A patient with Deep Vein Thrombosis (DVT) suddenly develops dyspnea and chest pain. The nurse should suspect:

RML 2023

Medical & Surgical Nursing

Medium

Appeared in: RML 2023

Explanation

A pulmonary embolism (PE) is a common and life-threatening complication of Deep Vein Thrombosis (DVT).
It occurs when a piece of the blood clot (embolus) from the deep veins breaks off, travels through the bloodstream to the lungs, and blocks a pulmonary artery.
The classic signs of a PE are the sudden onset of unexplained dyspnea (shortness of breath) and pleuritic chest pain, which match the patient's presentation.

Option A: A myocardial infarction is caused by a blockage in the coronary arteries, which are part of the systemic arterial circulation. A clot from a DVT is in the venous system and travels to the lungs.
Option C: Pneumonia is an infection of the lung parenchyma. Its onset is typically gradual and accompanied by fever, chills, and a productive cough, none of which are indicated in this acute scenario.
Option D: While a massive PE can cause acute right-sided heart failure (cor pulmonale), the primary event causing the sudden symptoms is the embolism itself. Heart failure is a potential consequence, not the initial diagnosis to suspect.

Clinical Relevance

Nursing practice connection: Use the key finding related to Complications of Deep Vein Thrombosis (DVT) and recognition of Pulmonary Embolism (PE) to guide bedside assessment, documentation, and the next nursing action.
Recognizing the signs of PE in a DVT patient is a critical nursing skill, as it is a medical emergency requiring immediate intervention to prevent deterioration and death.
The nurse's first actions for a suspected PE should be to raise the head of the bed, apply oxygen, and immediately notify the Rapid Response Team or physician.
What if the patient had a history of atrial fibrillation instead of DVT? In that case, while a PE is still possible (from a right atrial thrombus), a systemic embolism causing a stroke would be a higher suspicion if neurological symptoms were present.

How to Approach the Question

First, identify the key information in the clinical scenario: the patient has a known diagnosis of DVT.
Next, analyze the new symptoms: sudden onset of dyspnea and chest pain. The word 'suddenly' is a critical clue for an acute event.
Connect the patient's history (DVT) with the new symptoms. Think about the most likely and life-threatening complications of DVT.
Evaluate the options based on this connection. A dislodged clot from a DVT travels to the lungs, causing a pulmonary embolism.
Eliminate other options by considering their typical causes and presentations, which do not directly relate to a DVT as the immediate cause.

Concept Tested & Keywords

Concept Tested: Complications of Deep Vein Thrombosis (DVT) and recognition of Pulmonary Embolism (PE).
Stem keywords: Deep Vein Thrombosis (DVT), suddenly develops, dyspnea, chest pain
Lead-in keywords: suspect
Clinical cues: History of DVT is a major clue for a complication related to a dislodged clot.
Clinical cues: Sudden onset of respiratory distress points to an acute event like an embolism.

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