A week has passed. L.J. responded to heparin therapy and was bridged to oral warfarin therapy. His ...

The answer to question 1  You observe that L.J. doesn't seem to have realistic expectations associated with his recovery, so you
explain the following:
 He is going to require daily follow-up visits to monitor his status.
 Sitting on a plane for several hours, along with the vigorous activity required to make plane
changes, is not safe for him at this time. He is likely to have another DVT develop from sitting on
the plane (not to mention sitting at the wedding and reception). He is going to continue to receive
warfarin for life and will be at risk for bleeding and bruising; in addition, after his hospitalization
and bed rest, it will take him weeks or even months to adapt to the rigors of everyday life.
 Explore with him the possibility of sending an audiotaped or videotaped message from him to the
newlyweds. Ask whether anyone can video-record the ceremony and parts of the reception for him
to view at home so that he won't feel so isolated.

The answer to question 2  The rhythm is atrial flutter. You can see flutter waves with varying numbers between the QRS
intervals. The problem with atrial flutter is that the atria are quivering, or not contracting correctly.
Blood can pool inside the atria, and clot formation might occur.

The answer to question 3   Platelet count: Enoxaparin might decrease the platelet count.
 Complete blood count (CBC): Used to monitor for blood loss from bleeding that might or might not
be evident while L.J. is on anticoagulant therapy.
 Chest x-ray (CXR) examination: For evaluation of pulmonary and cardiac systems.
 D-dimer assay: High levels are associated with thrombotic problems, such as DVT.
 scan (ventilation/perfusion lung scan): Used to test for the presence of pulmonary embolism.
 Computerized tomographic angiography (CT angiography or CTA): Used to test for the presence of
pulmonary embolism.
 Arterial blood gases (ABGs): Used to monitor respiratory status and oxygenation.
 Test for occult blood in stool (guaiac) and/or emesis: To monitor for occult gastrointestinal bleeding.

The answer to question 4   Get specific information on the symptoms; verify with the patient the location, quality, intensity,
onset, duration, and expression of pain.
 Assess and monitor those factors that increase or decrease pain.
 Assess and monitor emotional responses and coping mechanisms to pain.
 Eliminate or modify those stimuli that increase pain.
 Evaluate the effectiveness of his pain medication.
 Teach him techniques he can use to modify his own pain (e.g., relaxation, imagery, distraction).

This calls for a celebration