Athena Papadopoulos

💡 Summary of Case:

Patient: Athena Papadopoulos, 28 y/o female
Presentation: Dyspnoea, chest pain, tachycardia, diaphoresis post-caesarean section (3 days ago) following miscarriage at 25 weeks.
Diagnosis: Pulmonary Embolism (PE) – confirmed via elevated D-Dimer and CTPA.
Current Location: Cardiac ward (transferred via MET call from maternity).
Allergies: None (NKDA)

📋 Admission Vitals (MET Call):

Temp: 37.1°C (normal)
HR: 129 bpm (tachycardia)
RR: 34 bpm (tachypnoea)
BP: 172/87 mmHg (hypertension)
SpO2: 89% on room air (hypoxaemia)

💊 Medications Prescribed:

Medication	Purpose
Apixaban 10mg BD	Anticoagulant (to treat PE)
Oxycodone 5–10mg PRN	Pain relief (post-op/PE chest pain)
Metronidazole 500mg TDS	Antibiotic (likely post-op infection prophylaxis)
Cephalexin 500mg TDS	Antibiotic (coverage for post-surgical infection)

🏥 Medical Orders & Nursing Actions:

Order	Nursing Responsibility
Apixaban	Monitor for bleeding, bruising, educate on bleeding risk
Oxygen therapy (SpO2 >95%)	Apply oxygen immediately – nasal prongs or mask
Sequential compression device (SCD)	Ensure it's applied and functioning to prevent further clots
Thrombophilia screening	Collect and send bloods as ordered
12 lead ECG (stat)	Perform ASAP to rule out cardiac involvement
Oxycodone PRN	Administer for pain and monitor sedation & respiratory rate

🔍 Clinical Priorities:

Airway/Breathing: Hypoxia (SpO2 89%) → initiate oxygen therapy immediately.
Circulation: Tachycardia, high BP → monitor for hemodynamic instability.
Pain: Administer PRN Oxycodone; assess pain relief.
Anticoagulation: Start Apixaban as ordered; monitor for bleeding.
Infection: Continue antibiotics, observe for signs of sepsis.
Monitoring:
- ECG results
- Resp status (for PE deterioration)
- Pain scores
- Signs of further embolic events or bleeding

Education:

PE signs/symptoms
Importance of medication compliance (Apixaban)

When to seek help (e.g. bleeding)

🧾 PRIORITISED NURSING PROBLEMS – TEMPLATE (with examples for Athena)

Priority	Nursing Problem	Related to (R/T)	Evidenced by (E/B)	Goals / Expected Outcomes	Nursing Interventions
1 – Breathing	Impaired gas exchange	Pulmonary embolism	RR 34, SpO2 89% RA, dyspnoea	Maintain SpO2 ≥ 95% on oxygen therapy	- Apply oxygen as prescribed - Monitor SpO2 and RR - Position in high-Fowler’s - Monitor for signs of deterioration
2 – Circulation	Risk of further thromboembolism	Hypercoagulable state post C-section	Confirmed PE, high D-Dimer	Prevent recurrence of PE or DVT	- Administer Apixaban as charted - Apply sequential compression device - Encourage early mobilization if safe - Monitor for signs of DVT or bleeding
3 – Pain	Acute pain	Post-op recovery and PE	Reports of chest pain, PRN oxycodone ordered	Pain score < 3/10 within 30–60 mins post analgesia	- Administer oxycodone PRN - Monitor pain using pain scale - Reassess pain after 30–60 mins - Educate on non-pharm pain relief
4 – Infection Risk	Risk for infection	Post-op C-section	On Metronidazole and Cephalexin	No signs of systemic/local infection	- Administer antibiotics as ordered - Monitor temp, WCC, wound site - Promote hygiene and handwashing
5 – Knowledge Deficit	Lack of knowledge about anticoagulation therapy	New prescription of Apixaban	PE diagnosis; high-risk medication	Patient verbalises understanding of med use and precautions	- Educate on Apixaban purpose, dosing, signs of bleeding - Provide written material - Encourage questions

✅ Prioritisation Rationale (why in this order):

Breathing first – PE compromises oxygenation, immediate SpO2 correction needed.
Circulation second – Prevent clot progression and recurrence.
Pain third – Pain increases RR and stress, worsening respiratory effort.
Infection prevention – Vital post-surgery and during recovery.
Education – Ensures safe discharge and medication compliance.

