The nurse is taking care of a patient after vaginal hysterectomy for prolapsed uterus. Which of the following nursing interventions by the nurse would best minimize the risk of pulmonary embolism in this patient?

1. A

   Positioning the patient at high fowler's position

2. B

   Providing small pillow under the knees for comfort

3. C

   Assessing lower extremities for warmth and swelling

4. D

   Early ambulation

Appeared in: HPSSSB Staff Nurse - 2016

Explanation

• Early ambulation is the most effective non-pharmacological intervention to prevent venous stasis, which is the primary cause of deep vein thrombosis (DVT).
• Walking activates the calf muscle pump, which compresses the deep veins in the legs and propels blood toward the heart, directly reducing the risk of clot formation.
• Pulmonary embolism (PE) is most often a serious complication of a DVT that dislodges from the leg and travels to the lungs.
• This intervention directly counteracts the effects of immobility, a major risk factor for thromboembolism in all postoperative patients.

Why Other Options Were Wrong

• Option A: The high Fowler's position does not actively promote venous return from the lower extremities. If the patient remains immobile in this position, it can contribute to venous pooling in the pelvic region and legs.
• Option B: This action is contraindicated. Placing a pillow under the knees compresses the popliteal veins, which severely impedes venous return from the lower legs and significantly increases the risk of DVT formation.
• Option C: This is an act of surveillance or detection, not prevention. While assessing for warmth, redness, and swelling is a critical nursing responsibility to identify a DVT early, it does not do anything to prevent the clot from forming in the first place.

Related Visual

Clinical Relevance

• Nursing practice connection: Safe nursing care depends on performing Postoperative prevention of pulmonary embolism (PE) and deep vein thrombosis (DVT) in the correct sequence, documenting the action clearly, and monitoring for the expected response.
• Nurses are at the forefront of DVT/PE prophylaxis through patient education, consistent encouragement of mobility, and correct application of mechanical prophylaxis (like SCDs) and administration of prescribed anticoagulants.
• A fundamental patient safety principle is to avoid any positioning that creates pressure on major venous structures, especially the popliteal space behind the knee.
• What if? The patient is unable to ambulate due to epidural anesthesia or hemodynamic instability. The nurse's priority for prevention would shift to implementing other measures like applying sequential compression devices (SCDs), encouraging in-bed ankle pump exercises, and ensuring prophylactic anticoagulants are administered as ordered.

How to Approach the Question

• First, identify the key concept in the question: it asks for the 'best' 'preventive' intervention for pulmonary embolism.
• Recognize that PE is most commonly a complication of DVT, so the core goal is to prevent DVT formation.
• Analyze the options by categorizing their function: is the action preventive, for assessment, or potentially harmful?
• Evaluate each option's physiological effect on venous circulation. Does it promote blood flow from the legs or hinder it?
• Option A (Fowler's) is for breathing. Option B (pillow under knees) is dangerous as it blocks blood flow. Option C (assessment) only detects a problem but doesn't prevent it.
• Conclude that early ambulation is the only option that actively, safely, and directly prevents the root cause of the problem (venous stasis).

Concept Tested & Keywords

• Concept Tested: Postoperative prevention of pulmonary embolism (PE) and deep vein thrombosis (DVT).
• Stem keywords: vaginal hysterectomy, postoperative, pulmonary embolism, minimize risk, nursing interventions
• Lead-in keywords: best
• Clinical cues: The patient's status as 'post-vaginal hysterectomy' indicates they are in a postoperative period, a high-risk time for immobility-related complications like DVT and PE.

Question ID

QOb6UNRTMpIoR07X5Efnzm

Copy ID

Reference Book

E6 Nursing Brunner Adult Health 3SA Vol 1 Part 1 p. 121-123

E6 Nursing Fundamentals Potter Perry 12e Part 6 p. 201-203