A nurse is assisting with the plan of care for a client who has a new deep-vein thrombosis (DVT) in his leg. Which of the following interventions should the nurse include in the plan?
Explanation & Rationale
A. Rub the client's affected leg every 4 hr. Rubbing/massaging the leg is contraindicated because it can dislodge part of the thrombus and cause pulmonary embolism. B. Keep the client's affected leg elevated. Elevation reduces venous stasis and edema and helps relieve discomfort; it’s a standard supportive measure for DVT. C. Apply cool compresses to the client's affected leg. Warm, moist compresses may be used to relieve pain; cold compresses are not typically recommended and may worsen vasoconstriction. D. Ambulate the client every shift. Early ambulation may be allowed once anticoagulation is started and the provider approves, but immediate ambulation without orders is not appropriate; in acute DVT, strict early ambulation is not routinely prescribed because of embolic risk until stabilized.