A client diagnosed with thrombophlebitis, one day ago suddenly develops shortness of breath and is anxious. A nurse immediately assesses the client for other signs and symptoms of?

Appeared in: PGIMER Chandigarh NO - 2015

Explanation

The patient's recent diagnosis of thrombophlebitis is a primary risk factor for developing a deep vein thrombosis (DVT).
A pulmonary embolism (PE) is the most common and life-threatening complication of DVT, occurring when a part of the clot breaks off and travels to the lungs.
The sudden onset of unexplained shortness of breath (dyspnea) and anxiety are hallmark symptoms of an acute PE, as stated in the clinical scenario.
Therefore, the nurse's immediate priority is to assess for further signs of a PE.

Option A: Myocardial infarction (MI) typically presents with crushing substernal chest pain that may radiate, along with diaphoresis and nausea. While shortness of breath can occur, it's not usually the primary isolated symptom, and the direct link to thrombophlebitis is weak.
Option B: Acute Respiratory Distress Syndrome (ARDS) is a severe inflammatory lung condition that typically develops in critically ill patients (e.g., due to sepsis, major trauma, or severe pneumonia). Its onset is usually progressive over hours to days, not as sudden as described.
Option D: Pulmonary oedema is fluid accumulation in the lungs, most often caused by left-sided heart failure. Its classic signs include shortness of breath that worsens when lying down (orthopnea), pink and frothy sputum, and diffuse crackles on lung auscultation. These were not reported.

Clinical Relevance

Nursing practice connection: Use the key finding related to Recognition of Pulmonary Embolism in a high-risk patient to guide bedside assessment, documentation, and the next nursing action.
Recognizing the signs of PE in a patient with DVT or risk factors for DVT is a critical nursing skill, as PE is a life-threatening emergency.
The nurse's role in a suspected PE is to act quickly: stabilize the patient (oxygen, positioning), perform a rapid assessment, and immediately escalate care to the provider or rapid response team.
What if? If the patient was postoperative from a hip replacement surgery instead of having thrombophlebitis, the suspicion for PE would be just as high, as major orthopedic surgery is a significant risk factor for DVT and subsequent PE.

How to Approach the Question

First, identify the key clinical information provided in the patient scenario: a diagnosis of 'thrombophlebitis' and the 'sudden' onset of 'shortness of breath' and 'anxiety'.
Recognize that thrombophlebitis is a major risk factor for Deep Vein Thrombosis (DVT).
Think about the potential complications of DVT. The most serious acute complication is a piece of the clot breaking off and traveling to the lungs.
Evaluate the options based on this connection. Pulmonary embolism is a direct and classic complication of DVT.
Compare the patient's symptoms (sudden dyspnea, anxiety) with the classic presentations of the other options (MI, ARDS, pulmonary oedema) to confirm that PE is the best fit.

Concept Tested & Keywords

Concept Tested: Recognition of Pulmonary Embolism in a high-risk patient
Stem keywords: thrombophlebitis, suddenly develops shortness of breath, anxious
Lead-in keywords: assess for other signs and symptoms of
Clinical cues: The patient's history of thrombophlebitis is a major clue, indicating a risk for DVT.
Clinical cues: The sudden onset of symptoms points to an acute event like an embolism rather than a slowly developing condition.

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E6 Nursing Brunner Adult Health 3SA Vol 1 Part 2 p. 10-12

E6 Medicine Harrison 22e Part 2 p. 63-65

Practise the full PGIMER Chandigarh NO - 2015

Attempt every question from this paper in a timed mock, then review the full solution for each one.