NURS 6501 Week 4 Assignment; Case Study Analysis - Pulmonary Embolism Risk Factors

Week Four Case Study Analysis Overview A thirty-eight-year-old female presents to the emergency department with complaints of dyspnea and left leg pain. The patient reports that her left leg started feeling heavy a few days ago and has also been red since she returned from a recent drip. She denies any injury to her leg. The patient reports that she started experiencing dyspnea in the last twenty-four hours. Patient history is remarkable for systemic lupus erythematosus as well as recent airplane travel. She is also taking oral birth control. Her blood pressure is 138/80, her heart rate is 100, her respiratory rate is 24, and her temperature is 100.4F. Physical exam reveals 2+ pitting edema to left leg with erythema. Based on this patient’s physical examination and verbal report, it appears as though she is presenting with a possible pulmonary embolism secondary to a blood clot in the left extremity. The patient's presentation consists of increased respiratory rate, tachycardia, slightly elevated blood pressure, leg pain, low-grade fever, and dyspnea, which are signs and all symptoms consistent with a pulmonary embolism (McCance & Huether, 2019). Though there are no racial or ethnic variables included in the case study, the patient has a significant history of systemic lupus erythematosus (SLE). Patients with SLE have a significantly increased risk for deep vein thrombosis leading to pulmonary embolism (Bilijana et.al., 2020). This is due to the autoimmune component of the immune cells' impact on the dysregulation of the coagulation cascade (McKerrow et al., 2022). In conjunction with the already hypercoagulable state of patients with SLE, if her oral contraceptives were estrogen-based, she would also be at an increased risk because of the increase in plasma fibrinogen and the activity of coagulation factors (McCance & Huether, 2019). The final detail of the case study reported recent travel (by airplane). Longer References Biljana, L., Sarac, S., Milic, R., Zugic, V. (2020). Prevalence of pulmonary embolism among systemic lupus erythematosus patients. European Respiratory Journal, 56(64). DOI: 10.1183/13993003.congress-2020.344 Ferreira, K., Cicarini, W., Alves, L., Loures, C., Campos, F., Santos, L., da Silva, M., Guimarães, T., Toledo, V., Reis, E., Neiva, C., Consoli, R., de Pádua, P., & Carvalho, M. (2019). Correlation between active disease and hypercoagulability state in patients with systemic lupus erythematosus. Clinica Chimica Acta, 490, 107–112. HYPERLINK "https://doi.org/10.1016/j.cca.2018.12.008"https://doi.org/10.1016/j.cca.2018.12.008 McCance, K. L. & Huether, S. E. (2019). Pathophysiology: The biologic basis for disease in adults and children (8th ed.). St. Louis, MO: Mosby/Elsevier McKerrow Johnson, I., Shatzel, J., Olson, S., Kohl, T., Hamilton, A., & DeLoughery, T. G. (2022). Travel-associated venous thromboembolism. Wilderness & environmental medicine, 33(2), 169–178. https://doi.org/10.1016/j.wem.2022.02.004 Takahashi, H., Hanya, M., & Ishino, H. (2023). Fever of unknown origin with normal inflammatory markers due to latent pulmonary embolism and deep vein thrombosis: A case report. Cureus, 15(8), e42850. https://doi.org/10.7759/cureus.42850