Clinical Case Studies 

A 52-year-old female patient presents for follow-up 7 days after hospitalization for her first deep vein thrombosis (DVT) in the left leg. She is currently taking rivaroxaban (Xarelto) 15 mg once daily. She had thrombolysis while in hospital and reports a decrease in swelling and tenderness of left leg. She also is positive for Factor V Leiden. The patient is in today and asking why she is taking rivaroxaban and not warfarin (Coumadin) like some of her friends who had a similar problem. She also wants to know how long she should be on rivaroxaban. Past Medical History- Patient also reports that she is asthmatic and hypertensive. Allergies- None Known Medications- Rivaroxaban 15 mg daily, HCTZ 25 mg daily, Advair 250/50 daily, Ibuprofen 400-600 mg po prn Physical Exam: Weight: 160 lb Height: 65 in BMI: 26.6 BP: 160/92 Temp: 98 Pulse: 70 Resp: 18 Labs: CBC: WBC: 10.2 HGB: 13 HCT: 40 PLT: 326 BMP: Glucose: 145 BUN: 28 Creat: 1.5 K: 3.9 CrCl 50 mL/min LFT: AST: 35 ALT: 42 Alk Phos: 35 Question Nurse Administrator Students: Consider that you are the nurse manager for unit in an acute care facility and starting an anticoagulation clinic. You are developing standards and guidelines for staff and physicians related to a patient with a deep vein thrombosis (DVT). Please answer the following questions based on the case study. Your answers should be brief and to the point for ALL questions. The word count is outlined within each question. Points will be deducted for going over the word limit for each question. 1. Discuss the pathophysiology of a DVT. (in no more than 150 words) 2. List the tests that are commonly included in a coagulation panel and briefly describe what the test measures and why each is needed. (in no more than 150 words) 3. Explain thrombolysis and why it may be included in the original treatment of a DVT. (in no more than 100 words) 4. When nurses are performing an assessment of the patient in this case, what information will be needed in the history and review of the systems? (in no more than 150 words) 5. When nurses are performing a physical exam of the patient in this case, what specific components of a physical examination would be important to document during the physical exam? Provide documentation of a sample nursing note using the information from the case and any findings you might expect from a person with a DVT. (in no more than 2 pages) 6. Provide guidelines or an algorithm that can be used to adjust or monitor the rivaroxaban; including the length of time for the duration of the rivaroxaban, any lab work needed, any other considerations for this medication. Discuss why this is important. Use current clinical guidelines and other scholarly articles to support your information. (in 150 words or less) 7. Discuss how nurses and pharmacy should review the patient’s other medications. What tools might be used to identify drug interactions? (in 100 words or less) 8. Discuss detailed patient instructions and a teaching plan for this patient including medications, diet, follow-up care. (in no more than 2 pages)

CLINICAL CASE STUDIES
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