Patient with deep vein thrombosis (DVT) experiencing dyspnea, chest pain and diminished Breath sounds is sugg… - RUHS, Jaipur, PB B.Sc Nursing Entrance-2018

RUHS, Jaipur, PB B.Sc Nursing Entrance-2018

Medical & Surgical Nursing

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Appeared in: RUHS, Jaipur, PB B.Sc Nursing Entrance-2018

Explanation

Pulmonary embolism (PE) is the most common life-threatening complication of deep vein thrombosis (DVT).
The pathophysiology involves a piece of the thrombus from the DVT dislodging, traveling to the lungs, and obstructing a pulmonary artery.
The patient's symptoms of sudden onset dyspnea, chest pain, and diminished breath sounds are the classic clinical triad for PE.
This obstruction of blood flow in the lungs impairs gas exchange and increases pressure on the right side of the heart, leading to the observed signs and symptoms.

Option A: Pericarditis pain is typically sharp, retrosternal, and relieved by leaning forward. A pericardial friction rub is the classic auscultatory finding. These features are absent in the question, and pericarditis is not a direct complication of DVT.
Option B: Pneumothorax (collapsed lung) typically presents with unilateral absent breath sounds and hyperresonance on percussion, not just diminished sounds. While it causes sudden dyspnea and chest pain, it is not caused by a DVT.
Option D: A mediastinal tumor would cause symptoms with a slow, insidious onset over weeks to months (e.g., progressive cough, hoarseness, weight loss), not the sudden, acute presentation described.

Clinical Relevance

Nursing practice connection: Use the key finding related to Complications of Deep Vein Thrombosis (DVT) to guide bedside assessment, documentation, and the next nursing action.
Recognizing the signs of PE in a patient with DVT is a critical nursing skill, as immediate intervention is required to prevent mortality.
Key nursing actions for a suspected PE include calling for immediate help (e.g., Rapid Response Team), applying high-flow oxygen, placing the patient in a high-Fowler's position, and preparing for diagnostic tests (like CTPA) and anticoagulation therapy.
Patient education on DVT prevention and the signs of PE is crucial for at-risk individuals, especially post-surgery or during periods of immobility.

How to Approach the Question

First, identify the key information in the clinical scenario: the patient has a known diagnosis of deep vein thrombosis (DVT).
Next, analyze the new, acute symptoms: dyspnea (shortness of breath), chest pain, and diminished breath sounds.
Think about the direct complications of the patient's known condition. The most serious and common complication of DVT is a pulmonary embolism (PE).
Evaluate if the new symptoms match the expected presentation of a PE. The triad of sudden dyspnea, chest pain, and signs of respiratory compromise is classic for PE.
Review the other options to confirm they are less likely. Pericarditis, pneumothorax, and tumors have different typical presentations and are not direct complications of DVT.

Concept Tested & Keywords

Concept Tested: Complications of Deep Vein Thrombosis (DVT)
Stem keywords: deep vein thrombosis (DVT), dyspnea, chest pain, diminished Breath sounds
Lead-in keywords: suggestive of
Clinical cues: A known diagnosis of DVT is a major risk factor for pulmonary embolism.
Clinical cues: The acute onset of symptoms (dyspnea, chest pain) points towards an emergent condition rather than a chronic one.

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

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