A 68 year-old female, discharged from the hospital 4 days ag…
A 68 year-old female, discharged from the hospital 4 days ago following an exploratory laparotomy for a perforated duodenal ulcer, presented back to the emergency department (ED) complaining of right-sided pleuritic chest pain that started a day after discharge. Blood chemistry showed expected normal values, CBC revealed hemoglobin of 9.8 g/dL, hematocrit 28.5% and platelet count of 350,000 per µL. Chest x-ray revealed consolidation in the right lung. The patient was diagnosed with hospital-acquired pneumonia, admitted to the PCU, and treated with intravenous fluids and IV Cefepime, On hospital readmission day 2, the patient complained of right lower extremity pain but denied trauma. Physical exam revealed erythema around the posterior aspect of the right calf. The patient was re-evaluated 2 hours later. The entire right leg was noted swollen and tender to touch. An ultrasound was done to asses for deep vein thrombosis (DVT) and showed acute thrombosis of right peroneal vein. The patient was started on therapeutic dose low molecular weight heparin subcutaneous injections. On hospital readmission day 6, the AGACNP was reviewing labs and noted leukocyte count 8.8 x103 per µL, hemoglobin 9 g/dL, hematocrit 27%, platelet count 84,000 per µL. Based on the laboratory findings and clinical case, the AGACNP is most concerned for: