Exam (elaborations)
NUR 6111 Adv Nursing Practice 1 Case study 10_1_ week 10
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- William Paterson University
NUR 6111 Adv Nursing Practice 1
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Case study#10-Explain you answerAn 18-year-old high school football player suffered a torn anterior cruciate ligament (ACL) in the state
playoffs. After undergoing repair, he found it difficult to ambulate with the knee brace. Weighing close to
140 kg (approximately 300 pounds), the athlete found it difficult to stand and balance on one leg. His
mother was unable to support him by herself. After 1 week, the young man began to have increased pain
and swelling in the calf of his affected leg. In the middle of the night, the teen called out to his mother,
complaining of a shortness of breath and unexplained anxiety. His mother called 9-1-1, and he was taken
to a local hospital. In the emergency department, he was diagnosed with a deep vein thrombosis and a
pulmonary embolism. Oxygen and low-molecular–weight heparin were administered, and the young
man was admitted to the intensive care unit.
As a result of the thrombus lodging in the pulmonary circulation, the sympathetic nervous system is
activated. Hemodynamically, this results in:
1. Vasodilatation
2. Embolization
3. Decreased pulmonary artery pressure
4. Right heart failure
Answer: Hemodynamically, this results in right heart failure. When a thrombus lodges in the pulmonary
circulation inflammatory mediators and neurohumoral substances are released. This causes widespread
vasoconstriction. This obstructs blood flow to the lung. Embolization is the process of occluding a blood
vessel by purposefully introducing emboli. This results in increased pulmonary artery pressures and can
lead to right heart failure.
The young man suffers an infarction or death of a portion of his lung tissue. Absent blood flow to a lung
segment causes:
1. Surfactant impairment
2. Absorption atelectasis
3. Collateral ventilation of the alveoli
4. Bronchiectasis
Answer: Absent blood flow to lung segment causes surfactant impairment. A decrease production or
inactivation of surfactant leads to atelectasis, which causes hypoxia. Without normal surfactant, the
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