The nurse is assigned a patient with Hodgkin’s lymphoma undergoing initial treatment. On the patient’s second day, he develops an acute painful swelling and erythema of the right gastrocnemius. The following morning, the patient develops an acute shortness of breath and pleuritic chest pain. Within minutes, the patient loses consciousness and dies. Which of the following interventions would most likely have prevented this patient’s death?

Question

The nurse is assigned a patient with Hodgkin&rsquo;s lymphoma undergoing initial treatment.  On the patient&rsquo;s second day, he develops an acute painful swelling and erythema of the right gastrocnemius.  The following morning, the patient develops an acute shortness of breath and pleuritic chest pain.  Within minutes, the patient loses consciousness and dies.  Which of the following interventions would most likely have prevented this patient&rsquo;s death?

Accepted Answer

Anticoagulation therapy. Patients who have a malignancy, especially if it is a leukemia or lymphoma, are in a hypercoagulable state.  This patient with Hodgkin&rsquo;s disease (HD) acutely developed on his 2nd day signs and symptoms of a deep vein thrombosis (DVT), namely acute painful swelling and erythema of the gastrocnemius muscle.  Patients with a DVT who have significant risk factors (i.e. malignancy, hospitalization) should be placed on anticoagulant therapy immediately to prevent extension of the DVT or a pulmonary embolus, which is likely the cause of this patient&rsquo;s demise.  Pericardiocentesis would be appropriate if the patient presented in cardiac tamponade (hypotension, distant heart sounds, electrical alternans on EKG).  Electrical cardioversion is appropriate for patients who present with cardiac arrhythmias, specifically supraventricular tachycardias.  Broad spectrum antibiotics would be appropriate if the swelling and erythema of the gastrocnemius were due to an infectious process.

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