Which nursing intervention is appropriate to prevent pulmonary embolus in a patient who is prescribed bed res… - JODHPUR AIIMS SNO-2018

JODHPUR AIIMS SNO-2018

Medical Surgical Nursing

Hard

Appeared in: JODHPUR AIIMS SNO-2018

Explanation

Teaching a patient on bed rest to perform leg exercises is a primary nursing intervention to prevent venous thromboembolism (VTE), which includes DVT and PE.
These movements activate the calf muscle pump, which promotes venous return from the lower extremities and counteracts venous stasis caused by immobility.
Venous stasis is a key component of Virchow's triad (the three main factors contributing to DVT), and bed rest is a major cause of stasis.
Preventing DVT is the most effective way to prevent a pulmonary embolus, as most PEs originate from a dislodged thrombus in the deep veins of the legs.

Option A: Deep breathing and coughing exercises are aimed at preventing respiratory complications like atelectasis and pneumonia by promoting lung expansion and clearing secretions, not preventing blood clots.
Option C: Using the knee gatch of the bed is contraindicated. It causes flexion at the knee, which can compress the popliteal veins, impede venous return, and increase venous stasis, thereby raising the risk of DVT.
Option D: Limiting fluids can lead to dehydration. Dehydration increases blood viscosity (hypercoagulability), which is another component of Virchow's triad and actually elevates the risk of thrombus formation.

Clinical Relevance

Nursing practice connection: Use the key finding related to Prevention of pulmonary embolism in an immobilized patient to guide bedside assessment, documentation, and the next nursing action.
Nurses are at the forefront of VTE prophylaxis for all immobilized patients through education, encouraging mobility, applying mechanical compression devices, and administering prescribed anticoagulants.
A critical nursing assessment is to constantly monitor for signs of DVT (unilateral leg swelling, pain, redness, warmth) and PE (sudden shortness of breath, chest pain, tachycardia, hypoxia).
What if? If the patient were unconscious or had a spinal cord injury and could not move their legs actively, the nurse's responsibility would be to perform passive range-of-motion (PROM) exercises on the patient's legs to achieve the same goal of promoting venous return.

How to Approach the Question

First, identify the core clinical problem: preventing a pulmonary embolus (PE).
Recall the pathophysiology of PE. Most PEs arise from a deep vein thrombosis (DVT) in the legs.
Connect the patient's condition (bed rest) to the primary risk factor for DVT, which is venous stasis (blood pooling).
Evaluate each option based on its effect on venous stasis and blood coagulation.
The correct intervention will be one that directly counteracts venous stasis. Leg exercises promote muscle contraction and blood flow.
Eliminate options that are either irrelevant to blood clots (deep breathing) or are contraindicated because they worsen the risk (knee gatch, fluid restriction).

Concept Tested & Keywords

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