Top Case 2:

H.L. is a 46-year-old man who is relatively healthy but obese (weight: 250 lb; height: 5 ft, 9 in). He visits the clinic to see the nurse practitioner with the following concern:

"I must have pulled something in my right leg. I was walking when I felt some soreness in my lower right leg, and now there is some swelling. It really hurts to walk."

He states that he is a self-employed developer of computer software programs and reports sitting for hours at the computer with few breaks. He occasionally remembers to exercise his feet and lower legs. The right calf pain and swelling began 3 days ago, and discomfort increases when walking. Swelling and pain improve when the leg is elevated. There are no color or temperature changes in his arms or left leg, and no pain in the left leg. However, he reports having mild to moderate pain in the right lower leg, especially when he is up and moving around. He has been taking acetaminophen 1,000 mg 2-3 times per day to relieve leg pain.

He has hypertension and hyperlipidemia, both controlled by medication. He has had no angina since his coronary artery bypass graft (CABG) 5 years ago but developed a pulmonary embolism following surgery. There have been no other previous surgeries on veins or arteries. He is a nonsmoker, drinks occasionally, and exercises by walking a few blocks most days. He denies problems with sexual activity.

7. Identify a minimum of three subjective cues (risk factors) that are clinically significant and provide a brief rationale for each cue.

8. Based on the clinically significant data, what health condition is the client experiencing?

9. Using your words, describe the pathophysiology consistent with this condition.

10. What objective signs will you anticipate on inspection and palpation?

11. Discuss one health promotion teaching.

12. Based on the information, discuss one older adult's consideration.

Based on the provided information, the client is experiencing symptoms and risk factors that are clinically significant for deep vein thrombosis (DVT), a condition characterized by the formation of blood clots in the deep veins, usually in the lower extremities.

1. Subjective cues (risk factors):

a. Prolonged sitting with few breaks: The client's sedentary occupation and prolonged sitting increase the risk of DVT. Immobility slows down blood flow, promoting the formation of blood clots.

b. Obesity: The client's weight of 250 lb and height of 5 ft, 9 in indicate obesity. Obesity is a risk factor for DVT as it can impair blood circulation and increase the strain on the veins.

c. Previous pulmonary embolism: The client's history of developing pulmonary embolism following coronary artery bypass graft (CABG) surgery suggests a higher risk for recurrent thrombosis.

8. Based on the clinically significant data, the client is experiencing deep vein thrombosis (DVT), which is the formation of blood clots in the deep veins, commonly in the legs.

9. Pathophysiology consistent with DVT:

The prolonged sitting and obesity contribute to reduced blood flow and stasis in the deep veins of the lower leg. This stagnant blood flow predisposes to the formation of blood clots, which can obstruct the veins and cause symptoms such as pain, swelling, and tenderness.

10. Objective signs anticipated on inspection and palpation may include:

- Swelling and edema in the affected leg, especially in the calf area.

- Warmth and erythema (redness) over the affected area.

- Tenderness or pain on palpation of the calf muscles or along the course of the affected vein.

- Possible visible or palpable cord-like structure (thrombosed vein) in the affected leg.

11. Health promotion teaching:

It is important to educate the client about the importance of regular movement and avoiding prolonged periods of sitting. Encouraging frequent breaks, leg exercises, and calf muscle contractions during prolonged sitting can help improve blood circulation and reduce the risk of DVT.

12. Older adult's consideration:

Older adults may have an increased risk of DVT due to age-related factors such as decreased mobility, changes in blood clotting mechanisms, and comorbidities. Careful monitoring and appropriate preventive measures should be taken to reduce the risk of DVT in older adults.

In conclusion, the client in the case study is presenting with subjective cues and risk factors suggestive of deep vein thrombosis (DVT), including prolonged sitting, obesity, and a history of pulmonary embolism. The pathophysiology of DVT involves reduced blood flow and stasis in the deep veins, leading to the formation of blood clots.

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