To prevent pulmonary embolism in a bedridden patient, the nurse should?

KPSC Staff Nurse - 2017

Medical & Surgical Nursing

Hard

Appeared in: KPSC Staff Nurse - 2017

Explanation

Immobility in bedridden patients causes venous stasis (pooling of blood) in the legs, a major risk factor for Deep Vein Thrombosis (DVT).
Pulmonary Embolism (PE) is most commonly a complication of DVT, where a clot travels from the legs to the lungs.
Limb physiotherapy, such as ankle pumps and leg flexion, activates the calf muscles.
This 'muscle pump' action squeezes deep veins, promoting venous return to the heart and preventing the blood stasis that leads to clot formation.
Therefore, teaching these exercises is a primary nursing intervention to prevent DVT and subsequent PE.

Option A: Limiting fluid intake leads to dehydration, which increases blood viscosity (thickness) and elevates the risk of thrombus (clot) formation. This action is counterproductive.
Option B: Deep breathing and coughing exercises are crucial for preventing respiratory complications in immobile patients, such as atelectasis (lung collapse) and pneumonia, by keeping the airways clear. They do not directly impact venous circulation in the legs.
Option C: Using a bedpan is an intervention related to managing elimination for a patient who cannot get out of bed. It has no physiological effect on blood circulation or clot prevention.

Clinical Relevance

Nursing practice connection: Use the key finding related to Prevention of pulmonary embolism in immobile patients to guide bedside assessment, documentation, and the next nursing action.
VTE (Venous Thromboembolism, which includes DVT and PE) prophylaxis is a fundamental nursing responsibility for all patients with impaired mobility.
Nurses must assess for signs of DVT daily, including unilateral leg swelling, pain, warmth, and redness. A positive Homan's sign is an unreliable indicator.
Patient and family education on the importance of these simple exercises is critical for adherence and prevention, especially as they are non-invasive and have no side effects.

How to Approach the Question

First, identify the core clinical problem: preventing a pulmonary embolism (PE) in a high-risk (bedridden) patient.
Recall the primary cause of PE in this population. Most PEs originate as deep vein thrombosis (DVT) in the lower extremities due to venous stasis from immobility (Virchow's Triad).
The goal, therefore, is to find the intervention that best prevents DVT by addressing venous stasis.
Evaluate each option's effect on circulation:
Limiting fluids would worsen blood viscosity, increasing clot risk.
Deep breathing affects the lungs, not leg circulation.

Concept Tested & Keywords

Concept Tested: Prevention of pulmonary embolism in immobile patients.
Stem keywords: prevent, pulmonary embolism, bedridden patient
Lead-in keywords: should
Clinical cues: The patient's immobility (bedridden status) is the key risk factor.

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