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This Concept Map, created with IHMC CmapTools, has information related to: Deep Vein Thrombosis, K. B. 68 year old female Hx: osteoarthritis S/P Left Total Knee Arthroplasty, POD#3 Deep Vein Thrombosis results in Problem: Acute Post-Operative Pain ND: Acute Pain Data: Pain described as 8/10 Grimacing Outcome: (Short-term) Pt wil describe pain as tolerable. (Long-term) Pt will develop and use alternative methods of pain control. Interventions: Norco 10/325 PO q 4 hrs prn Dilaudid 1-2 mg IVP q 2 hrs prn breakthrough pain Educate patient about alternative methods of pain control Relaxation techniques, Pet therapy Educate patient about risk of constipation, Problem: Deep Vein Thrombosis ND:Risk for Bleeding Data:Swollen, tender left calf. Positive Homan's sign. Positive Venous Ultrasound. Positive D-Dimer Outcomes: (Short-term) Pt will have therapuetic PTT levels (Intermdediate) Pt will not develop complications of heparin therapy. Interventions: Heparin drip. Follow heparin protocol to achieve tharapeutic PTT levels Daily CBC, PT, PTT Monitor for signs of bleeding Educate patient about pathophysiology of DVT, risk for pulmonary embolism, anticoagulants (Urden, Stacy & Lough, 2010) (Kearon et al., 2008) at risk for Problem: Pulmonary Embolism ND: Potential for Impaired Gas Exchange Data: RR 18, easy and non-labored Lungs CTA Pulse oximeter 98% on O2 2L/NC Outcome: (Intermediate) Pt will not develop PE. Interventions: Assess lung sounds q shift Continuous pulse oximeter Encourage IS q 1 hr Educate patient to inform nurse of sudden shortness of breath, chest pain, or respiratory distress (Urden, Stacy & Lough, 2010), Problem: Constipation ND: Constipation Data: Hypoactive BS + flatus no BM for 4 days Abd distention Outcome: (Intermediate) Pt will not develop constipation. Interventions: Colace 100 mg PO BID MOM 30 ml PO prn Dulcolax supp 10 mg PR prn Fleets enema PR prn at risk for Problem: Ileus ND: Potential for Impaired Elimination Data: Abd distention Hyoactive BS Outcome: (Intermediate) Pt will not develop ileus. Intervention: Monitor BS q shift Be alert to absence of BS or - flatus Continue aggressive bowel elimination treatment, Problem: Acute Post-Operative Pain ND: Acute Pain Data: Pain described as 8/10 Grimacing Outcome: (Short-term) Pt wil describe pain as tolerable. (Long-term) Pt will develop and use alternative methods of pain control. Interventions: Norco 10/325 PO q 4 hrs prn Dilaudid 1-2 mg IVP q 2 hrs prn breakthrough pain Educate patient about alternative methods of pain control Relaxation techniques, Pet therapy Educate patient about risk of constipation can contribute to Problem: Immobility ND: Impaired Physical Mobility Data: Large surgical dressing and ace wrap on left leg. Knee immobilizer for first 24 hours post-op due to spinal block. Virchow's Triad Outcomes: (Short-term) Pt will maintain mobillity. Pt will not develop DVT. Interventions: Lovenox 40 mg SQ q 12hrs Early ambulation on operative day PT/OT BID Sequential Compression Device Thigh high TED hose Coumadin therapy to achieve INR 2-3 Daily PT/INR (American Academy of Orthopaedic Surgeons 2011), Problem: Acute Post-Operative Pain ND: Acute Pain Data: Pain described as 8/10 Grimacing Outcome: (Short-term) Pt wil describe pain as tolerable. (Long-term) Pt will develop and use alternative methods of pain control. Interventions: Norco 10/325 PO q 4 hrs prn Dilaudid 1-2 mg IVP q 2 hrs prn breakthrough pain Educate patient about alternative methods of pain control Relaxation techniques, Pet therapy Educate patient about risk of constipation can lead to Problem: Constipation ND: Constipation Data: Hypoactive BS + flatus no BM for 4 days Abd distention Outcome: (Intermediate) Pt will not develop constipation. Interventions: Colace 100 mg PO BID MOM 30 ml PO prn Dulcolax supp 10 mg PR prn Fleets enema PR prn, Problem: Deep Vein Thrombosis ND:Risk for Bleeding Data:Swollen, tender left calf. Positive Homan's sign. Positive Venous Ultrasound. Positive D-Dimer Outcomes: (Short-term) Pt will have therapuetic PTT levels (Intermdediate) Pt will not develop complications of heparin therapy. Interventions: Heparin drip. Follow heparin protocol to achieve tharapeutic PTT levels Daily CBC, PT, PTT Monitor for signs of bleeding Educate patient about pathophysiology of DVT, risk for pulmonary embolism, anticoagulants (Urden, Stacy & Lough, 2010) (Kearon et al., 2008) may contribute to Problem: Anxiety ND: Anxiety, Fear, Powerlessness Data: Patient crying States "What is happening to me? Am I going to be okay?" Outcomes: (Short-term) Pt will report decreased levels of anxiety. (Intermediate) Pt will report understanding of expected course of treatment. (Long-term) Pt will develop and use effective coping