? about DVT

[student-with-no-life]

Ok Im at a rehab hospital for my med-surge 1, today I go into a pt room to give him an IM of Phenergan. Now the pt is not one of mine, I was just grabbing up some treatments to do. so anyways I go in give the IM and find out the pt is in for bilateral knee replacement. (Im in the brain injury wing, but we get others). I notice the pt did not have pressure cuffs on, I asked the pt if they ever had the cuffs on and pt said not since they had been at rehab (3 days). I approach the nurse and she said it is protocol for them to be on. so ok 3 days have gone by and no pressure cuffs, so we order the cuffs up to the floor. in the mean time Im thinking possible DVT, so I asses pts lower limbs, pt c/o mild pain in lower calf area on both legs and pain when pt pushed against my hands. I asked the nurse IF we should not scan the lower legs for a DVT, that if we put the pressure cuffs on it could possible send the DVT to the lungs. her response was we do not do that here, we just put the cuffs on. am I wrong to question this? Sometimes I feel I know Im doing the right thing, but its not in their eyes .

please any in sight.

again pt bilateral knee replacement - 3 days in rehab - no pressure cuffs - has been nauseated for 3 days - c/o pain in lower calves

[WSU_Ally_RN, BSN, RN]

I would think that would be something that should be brought up to the physicians... if we even suspect a DVT in one of our pt's, the pressure cuffs are not put on and we strongly recommend to the physicians a duplex. Even if the doc's don't agree, at least they know what your concern is. With pain to the calf's when you push up on the feet, that would give me a red flag. If there was a DVT there, it is my understanding that the cuffs could dislodge the clot and cause a PE.

[Crash_Cart]

Did you follow established protocal?

Did you notify the responsible RN of your concern?

Perhaps the RN felt the calf pain the pt was experiencing is more likely related to the bilateral knee replacement and not a DVT. I would suspect a pt. who has just experienced a knee replacement will most likely experience a degree of pain upon plantar/dorsiflexion.

In any event, you expressed your concern and that was appropriate.

[deeDawntee, RN]

Frequently if a pt is up and doing rehab for 3 days, the cuffs are no longer necessary. However, that being said, if it is still part of the protocol to have them on, then they should definitely be on, even if it is just on at night.

I am truly impressed by the critical thinking you are showing and the questions you are asking! Way to go. You are on your way to be an awesome nurse.

[leslie :-D]

i would hope this pt is on anticoag tx s/p tkr...

half of dvt's are asymptomatic.

in these cases, chest pain is usually the 1st symptom.

it's usually the superficial thrombi that cause the calf pain.

i'd be more concerned with lower extremity swelling, since there won't always be erythema/tenderness.

nausea is very common, esp if taking opioids.

still, if primary nurse doesn't share your concerns, talk to cn.

and share this with your instructor.

sounds like you're on the ball.

good job. :balloons:

leslie

[loricatus]

You did a great job and had every right to question putting those cuffs on that patient, based upon the facts you presented. The patient should have had a DVT ruled out before putting them on.

You have been presented with a valuable lesson regarding complacency and task-orientated nursing; and, why malpractice insurance should be purchased when you become a nurse. Just to do something because it is ordered is not good nursing practice-something you have seemed to grasp very well.

Imagine if you were the nurse for that patient on the upcoming shift after those cuffs were placed; and, he threw a PE. Now, if that patient were to sue the hospital, you would be brought into that suit just because you were one of the caregivers, although you had not had anything to do with the actual cause behind what caused his PE......

Just wanted to give you a heads up on how good nurses can take the fall for the incompetent ones because you seem to be well on your way to be a very good nurse.

[chenoaspirit, ASN, RN]

Frequently if a pt is up and doing rehab for 3 days, the cuffs are no longer necessary. However, that being said, if it is still part of the protocol to have them on, then they should definitely be on, even if it is just on at night.

I am truly impressed by the critical thinking you are showing and the questions you are asking! Way to go. You are on your way to be an awesome nurse.

I agree totally. Great critical thinking and great assessment.

