Deep Vein Thrombosis Case Study

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According to Chisholm-Burns et al., deep vein thrombosis (DVT) is the result of venous thromboembolism (VTE) and can lead to pulmonary embolism, (PE). Deep vein thrombosis (DVT) is the result of a clot (blood that aggregates together) situated in a deep vein of the lower extremities (National Library of Medicine -PubMed Health, n.d.).
Pathophysiology of DVT “Deep venous thrombosis usually arises in the lower extremities. Most DVT’s forms in the calf veins, particularly in the Soleus sinusoids and the cusps of the valves” (McMaster Pathophysiology Review, 2011),
• Valves: Due to the obstruction, flow of blood decreases oxygenation, which leads to a hypoxic endothelium. This in turn causes a cascade of events via an extrinsic factor.
• Skeletal
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Relias (2008) ask the following questions when patients present with redness and swelling of the lower extremities: Any cardiac history? Any long hours of traveling? and have you increased your exercise level? Let’s look at a case study of a 52-year-old female and continue an assessment and treatment. Complete Physical Examination
Informant: Patient who reliable and good historian.
Chief Complaint: Questioning why INR is elevated and wants to know for how long she should take Coumadin. Follow-up appointment after treatment of thrombolysis.
History of Current Illness: A 52-year-old female with history of hypertension and asthma. Positive for Factor V Lieden. Surgical procedure: Thrombolysis to left leg on last admission. Reports decrease swelling and tenderness to left leg. Self-monitors INR at home.
Current Medications:
Coumadin 8 mg once daily. HCTZ 25 mg once daily. Advair 250/50 once daily
Past Health
General: Relatively in good health.
Allergies: No known allergies.
Immunizations: No pneumonia or flu vaccine information.
Laboratory Results
CBC: WBC- 10.2 HGB- 13 HCT- 40 PLT- 326
BMP: Glucose- 145 BUN- 24 Creat-1.4 K-

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