What is the primary purpose of using compression stockings for a patient with early-stage thrombophlebitis?

C) To promote venous return and reduce swelling

A) To enhance arterial blood flow

C) To promote venous return and reduce swelling

Which intervention is most important for the nurse to implement to prevent further complications in a patient with early-stage thrombophlebitis DVT?

A) Encourage the patient to perform mobility exercises regularly

B) Instruct the patient to apply heat packs to the affected leg

C) Advise the patient to increase fluid intake to flush out the clot

D) Suggest the patient massage the affected calf to relieve pain

What is the primary purpose of advising a patient with early-stage thrombophlebitis to elevate the affected leg during breaks?

B) To reduce venous stasis and promote venous return

A) To increase blood flow to the affected area

B) To reduce venous stasis and promote venous return

C) To strengthen the leg muscles

D) To promote arterial blood supply to the leg

Which intervention is most effective in reducing the patient's leg edema as described in the case?

B) Wearing compression stockings

A) Applying ice packs to the affected area

B) Wearing compression stockings

D) Elevating the leg on a pillow

What is the primary reason for adjusting the care plan to include the application of a hypoallergenic moisturizer for a patient with mild skin irritation from compression stockings?

B) To prevent further skin breakdown and maintain skin integrity

A) To enhance the effectiveness of compression therapy

B) To prevent further skin breakdown and maintain skin integrity

C) To reduce the risk of infection due to skin irritation

D) To increase patient adherence to mobility exercises

A patient with thrombophlebitis DVT is experiencing mild skin irritation from compression stockings. What is the most appropriate nursing intervention to address this issue?

A) Discontinue the use of compression stockings immediately.

C) Increase the tightness of the compression stockings for better effect.

D) Advise the patient to wear the stockings only at night.

Which intervention has most likely contributed to the improvement of the patient's skin condition around the compression stocking area?

A) Application of hypoallergenic moisturizer

C) Use of a different type of compression stocking

D) Administration of antibiotics

What is the primary reason for the nurse to educate the patient on avoiding prolonged periods of immobility in this scenario?

B) To reduce the risk of deep vein thrombosis

C) To improve circulation to the leg

D) To decrease the patient's discomfort

What is the primary reason the nurse should communicate the patient's slightly below therapeutic INR level to the healthcare provider?

B) To adjust the anticoagulant dosage

A) To confirm the patient's blood pressure is stable

B) To adjust the anticoagulant dosage

C) To verify the patient's heart rate

D) To monitor the patient's vital signs more frequently

Thrombophlebitis DVT - Nursing Case Study

Pathophysiology

• Primary mechanism: Thrombophlebitis DVT is primarily caused by venous stasis, where blood flow slows down in deep veins, often due to extended immobility, like during long flights or bed rest, increasing the risk of clot formation.

• Secondary mechanism: Vessel wall injury, such as trauma or inflammation, can trigger the coagulation cascade, leading to thrombus (clot) formation as platelets and fibrin accumulate at the injury site.

• Key complication: If the thrombus dislodges, it can travel to the lungs, causing a pulmonary embolism, which is a serious condition that can impair oxygen exchange and lead to respiratory distress.

Patient Profile

Demographics:

45-year-old female, office worker

History:

• Key past medical history: Mild hypertension

• Current medications: Lisinopril 10 mg daily

• Allergies: No known drug allergies

Current Presentation:

• Chief complaint: Mild pain and swelling in the left calf

• Key symptoms: Tenderness, warmth, and slight redness over the affected calf

• Vital signs: Blood pressure 128/82 mmHg, heart rate 78 bpm, respiratory rate 16 breaths per minute, temperature 98.6°F, oxygen saturation 98% on room air

Section 1

Initial assessment findings:

Upon further examination, the nurse conducts a thorough assessment of the patient’s left calf, confirming the presence of mild edema, tenderness upon palpation, and increased warmth compared to the right leg. The circumference of the left calf is measured and found to be 1.5 cm larger than the right, indicating localized swelling. There is also slight erythema present, but no visible bruising or signs of skin breakdown. The patient rates her pain as a 3 on a scale of 10, describing it as a dull ache that worsens when she stands for extended periods. The Homans’ sign test is performed, which remains negative, though the nurse notes that this test is not always reliable for DVT diagnosis.

Vital signs remain stable, with blood pressure at 128/82 mmHg, heart rate at 78 bpm, respiratory rate at 16 breaths per minute, and an oxygen saturation of 98% on room air. The patient's temperature is normal at 98.6°F. The nurse reviews the patient’s history and lifestyle, noting her sedentary work environment and recent long-distance travel, which may have contributed to venous stasis and subsequent thrombus formation. The assessment findings suggest early-stage thrombophlebitis DVT without significant complications at this time, allowing for timely intervention to prevent progression.

These initial findings guide the nursing team to prioritize patient education on mobility exercises and the importance of regular movement to promote venous return. Additionally, compression stockings are recommended to reduce swelling and improve circulation. The patient is advised to elevate her leg when sitting and avoid prolonged periods of immobility. This approach aims to mitigate risk factors and prevent further complications, such as clot extension or the development of a pulmonary embolism.

