Postpartum DVT nursing interventions

[MissChloe]

I've been given the following question:

A patient is 3 days postoperative from a cesarean birth. She has tenderness, localized heat, and redness of the left leg. She is afebrile. As a result of these symptoms, she most likely will be:

a)Allowed to ambulate freely.

b)Given aspirin 650 by mouth.

c)Given Methergine IM.

d)Placed on bed rest.

My textbook doesn't have any of those options discussed in the text at all, really. I'm leaning toward the aspirin, but everything I can find about anti-coagulation therapy for DVT talks about IV heparin and the like. I have pretty much eliminated the Methergine. I don't think she'd be allowed to ambulate freely because at this point the clot has already developed and might dislodge, though when I tried to Google that it seemed like that is an outdated recommendation. It could be the bed rest, at least until whatever anti-coagulation she's given has cleared the clot, but I'm not sure. Can anyone help point me in the right direction? (For what it's worth, just because it's not in my textbook means nothing, we have the worst text for this class in the history of all textbooks!)

[schnookimz]

d would be my guess as well.

[cayenne06, MSN, CNM]

Well, aspirin is sometimes used as a prophylaxis, but my understanding is that it is not used as a treatment. Methergine is not indicated in this situation. Usually with a superficial thrombosis, ambulation is encouraged. With DVT, you want to treat the clot before you encourage ambulation. Based on the limited data you have been given, I would have to say that the best answer would be bed rest until the patient is fully evaluated. I tried to look up some good references for you, but I could only find decent info on uptodate, which requires a subscription. Sorry I can't be of more help!

[Ozzy84]

I would say aspirin option. Think about outcome. If u do bed rest, what would be result? Or if you give aspirin what would happen? There for I would go aspiring if the dosage within therapeutic range.

[loving2024, BSN, RN]

Your answer is D because the other options does not relate to the question. Aspirin is use to treat fever, pain and it is antiplatelet but the question did not mention anything about pain, fever or blood thinners. So you see that the answer is clear. Also 650 mg by mouth is just too much for aspirin

[MissChloe]

Thank you guys!

I think I'm probably going to go with D, but 650mg isn't outside the adult dosage for aspirin, and the question does say she has tenderness. I'm just thinking that's more for prevention than immediate treatment.

[Ozzy84]

I just google quickly and find out this

"While less effective than other blood thinners, aspirin "at least provides some protection, and in the case of the patients with DVT who don't have any other options, aspirin does provide benefit," she said."

[Ozzy84]

She has post op also. Heparin may cause hemorrhage .. Bed rest of course most likely help to thrombi move lungs etc.

[loving2024, BSN, RN]

I just looked at the whole picture of the question and it seems the patient has DVT.

DVT-tenderness, heat redness on the leg (thats the clue"redness on the leg")

[phuretrotr]

She has post op also. Heparin may cause hemorrhage .. Bed rest of course most likely help to thrombi move lungs etc.

Bedrest would help prevent the clot from dislodging, not mobilize it. If you ambulate with a DVT, the clot has a chance to break off of the vein from the movement and circulate throughout the bloodstream. You would want to ambulate to before a clot has formed in order to keep effective circulation in the extremities so platelets do not clump.

While it is true heparin may cause hemorrhage, so does aspirin; in large enough doses. That is why there is constant monitoring with use of heparin, to prevent that. Just because medications may have adverse/side effects, does not mean we do not use them at all.

As it has been said, aspirin will help prevent a clot but will do minimal assistance in getting rid of an already developed clot. Aspirin's MOA is that it helps platelets not stick together, thereby reducing clots because platelets do not have a chance to bind to each other. Although it could be true that aspirin may break up a clot (I'm not totally sure), I sincerely doubt that if a patient has a known clot, that aspirin would be prescribed as the sole treatment. The treatment is usually a thrombolytic or "clot-buster" medication to resolve the clot.

I would feel confident with Answer D.

[Esme12, ASN, BSN, RN]

remember this is nursing care of a patient with DVT answer accordingly.

[Ozzy84]

Bedrest would help prevent the clot from dislodging, not mobilize it. If you ambulate with a DVT, the clot has a chance to break off of the vein from the movement and circulate throughout the bloodstream. You would want to ambulate to before a clot has formed in order to keep effective circulation in the extremities so platelets do not clump.

While it is true heparin may cause hemorrhage, so does aspirin; in large enough doses. That is why there is constant monitoring with use of heparin, to prevent that. Just because medications may have adverse/side effects, does not mean we do not use them at all.

As it has been said, aspirin will help prevent a clot but will do minimal assistance in getting rid of an already developed clot. Aspirin's MOA is that it helps platelets not stick together, thereby reducing clots because platelets do not have a chance to bind to each other. Although it could be true that aspirin may break up a clot (I'm not totally sure), I sincerely doubt that if a patient has a known clot, that aspirin would be prescribed as the sole treatment. The treatment is usually a thrombolytic or "clot-buster" medication to resolve the clot.

I would feel confident with Answer D.

Sorry there is typing error. I meant it will Prevent to moving it to lungs