⚠️ Reduction of Risk · Lesson 5 of 6 · 6 min

DVT Prevention and the Pulmonary Embolism You Must Not Miss

🫁 A client recovering from a hip replacement is sitting up chatting, then suddenly grabs her chest, gasps and says she feels like she is going to die. Her saturation is 84%. The next 60 seconds are an exam question.

💡 Key idea

Prevent with movement, compression and anticoagulants. DVT: one swollen warm leg, do not massage. PE: sudden dyspnea and chest pain: sit up, oxygen, rapid response, heparin.

🧠 Why it matters

VIRCHOW'S TRIAD explains clot risk: venous stasis, vessel injury and hypercoagulability, so immobility, surgery, cancer, pregnancy, estrogen and dehydration raise the risk. PREVENT deep vein thrombosis with early ambulation, leg exercises, intermittent compression devices or antiembolism stockings as ordered, hydration and prophylactic anticoagulants. DVT signs: unilateral leg swelling, warmth, redness and tenderness; measure calf circumference and compare sides; do not massage the leg; Homans' sign is unreliable and no longer recommended. Treat with anticoagulation and, often, continued ambulation per order. PULMONARY EMBOLISM: sudden dyspnea, pleuritic chest pain, tachycardia, tachypnea, hypoxemia, cough, anxiety and a feeling of doom, sometimes hemoptysis. Immediate actions: raise the head of the bed, apply oxygen, stay with the client, call the rapid response team, obtain IV access, and anticipate anticoagulation (heparin), CT pulmonary angiography and possibly thrombolytics. Teach discharge clients on anticoagulants about bleeding precautions and the signs of a new clot.

🏥 In the real world

⚡ The nurse raises the head of the bed, puts a non-rebreather on the gasping client, and calls the rapid response team while her colleague places a second IV. She does not leave the room to find the provider. A CT confirms a pulmonary embolism and a heparin infusion begins. The exam's correct sequence is the one that keeps the nurse at the bedside and the oxygen flowing.

📌 Takeaways

Stasis, vessel injury, hypercoagulability: the risk triad
DVT: unilateral swelling, warmth, tenderness; never massage
PE: sudden dyspnea and pleuritic pain: upright, oxygen, rapid response, anticoagulate

📖 Terms in this lesson

Pulmonary embolism: A clot lodged in the lung, causing sudden dyspnea, pleuritic chest pain, tachycardia and hypoxemia.

D-dimer: A clot-breakdown fragment, normally under about 0.5 mcg/mL (500 ng/mL); a normal value helps rule out DVT and pulmonary embolism, while a high one is nonspecific and rises in DIC, surgery, pregnancy and infection.

✅ Test yourself

A post-operative client suddenly develops dyspnea, chest pain and an oxygen saturation of 85%. What should the nurse do first?

Leave to notify the provider
Sit the client up and apply oxygen
Ambulate the client to improve circulation
Administer the scheduled oral anticoagulant

Answer: B · Sit the client up and apply oxygen

These are signs of pulmonary embolism. Stabilize the airway and oxygenation while summoning help; do not leave the client.

Which finding suggests a deep vein thrombosis in the left leg?

Left calf swelling, warmth and tenderness
Numbness in both feet
Bilateral ankle edema at the end of the day
Cool, pale left foot with absent pulses

Answer: A · Left calf swelling, warmth and tenderness

Unilateral swelling, warmth and tenderness point to venous thrombosis; cool pale pulseless limbs suggest arterial occlusion.

Which intervention is appropriate to prevent DVT in an immobile post-operative client?

Keeping the knees flexed with pillows under them
Applying pneumatic compression devices
Restricting oral fluids to reduce leg swelling
Massaging the calves every 4 hours to promote venous return

Answer: B · Applying pneumatic compression devices

Compression devices improve venous return. Massage can dislodge clots, pillows under the knees cause stasis, and dehydration thickens the blood.

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