A client is prescribed long-term rest after surgery. Which complication does the nurse expect to prevent by teaching the client to avoid pressure on the popliteal space?

1. A

   Cerebral embolism

2. B

   Pulmonary embolism

3. C

   Dry gangrene of a limb

4. D

   Coronary vessel occlusion

Appeared in: DSSSB Public Health Nurse - 2015

Explanation

• Long-term rest and immobility after surgery cause venous stasis, a primary factor in the development of blood clots in the deep veins of the legs (Deep Vein Thrombosis or DVT).
• Applying pressure to the popliteal space (behind the knee), for example with a pillow, compresses the popliteal vein, which further impedes venous blood return from the lower leg.
• This increased stasis significantly elevates the risk of DVT formation.
• A fragment of a DVT can dislodge, travel through the venous system to the right side of the heart, and then become lodged in the pulmonary arteries, causing a pulmonary embolism (PE).
• Therefore, teaching the client to avoid pressure on the popliteal space is a key nursing intervention to prevent DVT and the subsequent, potentially fatal, complication of PE.

Why Other Options Were Wrong

• Option A: A cerebral embolism is a blockage of an artery in the brain. Emboli causing this typically originate from the left side of the heart (e.g., in atrial fibrillation) or from atherosclerotic plaques in the carotid arteries.
• Option C: Dry gangrene is a form of tissue death caused by a critical lack of arterial blood supply (ischemia), not by venous stasis or a venous clot.
• Option D: Coronary vessel occlusion (a heart attack) is the blockage of the heart's own arteries (coronary arteries), most commonly due to the rupture of an atherosclerotic plaque.

Related Visual

Clinical Relevance

• Nursing practice connection: Safe nursing care depends on performing Prevention of postoperative venous thromboembolism (VTE) in the correct sequence, documenting the action clearly, and monitoring for the expected response.
• Venous thromboembolism (VTE), which includes DVT and PE, is one of the most common and preventable complications in hospitalized patients, especially after surgery.
• Nurses are at the forefront of VTE prevention through patient assessment, education, and implementation of prophylaxis measures (both mechanical and pharmacological).
• Key nursing interventions include encouraging early ambulation, teaching leg exercises (e.g., ankle pumps), ensuring correct application of anti-embolism stockings or sequential compression devices (SCDs), and educating patients to avoid crossing their legs or placing pillows directly under their knees.

How to Approach the Question

• First, analyze the question to identify the key clinical context: a postoperative client on long-term rest.
• Recognize that this scenario immediately flags a high risk for complications of immobility.
• Focus on the specific action mentioned: avoiding pressure on the popliteal space. Consider the anatomy of this area, which contains the popliteal artery and vein.
• Connect the action (avoiding pressure) to its physiological effect. Pressure on this space primarily compresses the vein, leading to venous stasis.
• Recall that venous stasis is a cornerstone of Virchow's triad, the three factors that promote venous thrombosis (DVT).
• Trace the potential path of a venous clot from the leg. It will travel through the venous system to the right atrium, right ventricle, and then into the pulmonary artery.

Concept Tested & Keywords

• Concept Tested: Prevention of postoperative venous thromboembolism (VTE)
• Stem keywords: long-term rest, after surgery, pressure on the popliteal space
• Lead-in keywords: prevent
• Clinical cues: The combination of immobility (long-term rest) and a specific pressure point (popliteal space) points directly to a risk for venous stasis and subsequent thrombosis.

Question ID

Q9rmGgbgxZW0AC2ARzZ1mC

Copy ID

Reference Book

E6 Nursing Brunner Adult Health 3SA Vol 1 Part 1 p. 125-127

E6 Nursing Fundamentals Potter Perry 12e Part 4 p. 132-134