- Calf pain, heat, and swelling while using an SCD. What is the first action?
Answer: Stop the SCD; call the nurse
Calf pain, heat, and swelling while using an SCD suggest a possible deep vein thrombosis. Stop the device immediately and notify the nurse, because continued compression could dislodge a clot. Massaging the calf is dangerous for the same reason, as it could also break off a clot. Lowering pressure or elevating the leg does not address the emergency need to stop compression and seek help.
- You are applying SCDs to a patient who underwent abdominal surgery 24 hours ago. The patient has been ambulating short distances but spends most time in bed. During application, you notice the inflation cycle seems slower than usual, and the compression feels less firm than on other patients. What should be your next action?
Answer: Check the device settings and tubing connections for proper function
Equipment malfunction assessment should precede other interventions. Checking settings, connections, and tubing integrity can identify correctable problems before escalating to equipment replacement or setting changes. A: Inadequate compression provides false security without therapeutic benefit. C: Adjusting settings without identifying the problem could cause harm. D: Replacement should occur after troubleshooting reveals irreparable malfunction.
- The patient folds the top thigh band down. What risk follows?
Answer: It creates a tight tourniquet
Folding the top thigh band down doubles the band's edge over a smaller area, so it tightens around the leg and can act like a tourniquet, restricting blood flow. The tempting wrong answer is that it lets the skin get air, but exposing skin doesn't remove the dangerous constriction, and it raises tension rather than lowering it.
- Which problem does thigh-first SCD compression cause?
Answer: It occludes venous outflow
Thigh-first SCD compression tightens the proximal veins before the lower chambers have moved blood upward, so it blocks the return path. The tempting wrong answer is that it helps leg blood flow up, but that only happens with correct distal-to-proximal sequencing. Proper SCDs inflate from foot upward; thigh-first reverses that and occludes venous outflow.
- A patient with a history of deep vein thrombosis is scheduled for a lengthy surgical procedure. The nurse instructs you to apply sequential compression devices (SCDs) preoperatively. Upon assessment, you note the patient has a palpable pedal pulse but reports calf tenderness and slight swelling in the left leg. What is the most appropriate action?
Answer: Apply the SCD only to the right leg and notify the nurse about the left leg findings
The presence of calf tenderness and swelling in a patient with DVT history suggests possible acute thrombosis. SCDs should not be applied to a leg with suspected active clot formation as compression could dislodge the clot, causing pulmonary embolism. The nurse must be notified immediately. A: Pedal pulse alone doesn't rule out DVT. C: Lower pressure doesn't eliminate embolism risk. D: Elevation alone doesn't address the contraindication or notification requirement.
- While applying antiembolism stockings to a post-surgical patient, you notice the patient's ankle circumference measures 28 cm and calf circumference measures 38 cm according to the sizing chart requirements. However, the medium stockings (24-27 cm ankle, 34-37 cm calf) feel loose at the ankle, while the large stockings (28-31 cm ankle, 38-41 cm calf) feel appropriately snug. What should you do?
Answer: Consult with the nurse about the sizing discrepancy before proceeding with application
When measurements fall at size boundaries or when there's a discrepancy between chart measurements and actual fit, clinical judgment requires nursing oversight. Improper fit can cause inadequate compression or circulatory compromise. A: Loose ankle fit can allow blood pooling. B: Chart measurements don't override clinical assessment of actual fit. C: Adding wrapping creates uneven pressure distribution and potential injury risk.
- Where should the top rest on a knee-high antiembolism stocking?
Answer: Two fingers below the knee
The top rests two fingers below the knee to keep pressure off the popliteal area behind the joint, where circulation can be impaired. Directly over the kneecap is the tempting wrong answer, but that position can wrinkle or shift and restrict blood flow. The widest calf point is used for sizing, not placement.
- A patient with heart failure is prescribed both antiembolism stockings and SCDs for thrombosis prevention. During your shift, the patient develops increased shortness of breath and bilateral lower extremity edema. The physician orders diuretic therapy. What adjustment to the compression devices should you anticipate?
Answer: Continue both devices but monitor for changes in fit as edema resolves
When caring for heart failure patients with compression therapy, you need to understand how diuretics affect fluid distribution and device effectiveness. Heart failure causes fluid retention, and when diuretics are started, they mobilize excess fluid from tissues back into circulation for elimination. This process changes limb circumference as edema resolves.
The correct approach is A) Continue both devices but monitor for changes in fit as edema resolves. Both antiembolism stockings and SCDs remain beneficial for thrombosis prevention during diuretic therapy. As the diuretics work and edema decreases, the devices may become loose and less effective, so you must regularly assess fit and adjust sizing as needed. The compression actually helps with venous return and complements the diuretic's action.
B) Remove both devices temporarily is wrong because this eliminates thrombosis protection when the patient still needs it. Diuretics don't interfere with compression therapy. C) Discontinue SCDs but continue stockings makes no clinical sense—both devices serve the same thrombosis prevention purpose and should both be continued. D) Switch to intermittent application is incorrect because consistent compression provides better thrombosis prevention than intermittent use, and there's no medical reason to reduce protection.
CPCTA Strategy: Remember that multiple therapies for the same condition (like heart failure) usually work together, not against each other. When patients receive new treatments, your role is typically to monitor and adjust existing interventions rather than discontinue them. Always prioritize patient safety by maintaining prescribed protections while adapting to physiological changes.
