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Assignment Task

Angela Thapa is a 72-year-old women who lives with her husband Arnold (also 72 years old) in their own home. Angela is a hospital in the home patient with nursing visits since she broke her hip after a fall while she was out in the garden. She had a fractured right Neck of Femur (NOF) and was taken for repair. The surgery went well; however, she developed a wound infection in the distal end of the suture line. Nurses visit to dress the wound and she takes oral Amoxil 500mg BD (twice daily) for the infection. Over the past 3 days Angela has noticed an uncomfortable pain in the centre of her chest, it is worse when she breathes and has also noticed a dry annoying cough. She has not mentioned it to Arnold as she did not want to worry him. Today she decides to mention it to you as her visiting nurse as the pain is more frequent and increasing and she feels quite short of breath.

You ask some more questions regarding the pain, and you have discovered she hasn’t been up and about as much with the pain in her hip, and she has lost confidence in mobilising since her fall. You look at her medical history, she has a history of HT and take antihypertensive, Osteo Arthritis and has no allergies. She is not a smoker and does not drink any alcohol. You see she is short of breath while talking to you, but you cannot see any use of accessory muscles for work of breathing.

You are very concerned about her observations and wonder if she has developed a Pulmonary Embolism (PE).

Questions: 

1. Discuss your assessments on this patient, identify signs of deterioration and clearly state if the patient requires a clinical review or rapid response as per Between the Flags (BTF). Justify your decision with data from the case and relevant support.
2. Considering the assessment findings, prioritise and discuss the immediate nursing management of the patient.
3. Succinctly discuss the ongoing management of this case and integrate the relevant members of the interdisciplinary team.