Please help me with this question

Question

Mr. Jim had R total hip replacement 1 day ago. He's having trouble coughing up secretions after her surgery, complaining of SOB & a sensation of "tightness" in his chest, pale & sweating. His apical rate is 127 bpm, laboured resp. rate of 26, and BP of 140/90.

-Why is he having difficulty coughing secretions? Explain.

-Why is he experiencing SOB? Explain.

-Why is he pale & sweating? Explain.

-Explain his VS.

-What assessments should you do?

-What's his Nursing Diagnosis?

-Identify Interventions (treatment/preventions)

Answer 1

So this patient likely has a couple of processes. I would wonder if some of his pain medications such as opioids might be leading to reduced secretions. Opiods do have this effect especially on patients who have not had them before, this is why opiod like compounds are often used in antitussives.

However this is another likely more concerning process in here. This patient is post op, he is immobilized he is hyper coagulable. And now his breathing is an issue and he has chest pain. You need to at least consider a PE. This patient is high risk, and many of his symptoms are concerning. He would in this case be short of breath due to a perfusion defect and consequently a ventilation perfusion mismatch. He does not have enough oxygenated blood. He is likely pale and sweating due to hypoxia. This patient is struggling to oxygenate his body and is in respiratory distress. his heart rate is high and respiratory rate is high in order to compensate for the hypoxia. Their blood pressure is going to be high due to stress and attempting to compensate. if the embolism is large you can also have acute heart failure, and possibly high blood pressure due to back up of blood. This particular patient is also in pain. Although we did not get it, this patient is also likely going to have a low O2 saturation.

At this point what you want to do is use Well's criteria on this patient. Well's criteria is

3 points for clinical features (YES!)

3 points for no other diagnosis that is more likely (YES!)

1.5 points for HR greater than 100 (YES!)

1.5 points for immoblization or surgery within 4 weeks (YES!)

1.6 points for prior PE DVT

1 point for hemoptysis

1 point for malignancy

Any score about 6 is high risk, and a probability of more than 78.4% of a PE. This patient has a score of TWELVE. The chance is very very high that he has a PE. This patient needs a CTA or V/Q scan right away to diagnose.

At this point the patient needs full dose anticoagulation. He needs to be in bedrest until it clears to make it worse and put on telemetry monitoring. this is an emergency. This patient may need to be moved to ICU.

In the future this patient will need anticoagulation at home and on the rest of his hospital stay.

Also, this never should have happened. This patient should have been placed on anticoagulation already.