A 52-Year-Old Hospitalized Patient Is Evaluated for Chest Pain and Persistent

A 52-year-old hospitalized patient is evaluated for chest pain and persistent tachycardia.  She was recently diagnosed with colon adenocarcinoma and underwent right hemicolectomy and ileocolic anastomosis 5 days ago.  Yesterday, the patient was noted to be tachycardic and hypoxemic during physical therapy, and the tachycardia persisted at rest.  She also has had shortness of breath and intermittent, right-sided chest pain.  The patient is not using the incentive spirometer as frequently as advised.  She is taking a liquid diet without significant abdominal pain or nausea but has had no bowel movements.  Current medications are prophylactic-dose low molecular weight heparin and an opioid analgesic as needed.  Temperature is 37.8 C (100 F) , blood pressure is 116/72 mm Hg, pulse is 112/min, and respirations are 20/min.  Oxygen saturation is 94% on 2 L/min oxygen by nasal cannula.  On physical examination, the patient appears slightly uncomfortable and speaks in short sentences.  Lung auscultation shows decreased breath sounds over the posterior right base.  Cardiac examination reveals a regular rhythm without murmurs or gallops.  The abdomen is soft with normal bowel sounds, and there is no erythema, drainage, or dehiscence of the surgical incision.  There is mild, bilateral lower extremity pitting edema.  ECG shows sinus tachycardia, and chest x-ray reveals right basal atelectasis.  Which of the following is the best next step in the management of this patient?

A) Begin broad-spectrum antibiotics
B) Check serum D-dimer level
C) Increase analgesic dosage
D) Initiate positive-pressure ventilation
E) Perform CT pulmonary angiography

Correct Answer:

Verified

Unlock this answer now
Get Access to more Verified Answers free of charge

Access For Free