Homan's sign is used to assess

ESIC Nursing Officer - 2019 (Shift-2)

Medical & Surgical Nursing

Easy

Appeared in: ESIC Nursing Officer - 2019 (Shift-2)

Explanation

Homan's sign is a physical assessment technique used to detect Deep Vein Thrombosis (DVT).
The sign is considered positive if the patient experiences pain in the calf or popliteal region upon passive dorsiflexion of the foot with the knee extended.
As seen in the image, this maneuver stretches the posterior tibial vein.
While historically used, it is now considered an unreliable sign due to low sensitivity and specificity; a negative result does not rule out DVT, and a positive result can occur with other conditions.
Confirmation of DVT requires more definitive diagnostic tests like compression ultrasonography.

Option A: Wound sepsis is an infection of a wound. Its assessment involves looking for signs of infection such as redness, warmth, swelling, purulent drainage, and systemic symptoms like fever and elevated white blood cell count.
Option C: Hypotension is low blood pressure. It is measured using a sphygmomanometer and is characterized by symptoms like dizziness, fainting, and blurred vision. It is unrelated to calf pain on foot movement.
Option D: A hematoma is a collection of blood outside of blood vessels, essentially a bruise. It is identified by localized swelling, discoloration (ecchymosis), and tenderness upon palpation. Homan's sign is not used for its assessment.

Visual 1: Diagram - A step-by-step illustration of how to perform the Homan's sign test, highlighting the dorsiflexion of the foot and the area of expected pain in the calf.
Visual 2: Infographic - The Virchow's triad (venous stasis, endothelial injury, hypercoagulability) to explain the pathophysiology and risk factors for DVT.
Visual 3: Image - A Doppler ultrasound image showing a thrombus within a deep vein of the leg, contrasting it with a normal, patent vein.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Assessment for Deep Vein Thrombosis (DVT) using Homan's sign as background academic context rather than a clinical decision trigger.
Although Homan's sign is taught, its clinical utility is limited. Current evidence-based practice emphasizes using validated clinical prediction rules (like the Wells score) combined with D-dimer testing and compression ultrasonography for diagnosing DVT.
A positive Homan's sign, while not diagnostic, should increase the nurse's suspicion of DVT and prompt immediate notification of the healthcare provider for further evaluation. It is a cue to be cautious.
Nurses must educate patients at risk for DVT (e.g., postoperative, immobile, pregnant) on preventive measures like leg exercises, early ambulation, and adequate hydration.

How to Approach the Question

Identify the key term in the question stem: "Homan's sign".
Recall the definition and clinical purpose of this specific assessment. Homan's sign involves a maneuver of the foot and leg to elicit pain.
Analyze the provided image, which visually demonstrates the maneuver: passive dorsiflexion of the foot.
Evaluate the options in the context of a leg/vascular assessment. 'Deep vein thrombosis' is a condition of the leg veins.
Systematically eliminate the other options. 'Wound sepsis' relates to infection, 'hypotension' to blood pressure, and 'hematoma' to bruising. None of these are assessed with the Homan's maneuver.
Conclude that Homan's sign is specifically associated with the assessment for deep vein thrombosis.

Concept Tested & Keywords

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