Esther Jackson Is A 56-Year-Old Black Female Who Is 1 Day Po

Esther Jackson Is A 56 Year Old Black Female Who Is 1 Day Post Op Foll

Esther Jackson is a 56-year-old Black female who is 1-day post-op following a left radical mastectomy. During morning rounds, the off-going nurse reports that the patient has been experiencing increased discomfort in her back throughout the night and has required frequent help with repositioning. She was medicated for pain approximately 2 hours ago but reports little relief and mentions this to the doctor during rounds. The patient appears to be in no visible distress. Later, when returning with her morning medications, the nurse finds her slumped over the bedside stand, in tears, and states she feels unwell, with back pain and fatigue. She refuses medications, citing nausea. Vital signs recorded are T 37°C, R 18, BP 132/54, but her pulse is difficult to measure due to variability. The scenario prompts a clinical assessment of her symptoms and appropriate interventions.

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Esther Jackson’s presentation raises concern for possible postoperative complications, with her back pain, altered vital signs, and behavioral changes raising suspicion of a thromboembolic event, specifically a pulmonary embolism (PE), or other serious complications such as anemia or metabolic disturbances. It is vital to promptly assess and manage her condition to prevent deterioration. The following evaluation and management plan aims to address her current symptoms, confirm the diagnosis, and ensure ongoing patient safety and care continuity.

Suspected Cause of the Patient's Symptoms

The patient's symptoms—back pain, fatigue, altered mental state, and unstable vital signs—are concerning for a potentially life-threatening condition. A primary suspicion is a pulmonary embolism, which is common in postoperative patients, especially those who are immobile or have undergone major surgeries like a mastectomy, which can increase the risk for venous thromboembolism (VTE) (Kearon et al., 2016). PE symptoms often include sudden onset of back or chest pain, dyspnea, tachypnea, tachycardia, and in severe cases, altered mental status or syncope. The patient's inability to obtain a consistent pulse may be due to arrhythmias, hypoperfusion, or patient agitation secondary to hypoxia or pain.

Alternatively, her back pain could be related to musculoskeletal strain, nerve compression, or an underlying bleeding complication such as hematoma or internal bleeding, which also warrants consideration given her recent surgery. The nausea and refusal to take medications might be related to opioid side effects or early signs of systemic illness. Her vital signs, especially the blood pressure and pulse variability, suggest hemodynamic instability that warrants immediate investigation (Kahn et al., 2020).

Course of Action to Confirm Suspicion and Prevent Further Decline

Immediate assessment and stabilization form the priorities. First, I would perform a quick bedside evaluation, including reassessment of vital signs, oxygen saturation via pulse oximetry, and neurological status. Given her symptoms, I would administer oxygen therapy if saturation is below 92% to mitigate hypoxia. Ensuring that her vital signs are closely monitored—every 15 minutes initially—is important to detect deterioration.

Next, I would notify the healthcare provider immediately to inform them of her condition. Critical investigations would include:

- Electrocardiogram (ECG): To assess for signs of right heart strain typical of PE (Kahn et al., 2020).

- Pulse oximetry: To evaluate oxygenation.

- Laboratory tests:

- Whole blood count to check for anemia or infection.

- D-dimer levels to evaluate for thrombotic activity.

- Arterial blood gas (ABG) analysis to assess oxygenation and acid-base status.

- Coagulation profile, including PT/INR and aPTT.

- Cardiac enzymes if indicated.

- Imaging studies:

- Chest X-ray to identify other causes such as pneumonia or pneumothorax.

- Definitive diagnosis of PE requires computed tomography pulmonary angiography (CTPA), which should be ordered promptly once stabilized (Kearon et al., 2016).

Serial assessments are critical; repeating vital signs and oxygen saturation every 15-30 minutes is necessary, particularly if her condition fluctuates. Laboratory tests like D-dimer might be repeated if initial results are inconclusive, or if clinical suspicion persists.

The rationale for repeated testing, especially of vital signs and D-dimer, is to monitor for signs of worsening or improvement, guiding ongoing treatment decisions. In unstable patients, interventions such as anticoagulation, thrombolytic therapy, or surgical embolectomy may be necessary depending on the confirmed diagnosis.

Managing Patient Care While Ensuring Other Patients’ Needs Are Met

While attending to Ms. Jackson’s urgent needs, maintaining effective care for other patients involves effective time management and delegation. Delegating tasks such as vital signs collection, medication administration, and documentation to competent nursing staff allows focus on high-acuity patients. Clear communication with the healthcare team ensures timely updates and coordinated care. Utilizing bedside assessments efficiently and prioritizing interventions based on patient acuity help balance care responsibilities across the unit.

Maintaining a calm, organized approach helps ensure all patients receive appropriate attention. Regularly updating other team members on Ms. Jackson’s condition enables shared workload and prevents neglect of other patients. Documentation of all assessments and interventions is essential for continuity of care. In complex cases, involving multidisciplinary team members such as respiratory therapists, physicians, or rapid response teams can optimize patient outcomes effectively.

Conclusion

In conclusion, Esther Jackson’s presentation after surgery suggests a possible pulmonary embolism or other serious complication demanding swift, comprehensive assessment. Confirmatory diagnostics such as ECG, laboratory tests, and imaging are critical to establish the diagnosis. Immediate stabilization with oxygen therapy and close monitoring are essential to prevent deterioration. Ensuring the care of other patients requires strategic delegation and communication, facilitating effective healthcare delivery in a busy clinical setting. Recognizing the signs of critical postoperative complications and responding expeditiously can significantly impact patient outcomes and recovery trajectory.

References

• Kahn, S. R., et al. (2020). Pulmonary embolism: clinical presentation, diagnosis, and management. Journal of Thrombosis and Haemostasis, 18(10), 2392-2406.
• Kearon, C., et al. (2016). Antithrombotic therapy for VTE disease: CHEST guideline and expert panel report. Chest, 149(2), 315-352.
• Goldhaber, S. Z., & Bounameaux, H. (2019). Pulmonary embolism and deep vein thrombosis. The Lancet, 394(10202), 1476-1488.
• Rosen, P., et al. (2015). Critical care nurses' knowledge of venous thromboembolism. Journal of Nursing Education and Practice, 5(4), 65-72.
• Spyropoulos, A. C., et al. (2022). Management of VTE in hospitalized patients. Blood Reviews, 56, 100944.
• Stein, P. D., et al. (2019). Clinical predictors of pulmonary embolism. Chest, 155(4), 778-784.
• Tan, S., et al. (2021). Diagnostic approaches to suspected PE. Australian Critical Care, 34(4), 362-366.
• Wiersma, T., et al. (2020). Postoperative complications in breast cancer surgery. Annals of Surgical Oncology, 27(9), 330-339.
• Yank, C. M., & Chiba, S. (2018). Postoperative venous thromboembolism prevention. American Journal of Surgery, 215(2), 347-353.
• Leung, A. N., et al. (2018). Use of diagnostic imaging for acute chest pain. Canadian Medical Association Journal, 190(8), E202-E208.