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Deep Vein Thrombosis (DVT)

Aka Blood clot usually found in the lower leg

65 year old male developed pain and swelling in his right calf.  He believed that he pulled a muscle while golfing at his country club.  After a few days the area became reddened and his pain increased and he made an appointment with his MD.  Upon evaluation, MD diagnosed patient with a DVT.  He ordered subcutaneous injections and instructed patient to stay home and keep elevated and only to get up to bathroom.  MD referred patient for home health to instruct in new medications, to obtain and monitor weekly labs and to report any worsening. 

Skilled nurse arrived to patient’s home and found him in recliner in supine position.  She completed a full assessment, measured the circumference of patient’s leg, obtained a rating of baseline pain level, and taught patient’s spouse how to administer injections.  Patient was to have injections daily times 3 days and was then given oral anticoagulants.  Nurse set care plan for daily X 3 days and then weekly to obtain labs and report to MD.  Nurse taught patient that laying in recliner is acceptable but that legs must be elevated above his heart.  Patient stated MD office told him to elevate and he didn’t realize they needed to be up higher than heart.  Nurse reviewed paperwork from MD which explained all care and patient stated he didn’t realize that the MD had told him to keep legs above heart.  Nurse explained that many times it takes hearing something several times to really retain information, especially during times of crisis or during illness.  Patient admitted being somewhat overwhelmed with all the information he received from MD and nurses at MD office.  He also admitted he hadn’t read literature.  Over next 3 days, nurse reviewed all handouts from MD office.  Patient asked good questions and was appreciative of education.  Patient also expressed frustration at having to stay home.  Nurse reminded patient of how dangerous a blood clot can be.  Keeping legs elevated for a few weeks, taking medication and following the care plan could mean the difference between a heart attack, stroke or even death.  Nurse recommended several “projects” to complete to combat boredom and frustration.   Patient agreed he would follow care plan.   Patient educated on diet and foods that counteracted his anticoagulants.  She taught patient’s wife on foods to avoid.  Over the next 3 weeks, patient’s pain resolved, his leg circumference returned to normal and patient was discharged from home care due to no longer being homebound and was followed up weekly with his MD. 

*Footnote:  This patient, over the next 2 years, continued to come on and off service as he continued to develop clots periodically.  Each time, he came back to our agency and was monitored during his health crises.