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.
To prepare:
• Review Part 11 of the Buttaro et al. text in this week’s Learning Resources.
• Select one of the cased studies provided. Reflect on what went wrong in this case study, as well as why patient blood clots continue to be misdiagnosed.
• 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.
Readings
• Buttaro, T. M., Trybulski, J., Polgar Bailey, P., & Sandberg-Cook, J. (2013). Primary care: A collaborative practice (4th ed.). St. Louis, MO: Mosby.
o Part 4, “Office Emergencies”
? Chapter 29, “Bradycardia and Tachycardia” (pp. 198–202)
This chapter covers the epidemiology, pathophysiology, clinical presentation, physical examination, and diagnostics of bradycardia and tachycardia. Differential diagnoses for these disorders are also explored.
? Chapter 30, “Cardiac Arrest” (pp. 202–205)
o
? This chapter examines factors contributing to the onset of cardiac arrest, as well as methods for managing patients with cardiac arrest.
? Part 11, “Evaluation and Management of Cardiovascular Disorders” (pp. 487–611)
This part explores diagnostics of cardiovascular disorders, including how to differentiate between normal and abnormal test results. It also outlines components of patient history and physical exams that help determine differential diagnoses for cardiovascular disorders.
? Part 18, “Evaluation and Management of Hematologic Disorders” (pp. 1139–1181)
This part examines causes and effects of hematologic disorders, as well as resulting symptoms and alterations. It also provides a differential diagnosis for hematologic disorders and outlines methods for managing patients.
o Courtenay, M. (2000). Reading and Interpreting the Electrocardiogram. In Advanced nursing skills: Principles and practice (pp. 39–55). London: Greenwich Medical Media. Retrieved fromhttp://assets.cambridge.org/97818411/00364/sample/9781841100364WS.pdf
This chapter examines how the heart functions, as well as how to read and interpret electrocardiograms.
o LearnTheHeart.com. (2005). ECG basics. Retrieved fromhttp://www.learntheheart.com/EKGBasics.html
This website outlines the basics of electrocardiograms (ECG or EKG), including how to interpret results.
