Discussion Board #3-Question 2

Question 2

K.P. is recovering from a cholecystectomy. During the morning assessment, she reports pain when the left knee is flexed and the left foot is plantar flexed. The calf circumference is 37 cm on the right and 40 cm on the left. The left calf is tender to palpation. These findings are not expected as normal for this patient’s physical state post-operatively. The data provided is all considered abnormal for this patient’s recovery.

In my experience working in the operating room, post anesthesia care unit and the same day stay unit, I have found most patients stay less than two days in the hospital (provided there are no complications) post-operative gall bladder removal. From the information given in the scenario, K.P. has probably been in the hospital for at least twenty-four hours. Within this time frame, a deep vein thrombosis (D.V.T.) could be forming. The subjective data (her pain complaints regarding flexing her left lower extremity and calf palpation tenderness) and the objective data (the left calf circumference bilateral disparity), are typical of the signs and symptoms of a possible D.V.T. as classic symptoms of D.V.T. includes pain, swelling, and discoloration in the affected extremity. I found it curious that a Homans’ sign (pain on passive dorsiflexion of the foot) was not mentioned as part of the assessment or if the patient had TED hose prior to surgery.

Before a judgment by the physician/surgeon can be made, the nurse must report her findings and request an order for a d-dimer blood test or a Doppler ultrasonography of the affected extremity performed at the bedside. A negative d-dimer result is very reliable for ruling out the need for anticoagulation therapy (Wells, Anderson, Rodger, Forgie, Kearon, Dreyer, et al.). The Doppler test is the most widely used bedside. However, a normal Doppler study can’t rule out a high-risk patient. Further investigation including a ventilation-perfusion scan could follow....