Running Head: VENOUS THROMBOEMBOLISM 1

Venous Thromboembolism Clinical Nursing Judgement

Kimberly Muccio

Youngstown State University

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Venous Thromboembolism Clinical Nursing Judgement

Clinical nursing judgement is an essential skill in caring for patients in the nursing

profession. Clinical nursing judgement is defined as “an interpretation and reaching a conclusion

about a patient’s situation and the decision of the nurse to intervene” (Yuan, 2014). Effective

clinical judgement improves the quality of nursing care and helps medical professionals make

sound decisions regarding the care of their patients. Clinical nursing judgement is not only taught

within the nursing curriculum, but it is also learned through many experiences in the clinical

setting. This is why new graduates generally have less clinical nursing judgement than highly

experienced nurses with much more intuition. Nurses will “utilize their professional knowledge

and clinical experience in order to recognize subtle variations in clinical situations, interpret what

they observe, and provide nursing care for individual patients” (Yuan, 2014). This skill is not

limited to identifying a problem, but it also involves seeking a broad range of possibilities.

Nursing judgement is important because when a nurse has the ability to critically think, they will

also use this skill in the outside world and are possibly able to suspect manifestations of a disease

or illness before it occurs. It is, therefore, essential for the nurse to have reasoning skills in order

to make reliable clinical observations and judgements to provide the best care possible.

The term venous thromboembolism is an umbrella term that describes deep vein

thrombosis and pulmonary embolism. Venous thromboembolism “shares prothrombic risk

factors with deep vein thrombosis and pulmonary embolism, such as personal or family history

of venous thromboembolism, active malignancy, recent surgery or trauma, immobilization,

inherited thrombophilia, use of oral contraceptives, infectious diseases, obesity, and cardiac or

respiratory failure” (Di Minno, 2016). Deep vein thrombosis (DVT) occurs when a blood clot

forms in one of the veins in the body. It generally manifests as pain, swelling, warmth, redness,

cramping of the legs, or skin discoloration. The most common site for deep vein thrombosis is
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the lower calf area. Pulmonary embolism (PE) is the most severe complication of a DVT when

the clot in the leg or elsewhere in the body travels up into the lung. This severe situation usually

manifests as shortness of breath, but the person can also experience chest pain, tachycardia, and

excessive sweating.

A very recent situation occurred where I used my clinical nursing judgement skills

outside of the clinical setting to observe and detect signs and symptoms of a venous

thromboembolism in one of my very good friends. In high school, my friend, Kyle, was

diagnosed with a DVT during basketball season of his senior year. He was experiencing pain,

swelling, and cramping in his lower calf, so he went to the doctor and was diagnosed with a

DVT. He had to sit out the rest of the season and was on Coumadin therapy for about 13 weeks

following his diagnosis. Frequently, he had to go get his blood drawn to make sure that his INR

was in therapeutic range for the medication to be working properly. Kyle was attuned to his

condition and understood all of the signs and symptoms of his diagnosis. Fast forward 6 years

later, me, Kyle, and some of our friends were hanging out playing video games. Without any

exertion, Kyle stated to us that he was experiencing shortness of breath for about two weeks

now, but he thought that he was just coming down with a cold that was going around. He was

also complaining about cramping in his lower legs. Knowing that he has had a previous DVT, I

used my clinical nursing judgement to come to the conclusion that Kyle was at a very high risk

for yet another DVT or PE, especially if he was exhibiting these signs and symptoms. I told Kyle

that he needed to go to the doctor as soon as possible and explained to him why he is at a higher

risk because he has had this condition before and that shortness of breath without exertion was a

huge red flag. He went to the doctor the next day and was taken by ambulance to St. Elizabeth’s

in Boardman. Kyle had a CT scan done to check for the presence of clots and was diagnosed

with multiple small pulmonary embolisms and many DVTs. He was closely monitored and
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placed on a heparin drip in the hospital for a couple of days. He was visited by numerous doctors

and specialists to make sure that his condition was under control. When one of the doctors

visited him, he asked Kyle why he did not show up to his appointment 6 months ago. Kyle

explained to him that he forgot to reschedule and the doctor made sure that he promised to

continue with his appointments so that they could ensure that he would not be in this life-

threatening situation again. He is out of the hospital as of last week and he must visit his

hematology doctor every 6 months for check-ups and to ensure that his prescribed medication is

effective in treating his condition.

Kyle was prescribed life-long therapy of Apixaban (Eliquis). Apixaban (Eliquis) is “an

oral factor Xa inhibitor administered in fixed doses without the need for laboratory monitoring”

(Liu, 2015). Compliance is very important with all drugs, but especially life-long therapy

medications. Eliquis is preferred over other oral anticoagulant therapy because there is no

laboratory monitoring and the risk of non-compliance is much less. In a study that compared to

enoxaparin and warfarin, “apixaban reduces all-cause hospitalizations, resulted in a lower

number of hospitalized patients, and reduces the mean length of hospital stays” (Liu, 2015). The

nurses and doctors spent much of his hospital stay teaching the risks and possible complications

of the prescription of Eliquis like the risk for bleeding or ease of bruising. They also described

the importance of making all of his appointments and not skipping doses of his medication.

In conclusion, clinical nursing judgement is vitally important inside and outside of the

clinical setting. Clinical judgement allows the nurse to associate these pieces of information,

explore them, establish known facts, and to analyze and interpret symptoms at hand form a

clinical and rational perspective. This situation allowed me to associate the signs and symptoms

that Kyle was experiencing with the condition of venous thromboembolism. Without anyone to

tell Kyle that he could have been experiencing signs and symptoms, he might not have went to
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the doctor and could have had a much worse outcome. This situation as well as so many others is

the reason why it is vitally important for medical professionals to have sound clinical nursing

judgment.
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References

Di Minno, M. N. D., Ambrosino, P., Ambrosini, F., Tremoli, E., Di Minno, G., & Dentali, F.

(2016). Prevalence of deep vein thrombosis and pulmonary embolism in patients with

superficial vein thrombosis: a systematic review and meta‐analysis. Journal of

Thrombosis and Haemostasis, 14(5), 964-972

Liu, X., Johnson, M., Mardekian, J., Phatak, H., Thompson, J., & Cohen, A. T. (2015). Apixaban

Reduces Hospitalizations in Patients With Venous Thromboembolism: An Analysis of

the Apixaban for the Initial Management of Pulmonary Embolism and Deep‐Vein

Thrombosis as First‐Line Therapy (AMPLIFY) Trial. Journal of the American Heart

Association, 4(12), e002340.

Yuan, H. B., Williams, B. A., & Man, C. Y. (2014). Nursing students' clinical judgment in high-

fidelity simulation based learning: a quasi-experimental study. Journal of Nursing

Education and Practice, 4(5), 7.