A 70 y/o female who had undergone right total hip replacement presents on the 5th postoperative day with central chest pain and acute-onset dypsnea.
HPI. She has been immobile since the surgery
PE. VS: low-grade fever; tachycardia; hypotension. central cyanosis; elevated Jugular venous pressure (JVP); right ventricullar gallop rythm with widely split S2
Labs. Arterial Blood Gas (ABGs); hypoxia and hypercapnia (type 2 respiratory failure). patient had sinus tachycardia on ECG
Imaging. Doppler Ultrasound shot clot in the right common femoral vein. CXR, showed right lower lobe atelectasis. V/Q scan demonstrated three areas of ventilation-perfusion mismatch in right lung. Angio-pulmonary: confirmatory; (not rrequired if V/Q scan is high probability).
Gross pathology. Large thrombus seen in pulmonary artery
Micro pathology. Large occlusive thrombus seen in pulmonary artery with variable degree of recanalization.
1) Please provide two nursing differential diagnoses for this presentation
2) Design a short term nursing protocol
3) Design a long term care protocol to adress this patient situation.
