question about my pt for future reference

also, for future reference, when you suspect a dvt, do you tell the pt to try to keep the area elevated and minimize activity to prevent the clot from breaking off and moving to the lungs/heart/brain? can you do this without an order? i know that if you suspect a dvt, you call the md, but do you minimize their activity without an order until you call the md and they r/o dvt?

thanks.

I'm curious as to what your clinical instructor said.

I'm just a level one nursing student, doing bed baths and what not. But I googled your question of the bluish potential DVT site.

Diagnosis:

Clinical: The clinical features - swelling, tenderness and warmth will be recognised in less than 50% of cases with calf DVT and in about 80-90% of patients with ilio-femoral DVT. The severe forms - phlegmasia cerulea (blue leg) and alba (white leg) dolens should he recognised, as more aggressive therapy may be appropriate.

Now the definition of phlegmasia cerula from Websters Dictionar(2007) states:

severe thrombophlebitis with extreme pain, edema, cyanosis, and possible ischemic necrosis

I don't really know if this helps, but from what i've read..I wouldn't let your DVT Dx slip away, because it's still a possibility. I think a more exp. person should elaborate on this.

http://books.google.com/books?id=yujV5S_TP_UC&pg=PA34&lpg=PA34&dq=swollen+blue+dvt&source=bl&ots=E3Ox57gfPP&sig=ES38xRsgSii67oGf5sg-_C_Ck9g&hl=en&ei=xYfLTJ7kGsKBlAfiqvyYBg&sa=X&oi=book_result&ct=result&resnum=2&ved=0CBoQ6AEwAQ#v=onepage&q=swollen%20blue%20dvt&f=false

I found this link to a book. Look at #11.

Thanks, guys. That helped a lot!! I told the nurse about my finding, but I don't know what happened after that. My teacher told me to tell the nurse, and I told the nurse but I don't know what happened after that because we left early that day, but I was just curious as to what may have happened. I wish I could have done more, but we really can't do more as students. I guess I wanted to know what we'd do when we've graduated because as a student when we find something out of the ordinary, we tell the nurse or our instructor.

I guess I wanted to know what we'd do when we've graduated because as a student when we find something out of the ordinary, we tell the nurse or our instructor.

As a nurse, here is what I would have done:

Upon learning of this, I would have asked the patient the history of the pain: how long had he had it, how long had the area been swollen and tender, etc. I would have done a complete vascular assessment on the lower extremities, including cap refill, warmth, palpate pulses, ask about sensation (tingling, numbness, etc). I would have asked the pt if he had discussed this with a physician, or if the area had been evaluated by a practitioner.

Then I would have looked at the H&P from his admission. Did the doc document anything regarding this? Have the physician's progress notes addressed it at all? If they have, explore it further. Does it seem changed from what the physicians describe? Have they done any sort of testing or have they made any sort of plan (will monitor for change in symptoms, well continue fragmin therapy, etc) regarding this?

If it had been addressed and did not appear much changed, I would simply have documented it in my notes and mentioned it to the oncoming shift, as an issue to actively monitor. If no one had addressed it at all, or there was a significant change, I would have contacted the physician.

Hope that helps.

And FYI, from what you describe, I don't know if I would have been thinking DVT so much as hematoma and/or infection, and I'd worry that there was some damage being done by the swelling, specifically that his vascular status was compromised due to the compression of the hematoma/infection on the vessels to and from the leg. It's also possible that the hernia had recurred, or there was some sort of combination of issues (bruising, infection, herniation) going on there.