I'm on my last clinical day...and I get an interesting case....
I get a 20 yr. old patient who has had tibia and fibula (both lower leg bones) fractures and a dislocated shoulder. Ouch!! He is in a full leg cast and has his upper right arm in a sling. It gets more interesting....Yesterday my patient was diagnosed with a pulmonary embolism. For those who don't know what this is, it is a very serious and life-threatening condition marked by a blood clot that has broken off somewhere in the venous system and lodged itself in the lungs. A blood clot in the lungs produces symptoms of shortness of breath, fever, and low oxygen saturation; basically my patient couldn't breath! They got him on oxygen 2L NC and raised the head of the bed up. He was placed on Coumadin and Lovenox (anticoagulants- blood thinners) to prevent coagulation of red blood cells to form yet another clot. My patient seemed stable and had no symptoms of the pulmonary embolism.
Now how do you get this?? Usually a clot forms at the site of injury, in his case, his leg. Due to in activity, poor circulation, lack of movement of the extremity, and/or poor wound healing, the clot could form and break off. The clot then breaks off and floats in the bloodstream where it will get lodged in the lungs. What amazes me is that he is so young. You rarely see this in patients under 40. Usually there is a history of vascular problems or a serious injury. This scared me.....
So monitoring my patient frequently was a must. He had tachycardia and became febrile a few times but his oxygen saturation was normal. I had to encourage fluids as well as the use of the Incentive Spirometer. It was very important to remind him to deep breath and move around.
The sad part to me was that his family and even the patient seemed to not understand that this was such a big deal. I mean, I'm glad no one was freaking out about it, but it seems like they don't know that this is life-threatening. Back then, like 50s and 60s, a diagnosis of a pulmonary embolism was a death sentence. Now, we know the symptoms and what to expect so we can have an immediate intervention. I know that when I'm in the hospital, I want the whole sha-bang....anti-embolism stockings, SCDs (sequential compression devices-helps with venous flow in the legs), assistance with active range of motion, exercise, fluid intake, IS use, deep breathing......I won't take any chances!
I left my patient in a stable condition. His family was educated on the medications he was to be given. His Hct and Hgb were low so he will be receiving a blood transfusion. My patient has well managed pain, and he is able to work with Physical Therapy about ambulation. He seemed in good spirits :) Though his symptoms are subsiding from the pulmonary embolism, he is now and forever will be at risk for another. So, if he has surgery again, he will have to be monitored very closely.
So I continue to learn with this experience; Life is so precious. Anything can happen at any age; whether you are physically fit or not. Health is important and knowing what is going on is important. That's why I am so glad I am going to be a nurse, because I can teach about the patient's condition and educate them on the severity as well as treatment and recovery. Like my instructor says.... "We aren't here to just take care of you.....we are here to teach you." :)
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