The nurse is caring for a 82 year old female in the outpatie…
The nurse is caring for a 82 year old female in the outpatient clinic with left leg swelling following an colon resection a week ago. Nurses Notes: 0930: Client reports that she has not been able to get up and move around at home since her surgery. A few days ago, she developed severe calf pain in her left leg with swelling that is not relieved by ice or elevation. 0945: Left leg >3mg when compared to the right and warmth noted at site. 1000: Client has intermittent episode of shortness of breath at rest. Oxygen Saturation currently 97% on room air. Chest is symmetrical. Breath sounds clear bilaterally. Denies Chest pain. 1030: Client sent to Radiology 1130: Client transferred to inpatient medical unit Vital Signs: Time: 0900 Time: 1000 Temperature 98.2F 98.5F Pulse 95 98 Respiratory Rate 18 20 Blood Pressure 120/78 125/82 Lab Report: Lab Results Platelet Count 145,000/mm3 Hemoglobin 15g/dL Hematocrit 42% Partial Thromboplastin Time (PTT) 36 Prothrombin Time (PT) 12.8 International Normalized Ratio (INR) 1.3 D-Dimer 2 Diagnostic Report: Venous Duplex Ultrasonography positive for left calf DVT Medications: Heparin Bolus 5,000 units IV stat, followed by continuous infusion 18units/kg/hr heparin drip Protamine Sulfate 1mg IV as needed for bleeding Warfarin 2.5mg PO daily Progress Note: Day 5 1500: Heparin was discontinued. Since the client has now been on warfarin daily for 3 days, the client will be discharged home on warfarin 2.5mg by mouth daily. Lung sounds clear bilaterally, denies chest pain or shortness or breath. Swelling to lower extremity is decreased and client denies calf pain. Vital signs are stable. Client remains alert and oriented. The nurse provides more client education about the home management plan. For each statement, indicate whether the statement indicates an understanding, or no understanding of the anticoagulant teaching provided.
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