Description
In this current clinical I see many medical issues that are being treated. One was from a person having DVT that progressed to PE’s as well. This patient is very obese and not very active. Patient works from home which does not require patient to move much. Patient presented with shortness of breath. Slightly diaphoretic, bp and heart rate was slightly elevated and oxygen saturation would only go up to 92% even after breathing treatment. When the patient arrived oxygen saturation was around eighty-eight with exertion. Patient never stated left leg hurt and not other real complications noted. Pt had breathing treatments at home but did not really use them correctly. Through Telehealth messaging nothing stuck out as being severe enough to be send patient to hospital. Since the issue has been going on for several days, we brought him in to assess patient. Lungs clear at time of assessment. Vitals did not red flag other than the oxygen sat when first coming in. We are unable to complete a chest x ray or CT in the clinic. Lab values would take some time. It was not until the patient stated something about the leg being discomfort behind the knee and calf. Patients’ legs were already swollen, no redness noted. Due to obesity, shortness of breath with very little activity along with the discomfort to left leg gave enough suspicion to send pt in further testing. Such as a U/S and x ray of chest if warned. Due to the inability to get an outpatient U/S of leg and the possibility of decline not to mention the stress and strain that it would have put on the patient the patient refused EMS and was instructed to head straight to the ER. The guideline that would have been used was a treatment for 3 months. This guideline state there is no one way to treat the patient. VTE treatment needs to be given promptly. Other things to consider are age and the patients’ ability to afford the medication. Thrombolytic therapy is necessary to treat patients with pulmonary embolism especially if unstable and having symptoms. Anticoagulant therapy is a secondary prevention at this point. Depending on the reason for DVT will determine the need to continue medication and for how long. Thrombolytic and anticoagulant therapy require monitoring of the patient. Clots do not go away in weeks they can take months. IVC filter may be needed for the protection of the patient (Ortel et al., 2020).
How can the NP balance shared decision making and the patient’s culture and/or preferences with safe clinical practice?
With shared decision making, there must be optimized organization among the team. There must be understanding, and trust built. Prompting the patient and family with the topic of discussion can help at times by allowing the topic or condition to be discussed and absorbed before coming into the clinic. It also allows them to brainstorm. To better understand if a patient or family member understands what was taught the teach back method is an effective way to gather that data. Document and write down the education and reason for the decisions being made (Raleigh et al., 2022). When allowing a patient and at times the family to make decisions based on the possible outcome of the health of the patient can bring unity and trust towards the health care team. This also allows the health care team the ability to understand culturally or logically how the patient feels. In shared decision making you must have communication, relationship building, and a shared decision of the direction the treatment will go. It really is a team approach (Truglio-Londrigan & Slyer, 2018).
References
Ortel, T. L., Neumann, I., Ageno, W., Beyth, R., Clark, N. P., Cuker, A., Hutten, B. A., Jaff, M. R., Manja, V., Schulman, S., Thurston, C., Vedantham, S., Verhamme, P., Witt, D. M., D. Florez, I., Izcovich, A., Nieuwlaat, R., Ross, S., J. Schünemann, H., … Zhang, Y. (2020, October 2). American Society of Hematology 2020 Guidelines for management of venous thromboembolism: Treatment of deep vein thrombosis and pulmonary embolism. American Society of Hematology. https://ashpublications.org/bloodadvances/article/4/19/4693/463998/American-Society-of-Hematology-2020-guidelines-for
Raleigh, M. F., Nelson, M. D., & Nguyen, D. R. (2022, July 31). Shared decision-making: Guidelines from the National Institute for Health and Care Excellence. American Family Physician. https://www.aafp.org/pubs/afp/issues/2022/0800/practice-guidelines-shared-decision-making.html
Truglio-Londrigan, M., & Slyer, J. T. (2018, January 22). Shared decision-making for nursing practice: An integrative review. The open nursing journal. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC58062…
