A 74-year-old obese man who has undergone open reduction and internal fixation of the right hip is 8 days postoperative. He has a history of arthritis and atrial fibrillation. He admits to right lower leg pain, described as "a cramp in my leg." An appropriate nursing action would be to?

1. A

   Assess for pain with plantarflexion

2. B

   Assess for edema and heat of the right leg

3. C

   Instruct him to rub the cramp out of his leg

4. D

   Elevate right lower extremity with pillows propped under the knee

Appeared in: NORCET 5 mains

Explanation

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• The patient's clinical picture, including age, obesity, recent major hip surgery, and a complaint of a leg cramp, strongly suggests a high risk for Deep Vein Thrombosis (DVT).
• The most appropriate and standard nursing action is to assess for the classic signs of DVT.
• These signs include unilateral edema (swelling), localized warmth (heat), and erythema (redness), which result from inflammation and venous obstruction.
• Comparing the affected leg to the unaffected leg for differences in circumference, temperature, and color is a critical first step in identifying a DVT.

Why Other Options Were Wrong

• Option A: Assessing for pain with plantarflexion is not a recognized or reliable diagnostic sign for DVT. The similar Homans' sign (pain on dorsiflexion) is no longer recommended in practice due to its low sensitivity and specificity.
• Option C: This is a dangerous action. Massaging a limb with a suspected DVT can dislodge the thrombus, leading to a potentially fatal pulmonary embolism (PE).
• Option D: Placing pillows directly under the knee causes compression of the popliteal vein. This obstructs venous blood flow from the lower leg, increases venous stasis, and paradoxically increases the risk of DVT.

Related Visual

• Visual 1: Infographic - Virchow's Triad. A diagram showing the three factors contributing to thrombosis: venous stasis (e.g., from immobility post-surgery), hypercoagulability (e.g., from surgical stress response), and endothelial injury (e.g., from the surgical procedure itself).
• Visual 2: Comparison Photo - A side-by-side image of two legs. One leg is normal, while the other shows the classic signs of DVT: significant swelling (edema), redness, and visibly distended superficial veins.

Clinical Relevance

• Nursing practice connection: Use the key finding related to Nursing assessment for suspected Deep Vein Thrombosis (DVT) in a postoperative patient to guide bedside assessment, documentation, and the next nursing action.
• Early recognition of DVT is a critical nursing responsibility to prevent the life-threatening complication of pulmonary embolism (PE).
• If signs of DVT are present, the nurse's immediate actions are to ensure the patient remains on bed rest, avoid any manipulation of the affected limb, and promptly notify the healthcare provider for further diagnostic evaluation (e.g., venous Doppler ultrasound) and initiation of anticoagulant therapy.
• In the Indian context, where access to prophylactic measures might vary, astute clinical assessment by nurses is paramount for early detection in high-risk postoperative patients.

How to Approach the Question

• First, analyze the patient's profile in the clinical scenario. Identify all risk factors: 74 years old (age), obese, 8 days post-op from major hip surgery, and history of A-fib. This combination screams 'high risk for VTE'.
• Next, connect the patient's chief complaint ('cramp in my leg') to the risk factors. A leg cramp in this context is a major warning sign for DVT.
• Evaluate each option based on the principles of DVT care and patient safety.
• Eliminate any options that are harmful. Rubbing the leg (can cause PE) and putting a pillow under the knee (worsens stasis) are both dangerous and incorrect.
• Eliminate options that are based on outdated or unreliable practices. Assessing for pain on movement (like the old Homans' sign) is not the standard of care.
• Select the option that represents the safest, most appropriate, and evidence-based initial action: a focused assessment for the cardinal signs of DVT (edema and heat).

Concept Tested & Keywords

• Concept Tested: Nursing assessment for suspected Deep Vein Thrombosis (DVT) in a postoperative patient.
• Stem keywords: open reduction and internal fixation, right hip, postoperative, leg pain, cramp, obese, atrial fibrillation
• Lead-in keywords: appropriate nursing action
• Clinical cues: 74-year-old obese man: High-risk demographic for DVT.
• Clinical cues: 8 days postoperative from hip ORIF: Major orthopedic surgery is a primary risk factor for DVT.

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