Questions: - Morphine 4 mg IV q2 hr pm pain - aPTT q6hr and titrate heparin drip according to nomogram 4. M.W. is developing a serious complication of PE. Based on the hints provided, what is the complication? Hint: - Right ventricular hypertrophy - Increased pulmonic heart sound - Right-sided fourth heart sound - Peripheral edema - Hepatomegaly

- Morphine 4 mg IV q2 hr pm pain - aPTT q6hr and titrate heparin drip according to nomogram 4. M.W. is developing a serious complication of PE. Based on the hints provided, what is the complication? Hint: - Right ventricular hypertrophy - Increased pulmonic heart sound - Right-sided fourth heart sound - Peripheral edema - Hepatomegaly
Transcript text: - Morphine 4 mg IV q2 hr pm pain - aPTT q6hr and titrate heparin drip according to nomogram 4. M.W. is developing a serious complication of PE. Based on the hints provided, what is the complication? Hint: - Right ventricular hypertrophy - Increased pulmonic heart sound - Right-sided fourth heart sound - Peripheral edema - Hepatomegaly
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Solution

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The complication that M.W. is developing, based on the provided hints, is likely "right heart failure" or "cor pulmonale."

Here's the reasoning for each hint:

  1. Right ventricular hypertrophy: This occurs when the right ventricle of the heart becomes thickened, often due to increased pressure it has to pump against, such as in pulmonary hypertension or chronic pulmonary embolism.

  2. Increased pulmonic heart sound: This can indicate increased pressure in the pulmonary artery, which is often seen in pulmonary hypertension and can lead to right heart strain.

  3. Right-sided fourth heart sound: This is associated with a stiff or hypertrophied right ventricle, often due to pressure overload.

  4. Peripheral edema: This is a common sign of right-sided heart failure, as the heart is unable to effectively pump blood, leading to fluid accumulation in the extremities.

  5. Hepatomegaly: Enlargement of the liver can occur due to congestion from right-sided heart failure, as blood backs up into the systemic circulation.

In summary, the combination of these signs and symptoms suggests that M.W. is experiencing right heart failure, likely secondary to pulmonary embolism and resultant pulmonary hypertension.

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