The nurse encourages a postoperative patient to move his legs. Contracting the leg muscles help to prevent which postoperative complication?

1. A

   Pleurisy

2. B

   Portal hypertension

3. C

   Hypostatic pneumonia

4. D

   Pulmonary embolism

Appeared in: AIIMS Bhatinda NO - 2019

Explanation

• Contracting leg muscles activates the 'muscle pump' mechanism, which squeezes deep veins in the legs.
• This action promotes venous return, preventing blood from pooling (venous stasis) in the lower extremities.
• Venous stasis is a primary risk factor for the formation of a deep vein thrombosis (DVT).
• Preventing DVT is the most effective way to prevent a pulmonary embolism (PE), which occurs when a piece of the thrombus breaks off and travels to the lungs.
• Early ambulation and leg exercises are standard postoperative care to reduce the risk of VTE.

Why Other Options Were Wrong

• Option A: Pleurisy is an inflammation of the lining around the lungs, often caused by infection or other inflammatory conditions. It is not related to blood circulation in the legs.
• Option B: Portal hypertension is high blood pressure in the portal venous system, which carries blood from the digestive organs to the liver. It is typically a complication of chronic liver disease like cirrhosis and is unrelated to postoperative immobility.
• Option C: Hypostatic pneumonia results from the pooling of secretions in the dependent parts of the lungs due to prolonged immobility. While general mobility helps, this complication is more directly prevented by interventions that promote lung expansion, such as deep breathing, coughing, and turning the patient frequently.

Related Visual

Clinical Relevance

• Nursing practice connection: Use the key finding related to Prevention of postoperative complications, specifically venous thromboembolism (VTE) to guide bedside assessment, documentation, and the next nursing action.
• Nurses play a vital role in preventing VTE by educating patients on the importance of leg exercises, encouraging early ambulation, and applying mechanical prophylaxis like anti-embolism stockings or sequential compression devices (SCDs) as ordered.
• Assessment for DVT includes checking for calf pain, tenderness, swelling, warmth, and redness. However, many DVTs are asymptomatic, making prophylaxis essential.
• What if? If a patient is unable to move their legs due to paralysis or a specific surgical contraindication, the nurse must ensure that alternative VTE prophylaxis is in place, such as anticoagulant medication (e.g., heparin) and/or SCDs, and escalate concerns about high-risk patients to the provider.

How to Approach the Question

• First, identify the core action in the question: 'contracting the leg muscles' postoperatively.
• Next, consider the physiological effect of this action. Leg muscle contraction acts as a pump to move blood out of the lower extremities and back to the heart.
• Think about the complications of immobility, especially related to blood circulation. Immobility leads to venous stasis (blood pooling).
• Evaluate the options based on this physiological link. Which complication is directly caused by venous stasis in the legs?
• Pleurisy and portal hypertension are unrelated. Hypostatic pneumonia is related to immobility but affects the lungs' secretions, not leg circulation.
• Pulmonary embolism is most often caused by a DVT, which is a direct result of venous stasis. Therefore, preventing stasis with leg exercises directly helps prevent PE.

Concept Tested & Keywords

• Concept Tested: Prevention of postoperative complications, specifically venous thromboembolism (VTE).
• Stem keywords: postoperative patient, move his legs, contracting leg muscles, prevent
• Lead-in keywords: which postoperative complication

Question ID

QUU8O91N5T_RLis7pfT08t

Copy ID

Reference Book

E6 Nursing Brunner Adult Health 3SA Vol 1 Part 1 pp. 125-127, 121-123

E6 Nursing Fundamentals Potter Perry 12e Part 6 p. 199-201