Assignment: Discuss Blood Clots
Blood clots form in various locations of the body and are not unique to any specific age group or gender. While there are certain risk factors that may make a patient more likely to develop blood clots, essentially any patient is a potential candidate. Unfortunately, blood clots often go unrecognized until something happens. Even if the patient identifies a problem and seeks medical care, blood clots are frequently misdiagnosed resulting in serious medical complications and sometimes death. Why does this happen? How can you, as the advanced practice nurse, protect your patients from misdiagnosis?
Consider the following case studies:
Case Study 1:
A 44-year-old African American male had a partial colectomy to have a cancerous tumor removed. The patient did really well after surgery and was discharged from post-op recovery to the surgical unit at a medical center. Approximately one hour after surgery, the patient complained of gas pains and shortness of breath. The patient continued to complain of gas pains after administration of morphine sulfate. Providers failed to diagnose a pulmonary embolism that resulted in the loss of the patient’s life.
Case Study 2:
A 50-year-old white male went to the emergency department with complaints of right leg pain. The patient is an avid runner, and knowing this, the provider diagnosed the patient with a right leg muscle strain. The patient was sent home with Flexeril as needed and Motrin 800 mg q8h as needed. One week later, the patient followed up with his primary care doctor with continued right leg pain. His doctor instructed him to continue to take the muscle relaxant and Motrin, and advised that the pain should subside in 5–10 days. The following day the right leg pain increased, prompting the patient to return to the emergency department. Multiple providers failed to diagnose a blood clot in the patient’s right leg.
Think about how you might have prevented the misdiagnosis of the patient the case study. Consider strategies for obtaining patient history, ordering diagnostics, and recommending potential treatment options.
Post on or before Day 3 a description of what went wrong in the case study that you selected, as well as why patient blood clots continue to be misdiagnosed. Then, explain how you might have prevented the misdiagnosis of the patient in the study. Include strategies for obtaining patient history, ordering diagnostics, and recommending potential treatment options.
Types of Anemia
In clinical settings, patients often present with many different types of anemia. Each type of anemia has its own causes and implications. For this reason, you must be able to differentiate between types of anemia as well as identify factors that put patients at greater risk of experiencing related complications. As you prepare for this Discussion, consider the following patient case studies:
Case Study 1:
An 82-year-old female presents to the office complaining of fatigue, dizziness, weakness, and increasing dyspnea on exertion. She has a past medical history of atrial fibrillation, hypertension, and hyperlipidemia. Medications include warfarin 2 milligrams po daily, lisinopril 10 milligrams po daily, and simvastatin 10 milligrams po daily. There are no known drug allergies. The physical exam reveals a 5’2” older female. Her weight is 128 pounds, blood pressure is 144/80, heart rate is 98, temperature is 98 degrees Fahrenheit, and O2 saturation is 98%. Further examination reveals the following:
Eyes: + pallor conjunctiva
Lungs: CTA w/o rales, wheezes, or rhonchi
Abdomen: soft, BS +, + epigastric tenderness. No organomegaly, rebound, or guarding
Rectal: no stool in rectal vault
Case Study 2:
A 28-year old female presents for a routine physical. She has no complaints. Her personal medical history reveals asthma that is well controlled with an albuterol inhaler prn and Advair 250/50 1 puff BID. Social history reveals she is a nursing student who is a non-smoker, rarely uses alcohol, and is mostly vegetarian. Her physical exam is negative, and she is sent for a CBC/differential and lipid profile. Laboratory results reveal the following: Hemoglobin 10, Hematocrit 30.1, MCV increased.
Case Study 3:
A 78-year-old female presents to the emergency room after a fall 3 days ago. She recently had a right above-the-knee amputation and was leaning over to pick something up when she fell. She did not want to come to the hospital, but she is having difficulty managing at home because of the pain in her left leg where she fell. Her patient medical history reveals RAKA, peripheral vascular disease, Type 2 diabetes, and stage 3 chronic kidney disease. Current medications include quinapril 20 milligrams PO daily, Lantus 30 units at bedtime, and Humalog to scale before meals. There are no known drug allergies. The physical exam is negative and x-rays reveal no acute injuries. Laboratory studies reveal a normal white blood cell count: Hgb of 8 and HCT 24. The MCV is normal.
Reflect on the pathophysiology of the type of anemia that you diagnosed, as well as potential treatment options. Consider the causes of this type of anemia. Think about whether the patient should be referred for specialized care.
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