Section 2

Response to Interventions

Over the next 48 hours, the patient diligently follows the nursing team's recommendations, incorporating mobility exercises into her daily routine and wearing compression stockings as advised. She reports an increased awareness of the need for regular movement, taking short walks every hour while at work and ensuring her leg is elevated during breaks. This change in routine appears to have a positive impact on her condition. Upon reassessment, the nurse notes a slight reduction in the edema of the left calf, with its circumference now only 1 cm larger than the right. The patient describes her pain as having decreased to a 2 on a scale of 10, expressing relief from the previous dull ache.

Vital signs remain stable, with blood pressure at 126/80 mmHg, heart rate at 76 bpm, respiratory rate at 16 breaths per minute, and oxygen saturation maintaining at 98% on room air. The patient's adherence to the recommended interventions seems to have facilitated improved circulation, as evidenced by the reduction in swelling and pain. The erythema observed earlier has lessened slightly, and the warmth of the affected area is now only marginally higher than that of the right leg. These findings suggest that the early-stage thrombophlebitis DVT is responding well to conservative management.

The positive response to interventions reassures the healthcare team and the patient, reinforcing the importance of continued adherence to the care plan. The nurse plans to educate the patient further on signs and symptoms of potential complications, such as increased pain, swelling, or shortness of breath, which would necessitate immediate medical attention. This proactive approach aims to ensure early detection and intervention should the patient's condition change, thereby promoting a safe and effective recovery trajectory.

Section 3

As the patient continues with the prescribed interventions, the nursing team notes a new development in her condition. During a routine check, the nurse observes a minor complication: the patient has developed mild skin irritation around the area where the compression stockings are applied. The irritation manifests as slight redness and dryness, likely due to the continuous wearing of the stockings and the patient's sensitive skin. While this does not currently pose a significant health risk, it prompts the nurse to adjust the care plan to prevent further skin breakdown and ensure the patient's comfort.

In response, the nurse advises the patient to apply a hypoallergenic moisturizer to the affected area twice daily, focusing on maintaining skin integrity while still adhering to the use of compression stockings. The patient is also encouraged to ensure the stockings are properly fitted and to remove them for short periods when resting in a safe environment, to allow the skin to breathe. This adjustment aims to balance the therapeutic benefits of compression with the patient's skin health, minimizing discomfort and preventing escalation of skin issues.

The patient expresses understanding and appreciation for the tailored advice, reflecting her proactive engagement in her care. She continues to follow the recommended mobility exercises and maintains vigilance for any signs of complications. The nurse schedules a follow-up assessment in two days to reevaluate the skin condition, ensuring that this minor complication does not hinder the overall positive trajectory of the patient's recovery from thrombophlebitis DVT. This ongoing monitoring and minor adjustment in the care plan exemplify the importance of individualized nursing care and patient education in managing early-stage thrombophlebitis DVT effectively.

Section 4

Two days after implementing the adjusted care plan, the nurse conducts a follow-up assessment to evaluate the patient's skin condition and overall progress. During this assessment, the nurse notes that the mild skin irritation around the compression stocking area has shown signs of improvement. The redness is significantly reduced, and the skin appears more hydrated, suggesting that the application of the hypoallergenic moisturizer and periodic removal of the stockings have been effective. The patient reports feeling more comfortable and is pleased with the improvement, expressing relief that her skin no longer feels as dry and irritated.

In addition to examining the skin, the nurse evaluates the patient's vital signs and assesses her overall condition. The patient's blood pressure is stable at 120/80 mmHg, and her heart rate is within normal limits at 76 beats per minute. She has been compliant with her mobility exercises, which include gentle leg elevation and walking short distances to promote circulation. The nurse also reviews recent laboratory results, which show that the patient's D-dimer levels are within a normal range, indicating no new clot formation.

As the patient continues to respond well to the interventions, the nurse reinforces the importance of adhering to the prescribed treatment plan, including medication adherence, regular mobility, and continued skin care. The nurse plans to schedule another follow-up appointment in a week's time to ensure the patient's progress remains steady and to address any potential new concerns. This proactive approach highlights the critical role of ongoing assessment and individualized patient care in achieving successful outcomes in managing early-stage thrombophlebitis DVT.

Section 5

Three days after the previous follow-up, the nurse conducts another assessment to ensure that the patient is maintaining her progress. During this visit, the nurse notes a slight increase in the patient's ankle and calf swelling compared to the last assessment. The patient mentions that she has been feeling some discomfort in her leg, especially after periods of prolonged sitting. Her vital signs are still stable, with a blood pressure of 118/78 mmHg and a heart rate of 80 beats per minute. However, the nurse observes that the patient's leg appears slightly more swollen and warmer to the touch, which could indicate minor complications or changes in her condition.

The nurse reviews the patient's recent laboratory results and finds that while the D-dimer levels remain within normal limits, the patient's INR (International Normalized Ratio) is slightly below the therapeutic range, suggesting that the anticoagulant therapy may need adjustment. The nurse communicates this finding to the healthcare provider to discuss potential changes to the medication dosage to ensure optimal anticoagulation and prevent further clot formation.

Given the new assessment findings, the nurse emphasizes the importance of adhering strictly to the mobility regimen and encourages the patient to avoid long periods of immobility. Additionally, the nurse educates the patient on recognizing early signs of potential complications, such as increased pain or significant changes in swelling or skin color. These proactive measures aim to prevent any progression of the condition and to address the current mild swelling. The nurse schedules another follow-up visit in three days to closely monitor the patient's response to any medication adjustments and to further evaluate the effectiveness of the ongoing interventions. This approach ensures that the patient's management plan is dynamic and responsive to her evolving needs.