Maternity Nursing: Postpartum Q 7
A PP nurse is assessing a mother who delivered a healthy newborn infant by C-section. The nurse is assessing for signs and symptoms of superficial venous thrombosis. Which of the following signs or symptoms would the nurse note if superficial venous thrombosis were present?
A. Paleness of the calf area
B. Enlarged, hardened veins
C. Coolness of the calf area
D. Palpable dorsalis pedis pulses
Correct Answer: B. Enlarged, hardened veins
Thrombosis of the superficial veins is usually accompanied by signs and symptoms of inflammation. These include swelling of the involved extremity and redness, tenderness, and warmth. Superficial thrombophlebitis is an inflammatory disorder of superficial veins with coexistent venous thrombosis. It usually affects lower limbs, particularly the great saphenous vein (60% to 80%) or the small/short saphenous vein (10% to 20%).
Option A: Patients with superficial thrombophlebitis typically present with a reddened, warm, inflamed, tender area overlying the track of a superficial vein. There is often a palpable cord. Some surrounding edema or associated pruritus may occur. In pregnancy, the risk of SVT is akin to that of DVT, most commonly in the postpartum period. Advanced age, exogenous estrogens, autoimmune or infectious diseases, obesity, recent trauma or surgery, active malignancy, history of venous thromboembolic disease, and respiratory or cardiac failure also increase the risk of SVT.
Option C: Significant swelling of the limb is more commonly associated with DVT and should only be attributed to SVT after DVT has been excluded. Patients may have a history of antecedent trauma, which can include intravenous cannulation or infusion of irritants, such as recent sclerotherapy for varicose veins. However, it can occur at other sites (10% to 20%) and may occur bilaterally (5% to 10%). Traditionally, this relatively common process was considered benign and self-limited.
Option D: Physical examination does not adequately identify the extent of disease; it has been shown to underestimate it in up to 77% of instances. Compressive ultrasonography can identify concomitant DVT, evaluate the extent of the thrombus, and confirm the diagnosis. A careful history is critical to identify risk factors for venous thromboembolism. Initial presentation in patients older than 40 years without other risk factors should prompt consideration of underlying malignancy.