🩺 Nursing Care Plan for Athena Papadopoulos

Nursing Problem	Goal	Interventions	Rationale	Evaluation
1. Impaired gas exchange related to pulmonary embolism as evidenced by SpO₂ 89%, dyspnoea, tachypnoea (RR 34)	Patient will maintain SpO₂ > 95% within 2 hours of oxygen therapy.	- Apply oxygen therapy as ordered. - Position in high-Fowler’s. - Monitor SpO₂, RR, effort of breathing hourly. - Perform frequent respiratory assessments.	- Increases oxygenation and ease of breathing. - Upright position maximises lung expansion. - Early identification of deterioration. - Assess effectiveness of interventions.	Patient’s SpO₂ maintained >95%, breathing rate improved, patient appears more comfortable.
2. Risk for further thromboembolism related to hypercoagulable state (postpartum, recent surgery, confirmed PE)	Patient will remain free from signs of new DVT or PE during admission.	- Administer Apixaban as prescribed. - Apply and monitor sequential compression device. - Encourage early ambulation if safe. - Monitor for signs of bleeding (bruising, hematuria, low BP).	- Prevent clot progression or recurrence. - Promote venous return. - Movement reduces stasis. - Early detection of bleeding complications.	No signs of new clot formation, no bleeding episodes, Apixaban tolerated.
3. Acute pain related to pulmonary embolism and surgical recovery as evidenced by chest pain and PRN oxycodone order	Patient will report pain ≤ 3/10 within 30–60 minutes of analgesia.	- Administer oxycodone PRN. - Assess and document pain scale before and after medication. - Provide comfort measures (e.g. relaxation techniques, positioning).	- Pain management improves respiratory function and mobility. - Pain assessments ensure effectiveness. - Non-pharmacological measures complement medication.	Patient verbalised pain reduced to 2/10 after oxycodone, appeared more relaxed.
4. Risk of infection related to recent C-section and immunocompromised state (anticoagulation therapy)	Patient will remain afebrile with no signs of wound or systemic infection during hospital stay.	- Administer antibiotics (Metronidazole, Cephalexin) as prescribed. - Monitor temperature, WCC, and wound site. - Educate patient on hygiene importance.	- Antibiotics prevent/treat infection. - Monitoring identifies early signs of infection. - Education empowers patient self-care.	No signs of infection; temp < 37.5°C; wound healing appropriate.
5. Knowledge deficit related to new anticoagulation therapy (Apixaban)	Patient will verbalise understanding of Apixaban, risks, and safety measures before discharge.	- Educate patient on purpose, dosing, side effects of Apixaban. - Provide written info. - Encourage questions and teach-back method.	- Knowledge reduces risk of medication error or non-compliance. - Reinforces understanding. - Engages patient in their care.	Patient verbalised understanding and demonstrated correct knowledge on questioning.

1⃣ COLLECT CUES / INFORMATION (Gather everything about Athena)

Type	Cues Collected
Patient history	- 28-year-old female - Recent C-section following miscarriage (25 weeks gestation) - No known drug allergies (NKDA)
Presenting symptoms	- Dyspnoea (difficulty breathing) - Chest pain - Tachycardia (HR 129 bpm) - Diaphoresis (sweating)
Observations (at MET call)	- Temp: 37.1°C (normal) - HR: 129 bpm (high) - RR: 34 bpm (very high) - BP: 172/87 mmHg (high) - SpO₂: 89% on room air (low)
Investigations	- Elevated D-Dimer - CTPA: Confirmed Pulmonary Embolism
Current medications	- Oxycodone PRN - Metronidazole 500mg PO TDS - Cephalexin 500mg PO TDS
New medical orders	- Apixaban 10mg BD - Oxygen therapy (target SpO₂ >95%) - Thrombophilia screen - Sequential compression device - 12-lead ECG stat
Social / Other	- Recent miscarriage → Emotional distress likely - Post-op recovery phase

2⃣ PROCESS INFORMATION (Analyse & understand the situation)

Process Step	Application to Athena
Interpret normal vs abnormal	- HR 129 bpm (abnormal, tachycardia) - RR 34 bpm (abnormal, tachypnoea) - BP 172/87 (abnormal, hypertensive) - SpO₂ 89% (very low, hypoxaemia)
Recognise relevant/irrelevant information	- Relevant: Dyspnoea, chest pain, PE diagnosis, hypoxia. - Less urgent for now: past antibiotics if no infection signs.
Predict potential complications	- Worsening PE (could block more vessels). - Bleeding from anticoagulants. - Further respiratory failure. - Anxiety or emotional trauma (after miscarriage).
Match information to expected patterns	- Classic signs of pulmonary embolism: sudden dyspnoea, chest pain, tachycardia, hypoxia. - Surgical postpartum patients = high risk for clots.
Identify urgency	- Immediate action needed for oxygenation (low SpO₂). - Start anticoagulation to prevent clot worsening. - Pain management to reduce oxygen demand.

🚑 Quick Summary:

Athena is critically hypoxic, tachycardic, and high risk for deterioration due to her postpartum PE.