[Solved]: Clinical Connections Case 2 History of Present…

Clinical Connections Case 2 History of Present Illness: Y. L. is a 23-year-old woman who presents to the emergency department with a chief complaint of acute onset of shortness of breath. She complains of right sided chest pain which is worse with inspiration and increased dyspnea with exertion. She denies any other respiratory symptoms. No lower extremity swelling. She has not been ill, bedridden, or immobile for prolonged periods. Describes her usual state of health as good and denies any other complaints. Past Medical History: DVT in the right lower extremity two years ago attributed to dehydration and immobility related to a 12-hour flight FH: Father: PE, deceased at age 42; mother: alive and well; brother: depression; maternal grandmother: diabetes; no other significant family history Meds: Ortho Tri Cyclen lo daily Review of Systems: As above, otherwise remainder of 10 system review is negative. Social History: Loan officer; No tobacco use, 1-2 glasses of wine “a few times per week”, no illicit drug use, lives alone Exam: Well-developed, well-nourished in moderate distress, diaphoretic, CV- tachycardic, regular rhythm, no murmurs, gallops, rubs (MGR); lungs clear to auscultation (CTA); no accessory muscle use; BP 116/60, P 110, RR 20 and unlabored, T 97.3, SpO2 93% on room air. Chest X-ray: unremarkable CTA chest: pending NURS 707 Case 2 Questions 1. What are 3 possible differential diagnoses for this patient’s chief complaint? List from most to least probable. 2. What constitutes the Virchow triad of predisposing factors for venous thrombosis? 3. Which components of the triad may be present in this patient? 4. Briefly discuss a common inherited hypercoagulable state specifically associated with the coagulations cascade. How does it result in hypercoagulability? 5. Would you continue her on oral contraceptives? Why? 6. Reference(s)