Adult Nursing: Patient Case Study - DVT, PE, and Cardiogenic Shock

This assignment analyzes a case study of a 60-year-old female patient admitted to the medical surgical unit with altered consciousness, shortness of breath, tachycardia, and a GCS of 7. The patient was diagnosed with deep vein thrombosis (DVT) leading to pulmonary embolism (PE) and cardiogenic shock. The assignment addresses the causes of PE, the symptoms of cardiogenic shock, and the patient's specific signs and symptoms including tachycardia, shortness of breath, and a GCS score of 7, as well as lab results indicating multiple organ failure. It also discusses the crackling sounds (Hamman sign), trauma, laceration, and epistaxis, along with abdominal distension, pressure ulcers, and edema, suggesting kidney failure. The solution proposes treatments including chest tubes or needles for lung puncture, dialysis for kidney failure, and topical vasoconstrictor therapy for trauma. Finally, it outlines nursing interventions such as monitoring for multi-organ failure, treating leg ulcers, and repeating dialysis and air removal until organ function returns to normal. The assignment also includes a list of references used in the solution.

Running head: ADULT NURSING
ADULT NURSING
Name of the Student:
Name of the University:
Author Note:

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Answer 1.
PE or pulmonary embolism results from a blockage in the blood vessels by the blood
clot. This is a condition that is often progressed from the deep vein thrombosis (DVT)
condition. Deep vein thrombosis is a disease condition that involves an event of blood
clotting in the deep veins. The blood clot then travels towards the lungs and creates a
blockage in a blood vessel. As a result, the normal blood flow becomes impaired, and the
heart faces difficulty with pumping the blood to the body, which leads to a shock (Turetz et
al., 2018)
The shock patient most likely to develop is a cardiogenic shock (Kosaraju & Hai,
2019).
Answer 2.
The patient was experiencing tachycardia, which can also be determined from the
heart rate of 128 bpm. She was also experiencing shortness of breath, and her GCS score was
only 7, which means that she was comatose. She was feeling pain, which can be determined
from her painful response to the nurse’s assessments. All of these signs and symptoms are
associated with cardiogenic shock in an individual (Kosaraju & Hai, 2019).
Answer 3.
The crackling sound that can be heard in the bilateral upper chest of the patient is
known as Hamman sign, which indicates a possible injury to the lungs and the air sacks. The
patient was also experiencing pain, and she was suffering from trauma (Beck, Sorge,
Schneider & Dietz, 2018). The laceration condition and the epistaxis conditions were the
indicators for this diagnosis. Her abdomen was distended, and there was a presence of the
pressure ulcer along with the edema on both of her legs. All these signs and symptoms were
indicating a possibility of kidney failure in her (Harjola et al., 2017). The doctor might ask to

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perform a complete blood test on her in order to assess her haemoglobin level, BUN level,
and creatinine level in her blood, which will be the diagnostic proof for the possible multiple
organ failure conditions in her.
Answer 4.
Firstly, the lung puncture condition will be addressed. There will be a use of the chest
tube or hollow needle into the pleural space to pump the air out of the pleural cavity. This
will help the lungs to be able to function again (Zisis et al., 2015). After that, the kidney
failure condition will be addressed by using dialysis. This treatment method will prevent
further damage to the heart and the brain (Vaidya & Aeddula, 2019). Finally, the trauma
condition will be treated by the application of topical vasoconstrictor therapy. This therapy
will stop the bleeding (Gupta, Garg & Ramachandran, 2017).
Answer 5.
The first nursing interventions should be continuously monitoring the patient for the
possible signs of multi-organ failure. Then her leg ulcer condition must also be treated by the
application of compression bandage and by keeping the legs uplifted. Additionally, the
dialysis and pumping out the air must be repeated until her lungs, and the kidney starts to
function normally (Kiernan, 2017).

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References:
Beck, R., Sorge, M., Schneider, A., & Dietz, A. (2018). Current approaches to epistaxis
treatment in primary and secondary care. Deutsches Ärzteblatt International, 115(1-
2), 12.
Gupta, B., Garg, N., & Ramachandran, R. (2017). Vasopressors: Do they have any role in
hemorrhagic shock?. Journal of anaesthesiology, clinical pharmacology, 33(1), 3.
Harjola, V. P., Mullens, W., Banaszewski, M., Bauersachs, J., Brunner‐La Rocca, H. P.,
Chioncel, O., ... & Fuhrmann, V. (2017). Organ dysfunction, injury and failure in
acute heart failure: from pathophysiology to diagnosis and management. A review on
behalf of the Acute Heart Failure Committee of the Heart Failure Association (HFA)
of the European Society of Cardiology (ESC). European journal of heart
failure, 19(7), 821-836.
Kiernan, F. (2017). Care of ICU survivors in the community: a guide for GPs. Br J Gen
Pract, 67(663), 477-478.
Kosaraju, A., & Hai, O. (2019). Cardiogenic Shock. In StatPearls [Internet]. StatPearls
Publishing.
Turetz, M., Sideris, A. T., Friedman, O. A., Triphathi, N., & Horowitz, J. M. (2018, June).
Epidemiology, pathophysiology, and natural history of pulmonary embolism.
In Seminars in interventional radiology (Vol. 35, No. 02, pp. 92-98). Thieme Medical
Publishers.
Vaidya, S. R., & Aeddula, N. R. (2019). Chronic Renal Failure. In StatPearls [Internet].
StatPearls Publishing.

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Zisis, C., Tsirgogianni, K., Lazaridis, G., Lampaki, S., Baka, S., Mpoukovinas, I., ... &
Tsakiridis, K. (2015). Chest drainage systems in use. Annals of translational
medicine, 3(3).