You are assigned to care for L.J., a 70 year old retired bus driver who has just been admitted to your medical floor with R leg deep vein thrombosis (DVT). L,J. has a 48 pack/year smoking history, although he states he quit 2 years ago.

You are assigned to care for L.J., a 70 year old retired bus driver who has just been admitted to your medical floor with R leg deep vein thrombosis (DVT). L,J. has a 48 pack/year smoking history, although he states he quit 2 years ago. He has had pneumonia several times, frequent episodes of atrial fibrillation, 2 previous episodes of DVT, and was diagnosed with rheumatoid arthritis 3 years ago. Two months ago he began experiencing shortness of breath on exertion and noticed swelling of his R foreleg that became profressively worse until it also involved his thigh to the groin. His wife brought him to the hospital when he complained of increaseingly sever pain in his leg. When a Doppler study indicated a probable thrombus of the external iliac vein extending distally to the lower leg, he was admitted for bed rest and IV heparin therapy. Significant admission lab values are: PT 12.4 sec, PTT 25 Sec, Hgb 13.3 g/dl, Hct 38.9% mg.dl, cholesterol 206 mg/dl.. (Learning Objectives 6 and 7)

List risk factors for DVT and identify which one’s that L.J. have.

Keeping in mind L.J’s health history and admitting diagnosis, what are the most important assessments you should make during your physical examination and assessment?

A week has passed and you now assigned to L.J. as he is preparing for discharge. He will be discharged on warfarin therapy, and is being discharged to home for home care follow-up. As you enter his room he says “ I am so glad to be discharged today because it is just in time to fly out West for my grandson’s wedding.” His wife, rolls her eyes and looks at the ceiling. You almost drop the discharge papers in disbelief at what you have just heard. (4 points)

What are you going to say to L.J.?