Med Surg Case Study #27: Luke Ruthers

Luke Ruthers | 55 years old

Chief Complaint: Luke presents with swelling and pain in his left leg.

Medical History:

• Luke has a history of hypertension and recent hip replacement surgery.

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1000

Nurse's Note: Luke complains of swelling and pain in his left leg, which he noticed upon waking up this morning. He describes the pain as dull and achy, localized to the calf area. Upon assessment, the left leg is visibly swollen compared to the right leg. Luke denies any recent trauma or injury to the leg.

Vital Signs:

• Blood pressure: 150/88 mmHg

• Heart rate: 84 bpm

• Respiratory rate: 16 breaths/min

• Temperature: 98.2°F (36.8°C)

Provider Orders:

• Perform a focused physical examination of the left leg.

• Order a venous duplex ultrasound to evaluate for deep vein thrombosis (DVT).

1130

Nurse's Note: Physical assessment reveals warmth, tenderness, and redness along the left calf. Homan's sign is positive, eliciting pain upon dorsiflexion of the left foot. Luke reports increased pain with movement. The venous duplex ultrasound confirms the presence of DVT in the left lower extremity.

Vital Signs

• Blood pressure: 152/90 mmHg

• Heart rate: 92 bpm

• Respiratory rate: 20 breaths/min

• Temperature: 98.6°F (37.0°C)
  

Provider Orders:

• Initiate anticoagulation therapy with subcutaneous enoxaparin.

• Elevate the left leg and apply compression stockings.

1300

Luke's pain has improved slightly with elevation and administration of pain medication. He expresses concern about the diagnosis and asks about the treatment plan. Nursing staff provide education about DVT, anticoagulation therapy, and the importance of compliance with treatment.

Vital Signs:

• Blood pressure: 148/86 mmHg

• Heart rate: 88 bpm

• Respiratory rate: 18 breaths/min

• Temperature: 98.4°F (36.9°C)
  

Question 1: What are the common signs and symptoms of DVT?

Question 2: Why is anticoagulation therapy initiated for Luke?

Question 3: How does elevation and compression stockings help in the management of DVT?

Question 4: What education should be provided to Luke regarding his condition?

Answers to Questions Below

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Answers

Question 1: What are the common signs and symptoms of DVT?

Common signs and symptoms of DVT include swelling, pain, warmth, and redness in the affected limb. Homan's sign, eliciting pain upon dorsiflexion of the foot, can also be present but is not always reliable.

Question 2: Why is anticoagulation therapy initiated for Luke?

Anticoagulation therapy is initiated to prevent further growth of the thrombus, reduce the risk of embolization, and prevent recurrence of thromboembolic events. Enoxaparin, a low molecular weight heparin, is commonly used for initial anticoagulation in DVT. However, many hospitals also use unfractionated heparin.

Question 3: How does elevation and compression stockings help in the management of DVT?

Elevation of the affected limb helps reduce swelling by promoting venous return and reducing venous stasis. Compression stockings apply external pressure to the veins, further aiding venous return and preventing clot formation.

Question 4: What education should be provided to Luke regarding his condition?

Luke should be educated about the importance of compliance with anticoagulation therapy, signs and symptoms of bleeding, and the need for regular follow-up appointments for monitoring. Additionally, he should be advised to avoid prolonged immobility and to notify healthcare providers of any new or worsening symptoms.

Med Surg Case Study