(3) Keep the affected limb horizontal and at rest until the physician has
examined the patient and ordered specific treatment. Support the entire limb from the
thigh to the ankle on pillows, keeping the limb level unless otherwise ordered. Orders
for treatment may include elevation and application of continuous massive warm, moist
packs to the entire limb.
Use a bed cradle to prevent any pressure from the bed linen.
(5) Be alert to any complaint or other evidence of respiratory difficulty or
chest pain. A clot which is adherent to the vein wall, or a portion of a clot, can become
dislodged and be carried in the circulation as an embolus to distant and smaller arterial
blood vessels in the lungs. Sudden dyspnea, violent coughing, or severe chest pain
may be the first sign of embolism.
(6) Discontinue routine postoperative exercise, ambulation, deep breathing,
and coughing measures until the physician has indicated which measures are to be
resumed and which precautions are to be taken.
(7) Carry out all subsequent treatment and nursing care measures in a
manner that will avoid abrupt movements and any strain on the part of the patient.
(8) When ordered, apply anti-embolism hose or intermittent external
pneumatic compression system to give support and aid venous circulation.
(9) When the patient is allowed out of bed, remind him to alternate walking
and resting with feet propped on a stool to avoid pressure in the popliteal space.
Prolonged standing or sitting with no movement must be avoided. Check to see that the
edge of the chair seat does not press the popliteal space and that the patient does not
sit with crossed legs.
An embolus is a blood clot or other foreign particle (fat globule or air bubble)
floating in the bloodstream. The embolus is usually undetectable until it suddenly
lodges in an arterial blood vessel. This may occur when the patient is apparently
convalescing and progressing normally. If the embolus is sufficiently large and the
arterial vessel which it obstructs supplies a vital area in the lungs, heart, or brain, the
patient may die before any symptoms of embolism are detectable. A special type of
embolism, pulmonary embolism, is caused by the obstruction of a pulmonary artery by
an embolus. The most frequent cause of a postoperative pulmonary embolism is a
thrombosed vein in the pelvis or lower extremities. Therefore, measures to prevent
development of thrombophlebitis are the most important ones to take to prevent the
possibly fatal complication of pulmonary embolism.