Mr. Green, 19 years old, with pelvic and left-arm fractures; in car accident, catheterized while awaiting surgery; he complains of pain in his right calf. How should the nurse revise the plan of care?

• A. Monitor for DVT
• B. Increase analgesics
• C. Start ambulation as soon as possible
• D. Apply heat and cold packs

Answer: (A)

The key idea is recognizing and watching for deep vein thrombosis in a trauma patient who is immobilized and has a pelvic fracture. When someone has pelvic fractures and is not yet fully mobile, blood flow in the legs can slow down, and clotting can start, especially after trauma and surgery are delayed. The calf pain in this situation is a red flag for DVT, so the care plan should prioritize monitoring for signs of a clot and initiating appropriate assessment rather than focusing only on pain relief or premature movement.

DVT monitoring involves looking for unilateral leg changes such as swelling, warmth, redness, and tenderness, and measuring calf circumference to detect asymmetry. It also means reporting new or worsening symptoms promptly and working with the medical team on diagnostic steps (like ultrasound) and preventive measures (such as compression devices or pharmacologic prophylaxis if ordered). This approach directly addresses the risk posed by Virchow’s triad—inactivity, vessel injury from fracture, and a hypercoagulable state after trauma.

While alleviating pain and promoting mobility are important, they don’t mitigate the immediate danger of a developing clot in this scenario. Increasing analgesics treats pain but not the risk; starting ambulation too early could be unsafe with unstable fractures awaiting surgery; applying heat or cold packs helps comfort but does not prevent DVT.