[RoxannMM]

I Work in Orthopeadic with alot of acute post operative Total knee replacements. I totally agree with you, about the pressure cuff what I refer to as SCD's (sequential compression devices) which help to prevent DVT. We use them in conjunction with Compression stockings. Post discharge patient's are expected to wear the stockings for 6 weeks depending of risk of DTV. They are allowed to remove them for 20mins. 4x per day. I have seen a few DTV to PE. So continue to use your skills when assessing patients.

[cmo421]

Ok Im at a rehab hospital for my med-surge 1, today I go into a pt room to give him an IM of Phenergan. Now the pt is not one of mine, I was just grabbing up some treatments to do. so anyways I go in give the IM and find out the pt is in for bilateral knee replacement. (Im in the brain injury wing, but we get others). I notice the pt did not have pressure cuffs on, I asked the pt if they ever had the cuffs on and pt said not since they had been at rehab (3 days). I approach the nurse and she said it is protocol for them to be on. so ok 3 days have gone by and no pressure cuffs, so we order the cuffs up to the floor. in the mean time Im thinking possible DVT, so I asses pts lower limbs, pt c/o mild pain in lower calf area on both legs and pain when pt pushed against my hands. I asked the nurse IF we should not scan the lower legs for a DVT, that if we put the pressure cuffs on it could possible send the DVT to the lungs. her response was we do not do that here, we just put the cuffs on. am I wrong to question this? Sometimes I feel I know Im doing the right thing, but its not in their eyes .

please any in sight.

again pt bilateral knee replacement - 3 days in rehab - no pressure cuffs - has been nauseated for 3 days - c/o pain in lower calves

excellent assessment and thinking! The nurse should have called the doc and stated calf pain. The doc then would have had to act on it. Students,unfortunately are often ignored when reporting s/s. Next time use the "I know I am only a student approach but,I feel that this pt has s/s of a dvt,could u come check it with me?" , sad I know. Some nurses have to be approached in a certain way or they get their tails is a tizzy! Continue with ur great job!

[student-with-no-life]

thank you for the replies. I did chart that I let the nurse know about my concerns. I also told my instructor about my concerns.

I myself have had knee replacement and I know the pain that can happen in the calf area. But my undrstanding is the pt has been very nauseated and has not been able to do his rehab, pt lays totally flat in bed, I was just so shocked that NOBODY else noticed no pc's on this pt. And it cannot be blamed on a "student nurse" over looking it since none of the students are assigned to the pt and we donot do new admites.

Thank you once again for reassuring me I was right in my questioning. When I see the Doc this afternoon I will mention it to him. I would have last night but they don't stick around, we have to text them if we have questions - and again students cannot do this.

[Crash_Cart]

thank you for the replies. I did chart that I let the nurse know about my concerns. I also told my instructor about my concerns.

I myself have had knee replacement and I know the pain that can happen in the calf area. But my undrstanding is the pt has been very nauseated and has not been able to do his rehab, pt lays totally flat in bed, I was just so shocked that NOBODY else noticed no pc's on this pt. And it cannot be blamed on a "student nurse" over looking it since none of the students are assigned to the pt and we donot do new admites.

Thank you once again for reassuring me I was right in my questioning. When I see the Doc this afternoon I will mention it to him. I would have last night but they don't stick around, we have to text them if we have questions - and again students cannot do this.[/quote

----------------

I am sorry to disagree with you but students have every right to disagree with an RN. Can you imagine a world where no one is allowed to provide any input because they are not a certified RN (yet)?

Yeah I know this doesn't make them happy, but always remember this is about the patient, not the RN. (Although I always admire them with great respect.)

My Best.

[GeminiTwinRN, BSN]

I think you're doing great regarding critical thinking skills, I'm sure having had the sx yourself, you were extra vigilent and also more knowledgeable about this particular sx and tx than some of the other students, and I daresay possibly even the RN.

The only thing I question is that you mentioned that you would "mention this to the Doc". I know that you mean well, and you are absolutely correct, this needs to be addressed with the physician, but as an RN who has had students many times already, I personally would not find it appropriate for a student to go "over my head" and straight to the Doctor. I hope you understand what I'm saying here.

I do, however, think if your instructor is present and you approach the doctor WITH the instructor, as the RN in charge of the pt, I would have much less chance of getting defensive about it.

Once again, I'm not flaming at all, just pointing out that there may be another way to skin this cat without po'ing the nurse.

:)

Good job!