A 52-year-old female patient presents for follow-up 7 days after hospitalization for her first deep vein thrombosis (DVT) in the left leg

Case 2

The case study assignment provides the student with the opportunity to synthesize and apply the concepts learned from Advanced Pathophysiology, Pharmacology, and Advanced Assessment. In this written assignment, the student will document their findings and demonstrate application of course content. The written assignment should be APA format 7th ed. and include current peer-reviewed references and scholarly citations.

Instructions: Each MSN specialty will use the case study to answer the questions specific for their specialty. All answers should be brief and to the point. The word count is outlined within each question. Points will be deducted for going over the word limit. The written assignment should be APA format 7th ed. You should also use current clinical guidelines, peer-reviewed references, and scholarly citations. 

Case Study: FNP and Adult Gero Primary Care NP

A 52-year-old female patient presents for follow-up 7 days after hospitalization for her first deep vein thrombosis (DVT) in the left leg. She is currently taking rivaroxaban (Xarelto) 15 mg once daily. She had thrombolysis while in hospital and reports a decrease in swelling and tenderness of left leg. She also is positive for Factor V Leiden.  The patient is in today and asking why she is taking rivaroxaban and not warfarin (Coumadin) like some of her friends who had a similar problem. She also wants to know how long she should be on rivaroxaban. 

Past Medical History- Patient also reports that she is asthmatic and hypertensive.

Allergies- None Known

Medications- Rivaroxaban 15 mg daily, HCTZ 25 mg daily, Advair 250/50 daily, Ibuprofen 400-600 mg po prn

Physical Exam:

Weight: 160 lb   Height: 65 in   BMI: 26.6  

BP: 160/92   Temp: 98   Pulse: 70   Resp: 18

Labs:

CBC: WBC: 10.2 HGB: 13 HCT: 40 PLT: 326

BMP: Glucose: 145 BUN: 28   Creat: 1.5   K: 3.9  CrCl 50 mL/min

LFT: AST: 35   ALT: 42   Alk Phos: 35

Please answer the following questions related to the case study. Your answers should be brief and to the point for ALL questions. The word count is outlined within each question. Points will be deducted for going over the word limit for each question. 

Clinical Guidelines: Use the link below to access the current clinical guidelines.

Kearon, C., Akl, E., Ornelas, J., Blaivas, A., Jimenez, D., Bounameax, H.,…Moores, L. (2016). Antithrombotic therapy for VTE disease: CHEST guidelines and expert panel report. Chest, 149, 315-352. Available from: https://www.sciencedirect.com/science/article/pii/S0012369215003359

1. Discuss the pathophysiology of a DVT. (in no more than 150 words)

2. List the tests that should be included in a coagulation panel and briefly describe what the test measures and why each is needed. (in no more than 150 words)

3. Explain thrombolysis and why it was included in the original treatment of the DVT. (in no more than 100 words)

4. When completing the history and physical exam, what questions would you include in the review of the systems? (in no more than 150 words)

5. Write a detailed history and physical examination using the information from the case and findings you might expect from a person with a DVT. Complete this in the form of a SOAP note.  (in no more than 2 pages)

6. Discuss why rivaroxaban was selected, how it should be adjusted, any specific scheduled timing and any other considerations you believe are important. What changes, if any, would you make and why? Use current clinical guidelines and other scholarly articles to support your information. (in 150 words or less)

7. How long should this patient remain on rivaroxaban and the rationale? (in 100 words or less)

8. When considering the information provided, are the current medications appropriate? Why or why not? (in 100 words or less)

9. Discuss a detailed treatment plan for this patient including patient education (in no more than 2 pages)