A nurse is assuming care of a client who has an existing deep-vein thrombosis (DVT). What interventions would be anticipated in their plan of care? (Select All that Apply).

Choice A rationale Encouraging and assisting with turning every 2 hours is a standard intervention for any client with restricted mobility, including those on bedrest due to DVT. This measure helps prevent skin breakdown and pressure ulcers by relieving pressure over bony prominences and promoting circulation to compressed tissues. Choice B rationale Positioning the legs dependently (hanging down) would increase venous pressure and worsen venous pooling and edema distal to the DVT site due to the effects of gravity, which could potentially increase pain and swelling. The affected leg should be elevated above the level of the heart to promote venous return and reduce edema and pressure. Choice C rationale Ibuprofen, a non-steroidal anti-inflammatory drug (NSAID), inhibits platelet aggregation and may increase the risk of bleeding when used concurrently with therapeutic anticoagulants like heparin or warfarin, which are standard DVT treatments. Acetaminophen (Tylenol) is generally preferred for pain management due to its lower bleeding risk. Choice D rationale Heparin (unfractionated or low molecular weight) is a common treatment for DVT. A severe complication of heparin therapy is Heparin-Induced Thrombocytopenia (HIT), an immune reaction leading to a significant drop in platelet count (normal range 150,000–450,000/mm) and paradoxical thrombosis. Therefore, monitoring platelet levels is crucial. Choice E rationale Applying ice (cold) to the extremity is a vasoconstrictor that can impair circulation and may reduce pain but is not the primary intervention for an acute DVT; it could theoretically worsen flow. Moist heat application is often preferred to promote vasodilation, which may reduce muscle spasms and provide comfort. Choice F rationale Compression stockings (graduated compression) help to reduce edema and promote venous return from the lower extremities, thereby reducing the symptoms of Post-Thrombotic Syndrome (PTS). The nurse must evaluate the fit to ensure the stockings are not too tight (risk for impaired arterial circulation) or too loose (ineffective compression).