Patient Data Exhibits Data is evaluated to determine possible conditions and appropriate interventions. Complete the diagram by dragging from the choices area to specify which condition the client is most likely experiencing, two actions the nurse should take to address that condition, and two parameters the nurse should monitor to assess the client's progress.

Rationale for Correct Choices: • Deep vein thrombosis (DVT): The client presents with classic DVT signs including unilateral calf pain, redness, edema, and increased calf circumference (15 in left vs 13 in right). Risk factors include recent hip surgery, immobilization, and history of tobacco use, all of which predispose to venous thromboembolism. • Begin anticoagulation therapy: Anticoagulants like enoxaparin prevent clot propagation and reduce the risk of pulmonary embolism. Timely administration is critical in postoperative patients showing early signs of DVT. • Early ambulation: Gradual, supervised ambulation promotes venous return and helps prevent further clot formation. It also supports overall recovery while minimizing the risk of thrombus extension. • Laboratory values: Monitoring laboratory markers such as D-dimer, platelet count, and coagulation studies helps evaluate effectiveness of anticoagulation therapy and detect potential complications like heparin-induced thrombocytopenia. • Development of pulmonary embolus: DVT can dislodge and travel to the lungs, causing a potentially life-threatening pulmonary embolism. Continuous monitoring for sudden shortness of breath, chest pain, or hypoxia is essential for early detection. Rationale for Incorrect Choices: • Surgical site infection: The left hip dressing shows only a small amount of dark red drainage, no purulent exudate or erythema around the incision, and no significant fever, making infection less likely at this stage. • Displaced hip: There is no indication of acute hip deformity, abnormal leg positioning, or loss of mobility; pain is localized to the calf rather than hip joint, reducing the likelihood of displacement. • Osteomyelitis: Infection of the bone is unlikely within 24 hours postoperatively without systemic signs or purulent drainage; early post-surgical pain and swelling are more consistent with DVT. • Massage the calf area: Massaging a suspected DVT is contraindicated as it may dislodge the clot and precipitate a pulmonary embolism. • Prep for return to surgery: There is no evidence of surgical complication such as wound dehiscence or hematoma requiring immediate reoperation. • Culture hip wound: There is no sign of infection (purulent drainage, significant erythema, systemic signs), so wound culture is unnecessary at this point. • Intake and output: While important for overall postoperative care, monitoring intake and output does not directly assess progression or resolution of DVT. • Nutritional intake: Nutrition is important for healing but does not provide direct data on DVT status or risk of pulmonary embolus. • Wound drainage: While important to monitor, the client's immediate and most critical problem is a potential DVT, which carries a much higher risk of morbidity and mortality than the hip wound drainage.