Which nursing intervention would best prevent development of deep vein thrombosis/pulmonary embolism in a pos… - GMCH Chandigarh - 2022

GMCH Chandigarh - 2022

Medical & Surgical Nursing

Medium

Appeared in: GMCH Chandigarh - 2022

Explanation

Post-surgical immobility leads to venous stasis (pooling of blood in the legs), a primary factor in DVT formation according to Virchow's triad.
Physical movement, including early ambulation and in-bed leg exercises, actively promotes venous return, directly counteracting stasis.
Adequate hydration helps maintain normal blood viscosity, reducing the state of hypercoagulability that is often present after surgery.
This combination of interventions is the most effective non-pharmacological strategy to prevent the formation of blood clots.

Option B: Psychological counseling addresses a patient's emotional and mental well-being but has no direct physiological effect on blood circulation or coagulation to prevent DVT.
Option C: This term is too vague. While proper patient positioning is part of good nursing care, passive positioning alone is not the 'best' or most effective method to prevent DVT. Active movement is required to effectively stimulate circulation.
Option D: This is contraindicated. 'Keeping patient' implies promoting immobility or bed rest, which is a primary cause of DVT, not a preventative measure.

Clinical Relevance

Nursing practice connection: Use the key finding related to Prevention of postoperative Venous Thromboembolism (VTE) to guide bedside assessment, documentation, and the next nursing action.
Nurses are at the forefront of DVT prevention. This involves assessing patient risk, implementing mobility protocols, administering prophylactic anticoagulants as prescribed, and educating the patient on the importance of movement.
A DVT can dislodge and travel to the lungs, causing a pulmonary embolism (PE), which is a life-threatening emergency. Prevention is the best strategy.
What if? If a patient is completely unable to ambulate (e.g., after major spinal or orthopedic surgery), the nurse's priority shifts to other methods of DVT prevention. This includes diligent use of sequential compression devices (SCDs), application of anti-embolism stockings (TED hose), ensuring administration of prescribed anticoagulants (like heparin or enoxaparin), and guiding the patient through in-bed leg exercises.

How to Approach the Question

First, identify the key clinical problem in the question: preventing DVT/PE in a post-surgical patient.
Recall the primary pathophysiological cause of this condition. For DVT, this is Virchow's triad, with venous stasis from immobility being the most significant and modifiable risk factor in this scenario.
Analyze each option to determine how directly it addresses this root cause.
Option A, 'Hydration and physical movement,' directly counteracts venous stasis and hypercoagulability.
Options B, C, and D are either irrelevant to the physiology (counseling), insufficient (bed management alone), or directly harmful (keeping the patient immobile).
Conclude that the intervention that most directly and effectively targets the cause is the 'best' answer.

Concept Tested & Keywords

Concept Tested: Prevention of postoperative Venous Thromboembolism (VTE)
Stem keywords: post-surgical patient, prevent, deep vein thrombosis, pulmonary embolism, nursing intervention
Lead-in keywords: best
Negative lead-in flag: false

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