You are assigned to care for L.J., a 70-year-old retired bus driver who has just been admitted to your medical floor with right leg deep vein thrombosis (DVT). L.J. has a 48–pack-year smoking history, although he states he quit 2 years ago
He has had pneumonia several times and frequent episodes of atrial flutter or fibrillation. He has had two previous episodes of DVT and was diagnosed with rheumatoid arthritis 3 years
ago. Two months ago he began experiencing shortness of breath on exertion and noticed swelling of his
right lower leg that became progressively worse until it extended up to his groin. His wife brought him to
the hospital when he complained of increasingly severe pain in his leg. When a Doppler study indicated a
probable thrombus of the external iliac vein extending distally to the lower leg, he was admitted for bed
rest and to initiate heparin therapy. His basic metabolic panel was normal; other laboratory results were
as follows.
Laboratory Testing
PT 12.4 sec
INR 1.11
aPTT 25 sec
Hgb 13.3 g/dL
Hct 38.9%
Cholesterol 206 mg/dL
List six risk factors for DVT.
Most risk factors fall within the three categories of Virchow triad:
• Venous stasis: lengthy surgery, immobility, older than age 40, pregnancy, atrial fibrillation, heart
failure, obesity, stroke, denervated limb, hip or knee replacement
• Venous endothelial injury: previous DVT, IV catheter, fractures, chemical injury (e.g., cigarette or
tobacco products, elevated glucose), trauma, varicose veins, hypertension
• Hypercoagulability: malignant neoplasms, dehydration, oral contraceptives, estrogen therapy,
sepsis, blood dyscrasias, burns, genetic predisposition (i.e., antiphospholipid syndrome, activated
protein C resistance, protein C deficiency, protein S deficiency, antithrombin III deficiency, and
factor V Leiden)
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The nurse plans care for a patient with presbycusis by taking which of the following into account?
A) Lower frequency hearing is lost more than high frequency hearing. B) Higher frequency hearing is lost more than low frequency hearing. C) It is a form of conductive hearing loss. D) Understanding speech in a quiet room is difficult.
The nurse is caring for a patient who has had a recent stroke and is paralyzed on his left side. He has no respiratory or cardiac issues, but he cannot walk
He becomes extremely frustrated when he cannot button his shirt and cannot feed himself because he was left-handed. He has shown no signs of dysphagia, but he has been eating very little and has lost 2 lbs. He asks the nurse, "How can I go home like this? I'm not getting better. I can't ask my wife to take care of me like a baby." Of the following list of health care team members, which member would the nurse need to consult? (Select all that apply.) a. Physical therapy b. Occupational therapy c. Respiratory therapy d. Cardiac rehabilitation e. Psychology services
Each institution has its own policies relating to admitting a patient
True False
The nurse is caring for a client whose heart rate suddenly becomes irregular. When notifying the physician, the nurse anticipates an order for what diagnostic study?
1. Electrocardiogram 2. Echocardiogram 3. Cardiac catheterization 4. Thallium stress test