Nursing 101 considerations for any patient with limited mobility include frequent movement to prevent complications that can include pneumonia, decubiti, and circulatory issues such as Venous Thromboembolism (VTE) which can include DVT (deep vein thrombosis) or PE (pulmonary embolism). One of the very first things taught in nursing school is to turn the patient every 2 hours to relieve pressure and encourage proper circulation and pulmonary toileting as well as to help maintain muscle tone. Added to this is periodic and often scheduled passive and active range of motion. For student nurses in their first clinical rotation, this may be the most important lesson to learn and perhaps comprise most of the hands-on care they perform with their first patient or two.
Basic Nursing Care: Turn Q 2 Hours
It’s a lesson that continues to remain part of basic nursing/patient care throughout the nurse’s career no matter the field. Educating patients and family members to continue this important self-care is a vital step in improving patient outcomes. Patients can be resistant when their symptomology includes issues such as pain, nausea, dyspnea, generalized discomfort from being repositioned on their side or back and a dislike of being disturbed every 2 hours to have to be moved. Their sleep may be disturbed or interactions with family members or watching TV, etc. It’s important that patients have a good understanding about the reasons why they need to be moved frequently. Managing their symptoms to minimize the negative effects is essential.
If the patient is at risk for VTE they need to understand the precautions necessary to prevent a DVT or any complications. As patient educators, nurses must be well-versed in patient care and disease progression. Complications of diseases and symptom management are important aspects of patient care as well as education.
It is simply impossible to nurses to learn everything they need to know in nursing school. Nursing is a lifelong learning experience and keeping up to date with changes in protocol and treatments is imperative. Continuing education courses for nurses provide specific in-depth coverage of topics necessary to enhance the knowledge base of nurses and improve the quality of care they provide.
Prevention Begins with Mobility
Anyone can develop a DVT or have a PE complication. It doesn’t always begin in the lower extremities. One of the most common causes is long trips (over 8 hours) in an airplane or in a car. According to the American Heart Association (AHA) a simple way to reduce the risk is to get up and walk every 2-3 hours. Plan a road trip to include periodic stops to get out and stretch and walk. They can accompany bathroom or meal stops, but make sure to walk for at least 2-3 minutes and stretch leg muscles before returning to the car. Take a few deep breaths and do some ROM to all extremities including the neck and shoulders. On board an airplane, stand and walk in place or walk around the plane. Encourage others in the row to do the same. This may help to reduce any frustrations about inconveniences. Wear comfortable, loose clothing that isn’t constrictive and stay hydrated. Leave room on the floor to be able to move feet and legs frequently and do simple seated ankle and calf exercises. Compression socks and low dose Aspirin are only necessary if there is prior history of VTE according to the American Society of Hematology (ASH).
Risk Factors for VTE
Patients who are bedbound or live a bed to chair existence are at risk for many possible complications of immobility such as skin breakdown, constipation, pneumonia, as well as DVT and PE. It’s important for nurses to educate patients and caregivers about the risks and ways to prevent complications. Hydration and nutrition are important factors. Medication compliance is essential. Thorough medical history can reveal other risk factors.
Patients who have a history of the following can be at higher risk for VTE and should consult with their primary healthcare provider:
- Recent surgery or immobility
- Heart rate > 100 BPM
- History of DVT or clotting issues
- Family history of VTE
- Certain medications can increase risk
- Active Cancer treatment or recent history of treatment in last 6 mos.
- Clinical signs of DVT
- Age 65 or over
- LE fracture
- Active malignancy or cure within the last 2 years
- Pain in one LE
- Edema in one LE
- Oxygen saturation over 95%
- Pregnancy
Diagnostics and Treatment of VTE
There are multiple tests which can provide a definitive or suspected diagnosis requiring further investigation from blood tests to scans and ultrasound diagnostics. Treatment includes anticoagulation which can be provided in several different ways from oral to sub q injection to IV administration depending on the severity and risk factors involved. The strength and duration of treatment is also defined by the diagnostics and symptoms. Other treatments include implanted inferior vena cava filters.
Patient taking anticoagulants should be monitored closely and educated about the risks of bleeding or hemorrhage. Anyone with a VTE is at risk for hemorrhage, stroke, increased bleeding, PE or another DVT. Precautions should be taken. Patients and caregivers should be aware of the diagnosis and treatment. Medic Alert bracelets are recommended. They should also be acutely aware of the seriousness and emergent nature of seeking medical care should they experience any signs or symptoms such as increased pain, chest pain, or shortness of breath.
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