techniques. Interventions: Actively listen to patient and accept her concerns regarding this threat to her health. Allow patient to ventilate her concerns. Re-inforce education about DVT and expected course of treatment. (Urden, Stacy & Lough, 2010), K. B. 68 year old female Hx: osteoarthritis S/P Left Total Knee Arthroplasty, POD#3 Deep Vein Thrombosis results in Problem: Immobility ND: Impaired Physical Mobility Data: Large surgical dressing and ace wrap on left leg. Knee immobilizer for first 24 hours post-op due to spinal block. Virchow's Triad Outcomes: (Short-term) Pt will maintain mobillity. Pt will not develop DVT. Interventions: Lovenox 40 mg SQ q 12hrs Early ambulation on operative day PT/OT BID Sequential Compression Device Thigh high TED hose Coumadin therapy to achieve INR 2-3 Daily PT/INR (American Academy of Orthopaedic Surgeons 2011), Problem: Immobility ND: Impaired Physical Mobility Data: Large surgical dressing and ace wrap on left leg. Knee immobilizer for first 24 hours post-op due to spinal block. Virchow's Triad Outcomes: (Short-term) Pt will maintain mobillity. Pt will not develop DVT. Interventions: Lovenox 40 mg SQ q 12hrs Early ambulation on operative day PT/OT BID Sequential Compression Device Thigh high TED hose Coumadin therapy to achieve INR 2-3 Daily PT/INR (American Academy of Orthopaedic Surgeons 2011) also contributes to Problem: Constipation ND: Constipation Data: Hypoactive BS + flatus no BM for 4 days Abd distention Outcome: (Intermediate) Pt will not develop constipation. Interventions: Colace 100 mg PO BID MOM 30 ml PO prn Dulcolax supp 10 mg PR prn Fleets enema PR prn, Problem: Immobility ND: Impaired Physical Mobility Data: Large surgical dressing and ace wrap on left leg. Knee immobilizer for first 24 hours post-op due to spinal block. Virchow's Triad Outcomes: (Short-term) Pt will maintain mobillity. Pt will not develop DVT. Interventions: Lovenox 40 mg SQ q 12hrs Early ambulation on operative day PT/OT BID Sequential Compression Device Thigh high TED hose Coumadin therapy to achieve INR 2-3 Daily PT/INR (American Academy of Orthopaedic Surgeons 2011) has contributed to development of Problem: Deep Vein Thrombosis ND:Risk for Bleeding Data:Swollen, tender left calf. Positive Homan's sign. Positive Venous Ultrasound. Positive D-Dimer Outcomes: (Short-term) Pt will have therapuetic PTT levels (Intermdediate) Pt will not develop complications of heparin therapy. Interventions: Heparin drip. Follow heparin protocol to achieve tharapeutic PTT levels Daily CBC, PT, PTT Monitor for signs of bleeding Educate patient about pathophysiology of DVT, risk for pulmonary embolism, anticoagulants (Urden, Stacy & Lough, 2010) (Kearon et al., 2008), Problem: Acute Post-Operative Pain ND: Acute Pain Data: Pain described as 8/10 Grimacing Outcome: (Short-term) Pt wil describe pain as tolerable. (Long-term) Pt will develop and use alternative methods of pain control. Interventions: Norco 10/325 PO q 4 hrs prn Dilaudid 1-2 mg IVP q 2 hrs prn breakthrough pain Educate patient about alternative methods of pain control Relaxation techniques, Pet therapy Educate patient about risk of constipation can result in Problem: Anxiety ND: Anxiety, Fear, Powerlessness Data: Patient crying States "What is happening to me? Am I going to be okay?" Outcomes: (Short-term) Pt will report decreased levels of anxiety. (Intermediate) Pt will report understanding of expected course of treatment. (Long-term) Pt will develop and use effective coping techniques. Interventions: Actively listen to patient and accept her concerns regarding this threat to her health. Allow patient to ventilate her concerns. Re-inforce education about DVT and expected course of treatment. (Urden, Stacy & Lough, 2010), Problem: Deep Vein Thrombosis ND:Risk for Bleeding Data:Swollen, tender left calf. Positive Homan's sign. Positive Venous Ultrasound. Positive D-Dimer Outcomes: (Short-term) Pt will have therapuetic PTT levels (Intermdediate) Pt will not develop complications of heparin therapy. Interventions: Heparin drip. Follow heparin protocol to achieve tharapeutic PTT levels Daily CBC, PT, PTT Monitor for signs of bleeding Educate patient about pathophysiology of DVT, risk for pulmonary embolism, anticoagulants (Urden, Stacy & Lough, 2010) (Kearon et al., 2008) now requires Problem: Immobility ND: Impaired Physical Mobility Data: Large surgical dressing and ace wrap on left leg. Knee immobilizer for first 24 hours post-op due to spinal block. Virchow's Triad Outcomes: (Short-term) Pt will maintain mobillity. Pt will not develop DVT. Interventions: Lovenox 40 mg SQ q 12hrs Early ambulation on operative day PT/OT BID Sequential Compression Device Thigh high TED hose Coumadin therapy to achieve INR 2-3 Daily PT/INR (American Academy of Orthopaedic Surgeons 2011)