Ruby Dwyer had looked forward to the trip and was anxious to see her grandchildren. When her son accepted an executive position with his company, she had no idea that he would be relocated to Bangkok. The trip would be long but certainly worth the effort. She never dreamed in her 74 years that she would be flying out of the United States, much less to Thailand. When the opportunity came to see her son and his family, she jumped at the chance. After all, it had been 5 years since he had left their home in Chicago. When she returned from her trip, she noticed some pain in her right leg. Although she sees herself as a healthy older woman, she does experience occasional arthritis pain. Considering that she was on a commercial airliner for more than 20 hours, she did not think much about the leg discomfort. However, after a few days, her leg became increasingly more painful and swollen. She could not imagine what was causing this problem. Finally, after 3 days, Ruby became worried about what seemed to be increasing leg swelling and pain. She is seen in her health care provider’s office. The following health information is documented in her medical record: Ruby Dwyer, 74-year-old Caucasian woman. Her physical examination revealed the following findings: alert, oriented 74-year-old woman with chief complaint of swelling, painful right lower extremity x 3 days. Cardio: Heart rate regular without murmurs; blood pressure 118/74 mmHg; all pulses present equal and strong in all extremities; no respiratory distress—regular, clear, breath sounds; audible bowel sounds in all four quadrants. Her right mid-calf area has 3–4+ pitting edema, and is hot and painful to touch and she has a moderate number of varicosities in lower extremities bilaterally. Ruby had a hysterectomy 15 years ago, and does not drink alcohol or use tobacco. She takes occasional aspirin for muscle aches, and has no known allergies. Her family history indicates that her father died from a stroke and her mother died of “old age.” She has one sister who has diabetes. Ruby was diagnosed with deep vein thrombosis (DVT) in her right leg. The treatment plan was to admit her into the hospital for anticoagulant therapy and pain control. In the hospital setting, Ruby will receive heparin therapy. You are the nurse caring for this patient.
1. Ruby asks, “How soon will the heparin dissolve my blood clot?” How would you respond to this question?
2. What patient education should you provide Ruby about anticoagulation therapy?
3. What is an activated partial thromboplastin time? How will this test be used to direct heparin therapy?
4. What factors predisposed this patient to deep vein thrombosis?
5. What should Ruby be taught about taking aspirin for arthritis pain?