Patient Encounter 1 Part

KK has been hospitalized for right hip fracture repair. Two weeks after her discharge from the hospital, she presents to the emergency department with complaints of swelling, redness, and pain in her right lower extremity. KK states her symptoms started 3 days ago and have gotten progressively worse. During your interview, the patient states that she was sent home with a prescription for fondaparinux 2.5 mg SC daily. A duplex ultrasound shows a proximal DVT in her right lower extremity. All of her other laboratory values are within normal limits.

Which ofKK's symptoms are consistent with an acute DVT?

Design an appropriate treatment plan forKK. Your plan should include acute and chronic therapy—specify the drug(s), dose(s), route, frequency of administration, and duration of each therapy, as well monitoring parameters, patient education, and follow-up plan.

Assuming KK continues to take the prescription and over-the-counter medications listed in her medication history obtained during her hospitalization, should any of these medications be discontinued or changed? If changed, what alternative therapy would you recommend?

Is KKa candidate for outpatient treatment of her DVT?

Compression Stockings

PTS occurs in 20% to 50% of patients within 8 years after a DVT. Wearing GCS after a DVT reduces the risk of PTS by as much as 50%. Current guidelines recommend the use of GCS with an ankle pressure of 30 to 40 mm Hg for 2 years after a DVT. To be effective, GCS must fit properly. Traditionally, strict bed rest has been recommended after a DVT, but this approach has now been refuted and patients should be encour-

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aged to ambulate as tolerated. '

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