Case 34 Part 1




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What's inside?


 

Ecchymosis
Livor mortis
Vascular access sites
Obesity
Stasis changes (lower legs)




This is a "High Independence" case. There is no explanatory audio.
Instructors: For more information, please visit the Case Selector.

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Discussion Questions


 

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1. Summarize the history.
 
 
2. What is the differential diagnosis of sudden onset of shortness of breath in the patient with obesity and COPD?
 
 
3. How many cardiac catheterizations did the patient have?
 
 
4. How does a cardiac cath work?
 
 
5. What is a coronary stent?
 
 
6. What medical conditions are associated with obesity?
 
 
7. What steps would you take to safely lift, turn, or transport a patient of this size?
 
 
8. What surgical risks increase for obese patients?
 
 
9. How much more difficult is it to insert a catheter into the groin of an obese patient than a thin patient?
 
 
10. What key medical errors were made in this case? What would you have done differently? (Revisit this question after viewing the entire case. Did your answer change? If so, why?)
 
 
11. The nurse diligently reported a key postoperative clinical finding to the physician. What was that key finding?
 
 
12. After learning a key postoperative clinical finding, the physician made an assessment that did not address a life-threatening issue. Why do you think this happened? What internal, relationship, or training factors might explain this outcome? How might this be addressed with this physician?
 
 
13. When does the nurse’s role extend beyond reporting of critical information? What is the nurse’s role when the physician makes a determination that puts the patient at risk? What is a team’s role when a key member makes an error, does not address issues competently, or puts a patient’s life at risk?
 
 
14. In general, how can you tell the difference between livor mortis and ecchymosis (bruising)?
 
 
15. In this patient, can you tell what’s ecchymosis and what’s livor mortis? How?
 
 
16. What’s the pathogenesis of livor mortis and ecchymosis?
 
 
17. What caused the holes in the right groin?
 
 
18. Is there any evidence of catheterization in the left groin (described in the history)?
 
 
19. What causes the brown color of the lower legs?
 
 
20. Why is there blue ink and contusions of the right arm?
 
 
21. What are your goals in assessing this patient at autopsy?
 
 
22. What incision(s) would you want to make to assess this patient at autopsy?




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