A 65-year-old is post-op day 1 from a hip arthroplasty. Which nursing action best supports DVT prophylaxis based on current evidence?
1Administer the prescribed enoxaparin subcutaneously daily, apply SCDs when in bed, and assist the patient to ambulate as soon as the provider clears for activity (typically post-op day 1 for hip arthroplasty).✓ Correct answer
2Massage the operative leg routinely every 2 hours from the calf to the thigh using firm, continuous strokes to promote venous return and reduce the risk of developing deep vein thrombosis.
3Keep the patient on complete bed rest with the operative leg flat for the first 7 days after surgery to prevent disruption of the surgical site, promote wound healing, and minimize the chance of deep vein thrombosis.
4Withhold the prescribed enoxaparin after the patient ambulates for the first time, as mechanical activity alone provides sufficient prophylaxis against clot formation and minimizes the risk of bleeding.
Explanation
Post-op DVT prophylaxis after hip arthroplasty combines pharmacologic (LMWH such as enoxaparin, DOAC, or fondaparinux) with mechanical (SCDs when in bed) AND early ambulation as cleared by surgery. Choice 2 (massage) can dislodge an undetected clot and is dangerous. Choice 3 (strict bed rest) maximizes Virchow's triad (stasis) and INCREASES DVT risk. Choice 4 (hold one if doing the other) is wrong — multimodal prophylaxis is additive in high-risk patients (hip, knee, hip fracture, major cancer surgery).
Hip and knee arthroplasty are the highest-risk procedures for DVT — multimodal prophylaxis is standard. The "stop one prophylaxis when starting another" trap is wrong; pharmacologic AND mechanical AND early ambulation are added together. The single most lethal DVT prevention error remains "patient is ambulating now, hold the LMWH" — it is not.
65-year-old, post-op day 1 from total hip arthroplasty. Pain controlled with PCA. The provider has ordered enoxaparin 40 mg subcutaneously daily and sequential compression devices (SCDs) when not ambulating.
Multimodal DVT prophylaxis — Pharmacologic (LMWH/DOAC/fondaparinux) + mechanical (SCDs) + early ambulation in high-risk surgery.
Virchow triad — Stasis, endothelial injury, hypercoagulability — the three pillars of thrombus formation.
Hip arthroplasty DVT risk — Highest among orthopedic procedures; prophylaxis recommended for ≥ 10-35 days postoperatively.