Clotted Cliff — Deep Vein Thrombosis & VTE Prevention
Unilateral calf swelling, warmth, and a positive Homans-like tenderness — never massage the leg, a clot may already be loose
Three days after hip surgery, Cliff's right calf becomes swollen, warm, and tender to touch, and he suddenly develops sharp pleuritic chest pain and shortness of breath while the nurse is assessing him.
Cliff spent a long postoperative recovery immobile in bed, and venous stasis, vessel wall injury, and hypercoagulability — the classic Virchow's triad — combined to form a clot in his calf vein. A swollen, warm, tender unilateral leg raises suspicion for DVT, confirmed by Doppler ultrasound. The greatest danger is embolization to the lungs, so nurses never massage or vigorously rub a suspected clot and instead focus on anticoagulation and mechanical prevention.
Read Clotted Cliff's full story →The story arc
The setup
Cliff underwent hip replacement surgery and has been largely immobile in bed for three days without his sequential compression devices consistently applied.
The turn
Cliff's right calf becomes visibly swollen compared to the left, warm to touch, and tender along the posterior calf.
The crisis
While being assessed, Cliff suddenly develops sharp pleuritic chest pain, shortness of breath, and his oxygen saturation drops to 88%.
The save
The nurse immediately keeps Cliff on strict bed rest without massaging the leg, raises the head of the bed, applies supplemental oxygen, and notifies the provider for emergent imaging and anticoagulation.
NCLEX study section — Deep Vein Thrombosis & VTE Prevention
What this chapter is testing: the recognition cues, the numbers and the priority action.
Study section: Cardiovascular
Take this chapter into practice questions on the same topic.