Deep vein thrombosis: recognition and prevention
Unilateral is the word that matters. Swelling, pain, warmth and redness of one calf or thigh, with a measurable difference in circumference between the two legs. Measure at the same point on both sides and record the numbers rather than an impression. Bilateral swelling points elsewhere: heart failure, kidney or liver disease, medication. Do not massage the limb and do not perform manoeuvres intended to provoke pain in a limb you suspect. The reason for the caution is the embolism. Prevention is where nursing changes the outcome. Early and repeated mobilization, mechanical devices actually worn rather than folded at the foot of the bed, pharmacological prophylaxis given on time, and adequate hydration. A prophylactic dose given two hours late, every day, is a prophylaxis that does not exist. In a client who declines mobilization or removes the compression, find out why. Pain, fear of falling, a device that is uncomfortable or the wrong size are the usual answers, and each has a solution. Teach at discharge: the signs of recurrence, the signs of pulmonary embolism, and that a swollen painful calf is a same-day consultation.