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A 70 y/o female who had undergone right total hip replacement presents

A 70 y/o female who had undergone right total hip replacement presents

Sample Answer 

A 70 y/o female who had undergone right total hip replacement presents

Nursing differential diagnoses for the presentation:

First, the initial diagnosis is for central chest pain and acute-onset dyspnoea pulmonary embolism, which is responsible for inducing the sudden onset of pleuritic chest pain. Other complications that may come as a result of this condition include manifestations of fatigue by the individual due to the fact that the patient is old, instances of fainting, spitting of blood as a result of an injured chest, and possibly a cardiac arrest which might lead to death (Amrohit, 2010).

Consistently, the second diagnosis that can be derived from the presentation is severe shortness of breath which might be accompanied by nausea, chest pain, and light-headedness. In this state, one should be put under immediate labored breathing to manage the condition.

The use of an electrocardiogram (ECG) is the best diagnosis. It can be used to measure the heart rhythm and beat rate (Olshansky, 2018). It applies the use of ultrasound to visualize the heart and determine the specific components that display the presentation.

Design a short-term nursing protocol:

            The first step is the assessment of the current nursing and healthcare practices using recommendations from the guidelines provided. The next step will be identifying recommendations that will address the gaps and needs of the health condition (Jyotsna, 2017). Last, systematic development of a plan to implement specific recommendations with the use of associated resources and tools to be addressed for the condition.

Long-term care protocol to address this patient situation:

The long-term protocol for the presentation would focus on implementing the healthcare recommendations that would have been provided, based on the medical reports indicating the patient’s condition for effective management.


Amrohit, G. (2010). Chapter-10 Difference Between Central and Peripheral Cyanosis. The Pocketbook of Chest Physiotherapy, 41-42. doi:10.5005/jp/books/11057_10

Jyotsna, M. (2017). JVP- Jugular Venous Pressure. Indian Journal of Cardiovascular Disease in Women WINCARS02(02), 064-076. doi:10.1055/s-0038-1656414

Olshansky, B. (2018). Sinus node-related tachycardias: physiological sinus tachycardia, inappropriate sinus tachycardia, sinus node reentrant tachycardia, and postural orthostatic tachycardia syndrome. Oxford Medicine Online. doi:10.1093/med/9780198784906.003.0483


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A 70 y/o female who had undergone right total hip replacement presents

Case Study 4

A 70 y/o female who had undergone right total hip replacement presents on the 5th postoperative day with central chest pain and acute-onset dyspnea.

HPI. She has been immobile since the surgery

  1. VS: low-grade fever; tachycardia; hypotension. central cyanosis; elevated Jugular venous pressure (JVP); right ventricular gallop rhythm with widely split S2

Labs. Arterial Blood Gas (ABGs); hypoxia and hypercapnia (type 2 respiratory failure). patient had sinus tachycardia on ECG

Imaging. Doppler Ultrasound shot clot in the right common femoral vein. CXR, showed right lower lobe atelectasis. V/Q scan demonstrated three areas of ventilation-perfusion mismatch in right lung. Angio-pulmonary: confirmatory; (not required if V/Q scan is high probability).

Gross pathology. Large thrombus seen in pulmonary artery

A 70 yr old female who had undergone right total hip replacement presents

A 70 yr old female who had undergone right total hip replacement presents

Micro pathology.  Large occlusive thrombus seen in pulmonary artery with variable degree of recanalization.

  1.  Please provide two nursing differential diagnoses for this presentation
  2.  Design a short-term nursing protocol
  3.  Design a long-term care protocol to address this patient’s situation.

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