Discussion question: Ms. B is a 63-year-old patient who had knee surgery 2 days

Discussion question: Ms. B is a 63-year-old patient who had knee surgery 2 days ago. Ms. B is experiencing a lot of pain and is refusing to get out of bed and walk. Ms. B begins to complain of an aching pain to the right calf. The nurse notes that patient’s right calf is swollen and red. What is mostly likely going on with this patient (10 points)? What is the pathogenesis of this problem (20 points)? What are the risk factors that lead to this problem (10 points)? What risk factors does Ms. B have (10 points)? Explain preventive measure and major consequences (10 points). Respond to this student: Ms. B is a patient experiencing much pain and is immobile since she refuses to walk or get out of bed. The aching pain, the swelling, and the redness indicate symptoms of inflammation. Moreover, it is only on one leg instead of two, which means it is unilateral in the lower extremities. These are the indicators of a venous circulation disease called Deep Vein Thrombosis, which is the formation of blood clots to the vein’s wall. This disorder has complications of inflammation and thrombosis, which can also lead from thrombosis to embolism (Norris,2019). In Virchow’s Triad, there are three pathogenesis to this venous thrombosis. The first one is the stasis of blood due to immobility. Stasis of blood can cause a decrease in blood flow, and when blood is still, it allows the accumulation of thrombin. This thrombin, procoagulant proteases, will induce thrombosis and overcome the anticoagulant pathway (Mackman, 2012). Second is the vessel wall damage, which could be endothelial injury. It must first contract or constrict during endothelial injury to prevent blood loss. From this, the platelet aggregation occurs as the platelet adhere and form a plug. Then, a formation of insoluble fibrin strands go over the site of injury and form a clot. Further, when a clot or thrombus is formed, it can trigger an inflammatory response due to irritation to the vessel wall. The third one is hypercoagulation, a situation of increased clot formation and activity related to clotting cascades. Hypercoagulation could be from acquired or inherited deficiencies in some plasma proteins that help to inhibit thrombus formation (Norris,2019). When this happens, the person experiencing it will have a higher chance of getting a clot. There are numerous risk factors leading to Deep Vein Thrombosis. Immobility is a significant factor that could lead to blood stasis and decreased blood flow. It could be anyone with surgery, hip fracture, prolonged sitting, and spinal cord injury. Another risk factor can be people who smoke or use oral contraceptives because it leads to high cholesterol levels, diabetes mellitus, and hemodynamic stress, which is more susceptible to vessel damage (endothelial injury) ( Norris,2019). It could also be women who are pregnant. In these risk factors, Ms. B has immobility due to knee surgery. This leads to her pain problems and the venous blood not flowing right. A significant consequence following Venous Thrombosis (Deep Vein Thrombosis) is Pulmonary Embolism. When a thrombus breaks loose and travels in the bloodstream, the emboli will go toward the heart through the inferior vena cava, to the right atrium, to tricuspid valve and then to the right ventricles. The right ventricle will go to the pulmonary artery and get clogged there. Pulmonary emboli can be life-threatening and cause death since it can result in pulmonary infarction and pleural effusion-fluid buildup in the lungs (Pennmedicine.n.d.). As a result, to prevent venous thrombosis from happening, patients need early immobility right after surgery. They should use compression hose/ intermittent compression devices to aid blood circulation. Leg exercises and medication to help with coagulation will also decrease the risk. References: Mackman, N. (2012, July). New insights into the mechanisms of venous thrombosis. The Journal of clinical investigation. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3386811/ Norris, T. L. (2019). Porth’s pathophysiology: Concepts of Altered Health States. Wolters Kluwer. Pennmedicine.org. (n.d.). https://www.pennmedicine.org/for-patients-and-visitors/patient-information/conditions-treated-a-to-z/pulmonary-embolus