Reflective Journaling

Name: __Michael Cook_______

Date: 11/12/2016

Situation:
An older adult male patient was admitted for a left knee replacement after years of osteoarthritic damage
and cartilage recession. The patient was post-operative day two when he was assigned to my care. The
patient had received orthopedic surgery several years prior and had a history of deep vein thrombosis. As
with all patients on the orthopedic floor after surgery, he was on anticoagulant medication aimed to
prevent blood clots after the procedure.
Noticing

Subjective and objective data: When I was introduced to the patient at 0800, he had
communicated to me that he was having severe pain in the left knee, around the site of the
surgery. Although this is common, an extensive area surrounding the affected site was severely
edematous. Furthermore, the area was warm and erythematous. The patients vital signs were all
within normal limits, with the exception of the heart rate which was slightly tachycardic at 108
beats per minute.

Although it is common for the area of the surgery to be painful, even severely painful at times,
the severity of the edema and redness were not common findings. Given the patients history it
was a concern for another thrombotic event.

Interpreting

I inquired with the patient about the specific details of his previous thrombotic experience. I
inquired about the current history of the edema and redness, as well as the pain profile that
accompanied it. Furthermore, I did a thorough respiratory and cardiac assessment to ensure that
the patient wasnt currently in a critical situation that needed immediate direct intervention.

I notified the orthopedic surgeon about the severity of the findings and about the patients history
of deep vein thrombosis after previous orthopedic surgery. I also notified the UAPs to be
cognizant of the situation with the left knee and not to apply pressure to the affected region or
manipulate the extremity until the physician had evaluated it.

The affected leg, when a deep vein thrombosis is suspected, should be in a particular position and
that position can be monitored and adjusted by UAPs.

Responding

The notification to the orthopedic surgery, I felt, needed to be quickly accomplished as the
dangers of a potential deep vein thrombosis are serious, and potentially life threatening. Given
that patients history I felt it was a fairly urgent communication.

I will know if I made the right decision if the patient has a reduction in the symptomology either
without a DVT diagnosis, or due to interventions employed as a consequence of the new DVT
diagnosis.

Informing the surgeon was justified as the symptomology and history provided adequate concern
and further evaluation was necessary to ensure that a thrombotic event had or had not occurred.
The patients position was also adjusted so that the affected leg was slightly elevated. This
position helps to reduce the symptomology related to a thrombotic event and reduces the
frequency of such events compared to leaving patients in supine position without elevation
(Ayatollahzade-Isfahani et al., 2013).

Reflecting

I did make the right decision as the patient was diagnosed via duplex ultrasound with a thrombus
near the surgical site. After that discovery by the orthopedic surgeon, new interventions were
initiated to combat the thrombus and prevent a worse outcome. Furthermore, the new
interventions and positioning helped to reduce much of the edema at the site.

I did well by taking into account the specific patients previous history and correlating that with
the new symptomology to guide my interventions. That being said, it made me realize how
important is to consistently enact the preventative measures for all relevant patients, including
SCDs, regular activity and ankle pump exercises to encourage circulation.

References:
Ayatollahzade-Isfahani, F., Pashang, M., Omran, A.S., Saadat, S., Shirani, S., & Fathollahi, M.S. (2013)
Comparing the impact of supine and leg elevation positions during coronary artery bypass graft
on deep vein thrombosis occurrence: A randomized clinical trial study. Journal of Vascular
Nursing, (2), 64. doi:10.1016/j.jvn.2012.08.003