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Mrs. Valentina Benavidez 78 years old, had Left hip hemi-arthroplasty two days ago after falling and fracturing her hip and her left humerus. She has a past medical history of COPD, dyslipidemia and HTN. As a result of somnolence associated with her analgesic, she has not gotten out of bed since her surgery. Today she reports left calf pain 7/10 especially with movement.  On assessment the left calf is warm and hard with a circumference of 45cm. The right calf is normal body temperature and soft with a circumference of 42cm. Her BP 145/83 mmHg, P 96 beats/min, RR 22, oral T 36.8 0C, O2Sat 92% Room air. Height 1.5 m, weight 75 kg. PTT 23s.

 

Medications 

Ventolin MDI ii puffs BID 

Pulmicort turbuhaler DPI ii puffs BID 

Furosemide (Lasix) 40mg PO QD 

Heparin infusion to start at 18 units/kg/hr. 

 

What data indicates the presence of Virchow’s triad?

 

 

     2. What signs and symptoms of a DVT did Mrs. Benavidez exhibit?

 

 

 

    3. What diagnostic test will Mrs. Benavidez have to diagnose the presence of a DVT? 

 

 

 

Mrs. Benavidez is diagnosed with DVT in her left calf. 

 

    4. what is a nursing diagnosis for Mrs. Benavidez.

 

 

 

     5. The following interventions are implemented. Give the rationale for each

 

Bedrest:

 

 

 

Elevation of left leg:

 

 

 

Increase oral fluid intake: 

 

 

 

 

 

   6. The protocol for IV heparin preparation on the unit is Heparin 25, 000 units in 500 mL of D5W. 

 

 

   a. Calculate the rate of infusion.

 

 

 

   b. Six hours later at 14h00 her ppt result is 44. Calculate the new infusion rate using the attached heparin protocol.

 

 

 

 

HEPARIN PROTOCOL
Heparin 25,000 units in 500 mL D5W
PTT Bolus Stop Rate change Next PTT

Start heparin IV protocol
80 units/kg ___ +18u/kg/h 6 hours

Start heparin IV protocol
No Bolus ___ +18u/kg/h 6 hours
<45 60u/kg/h 0 +2u/kg/h 6 hours 45-59 30u/kg/h 0 +1u/kg/h 6 hours 60-90 0 0 0 Next AM 91-105 0 0 -2u/kg/h 6 hours >105 0 30 min -3u/kg/h 6 hours
>240 0 60 min -3u/kg/h 6 hours

 

Routine Vital Signs at 16h00 are BP 147/84 mmHg, P 100 beats/min, RR 26 breaths/min, T 37.2 0C.  She reports mild chest pain with each breath and finds that it is difficult to catch her breath. There is decreased air entry in the left upper lobe. You suspect a pulmonary embolism and report your findings and suspicions to Dr. Nuygen. 

7) What diagnostic test will he order to make the diagnosis of pulmonary embolism?

 

 

8) What is the most likely cause of her pulmonary embolism?

 

 

9) What interventions could you implement to support Mrs. Benavidez’s breathing?

 

SCIENCE
HEALTH SCIENCE
NURSING
NUR 120

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