of his feet and run up into the calves, but again, if he gets up and is active it seems to reduce the discomfort considerably. His joints have not been red, or hot, or swollen. He has not had his limbs buckle or give way. He has not tried any medications for this. Interesting to note that he has started jogging some three weeks ago, and the discomfort in his shins is subsequent to that. He did not temporize that activity. The patient is concerned that he was on methadone and he knows that this can cause bony structure problems, dental problems. He was on it for about a year and he has been off of that now for at least two years. He is also concerned about his weight. He states he used to be 200 pounds he is now down to 160 pounds. Chart review shows that since he has been incarcerated in Faribault his weight has been pretty stable running between 155-165. I reassured him that this

He denies pain in calf muscle or radiating pain.Also the patient states that he is going TDY for the next 2 weeks , therefore he wish to be seen