- Where does the knee opening sit on a thigh-high SCD sleeve?
Answer: Over the back of the knee
The knee opening is positioned behind the knee so the sleeve can bend with you and avoid pressure on the kneecap. The most tempting error is placing it directly over the kneecap, but that would cause discomfort and reduce proper fit. It sits at the popliteal space, over the back of the knee.
- You are instructed to apply SCDs to a patient who is 2 days post-operative from hip replacement surgery. The patient is on bed rest and has been receiving anticoagulant therapy. When you enter the room, you find the patient has removed the SCDs stating they are "too noisy and uncomfortable." How should you respond?
Answer: Offer to adjust the settings for comfort and discuss concerns with the patient
Post-hip replacement patients have extremely high DVT/PE risk. Rather than forcing compliance or accepting refusal, addressing comfort concerns and patient education often resolves the issue. Settings can be adjusted for noise and comfort while maintaining therapeutic benefit. A: Reapplication without addressing concerns likely leads to repeated removal. B: Accepting refusal ignores the high-risk situation. D: Mandatory language doesn't address legitimate comfort concerns and may damage therapeutic relationship.
- You are preparing to apply SCDs to a diabetic patient who has decreased sensation in both feet. During your assessment, you notice the patient has a small healing ulcer on the lateral malleolus of the right ankle. The patient reports no pain from the ulcer site. What is the best course of action?
Answer: Apply the SCD only to the left leg and use passive range of motion for the right
Open wounds, especially in diabetic patients with decreased sensation, contraindicate SCD application to that extremity due to risk of tissue damage and impaired healing. The device could worsen the ulcer or cause additional skin breakdown that the patient cannot feel. Alternative interventions like passive ROM should be used. A: Pressure from the cuff edges could still affect healing. B: Padding doesn't eliminate pressure concerns. D: Cleaning doesn't address the contraindication.
- While applying antiembolism stockings to an elderly patient, you notice the skin appears fragile with several small ecchymoses on the lower legs from previous applications. The patient's circulation appears adequate, but they mention the stockings "hurt when you put them on." What modification to your technique would be most appropriate?
Answer: Turn the stocking inside-out to the heel, then roll up over the leg
The inside-out technique reduces shearing forces on fragile skin during application while maintaining proper compression. This method is gentler and reduces trauma to delicate tissue. A: Speed increases skin trauma risk. B: Powder can cause skin dryness; lotion affects stocking grip and compression. D: Standing application increases difficulty and doesn't address skin protection needs.
- You are caring for a patient with bilateral lower extremity SCDs who is scheduled for physical therapy in 2 hours. The patient asks if the devices need to be removed during therapy since they will be "walking around." The patient has been bedbound for 3 days following orthopedic surgery. How should you respond?
Answer: Contact the nurse to clarify the protocol for SCD use during physical therapy
SCD protocols during physical therapy vary by institution, patient condition, and therapy type. After prolonged bedrest, patients remain at high thrombosis risk even with ambulation. Some facilities continue SCDs during limited mobility therapy while others remove them for active ambulation. Clarification ensures appropriate care. A: Blanket rules don't account for individual situations. B: Shifts responsibility without ensuring proper communication. C: Assumes therapy provides equivalent protection without verification.
- A postpartum patient is prescribed antiembolism stockings following cesarean delivery. She is breastfeeding and reports that her legs "feel more swollen in the evening." You applied the stockings this morning using measurements taken at that time. During evening assessment, the stockings appear to be creating deeper indentations in the skin. What is the most appropriate response?
Answer: Remove stockings, reassess leg measurements, and apply properly fitting ones
Antiembolism stockings require proper fit to prevent blood clots while avoiding circulation compromise. When you encounter a postpartum patient with worsening edema and stockings creating deeper indentations, you're dealing with a sizing issue that needs immediate attention.
The correct response is A) Remove stockings, reassess leg measurements, and apply properly fitting ones. Postpartum patients commonly experience fluid shifts and increasing edema throughout the day, especially after cesarean delivery. When stockings become too tight (evidenced by deeper indentations), they can actually impede venous return and cause harm rather than prevent clots. Proper protocol requires removing ill-fitting stockings, taking fresh measurements when swelling is present, and applying correctly sized replacements.
Option B) rolling down the top creates a tourniquet effect that can worsen circulation problems. Option C) leaving the patient without compression overnight eliminates clot prevention during a high-risk period - postpartum patients need continuous thromboembolism prophylaxis. Option D) continuing with poorly fitting stockings ignores the fundamental problem and could lead to tissue damage or paradoxically increased clot risk.
The key insight here is that antiembolism stockings must be fitted to current measurements, not morning measurements when edema may be minimal. Evening swelling is normal postpartum, but your intervention must adapt to the patient's current condition.
Study tip: For CPCTA questions about compression garments, remember that proper fit trumps convenience. When stockings create indentations or patients report increased swelling, always reassess and refit rather than modify or ignore the problem.
- A patient is wearing antiembolism stockings that were applied 6 hours ago. During routine assessment, you observe that the stocking has rolled down and created a tight band around the mid-calf area. The patient's toes appear slightly bluish and feel cool to touch, but the patient denies numbness or pain. What is your immediate priority?
Answer: Remove the stockings immediately and assess circulation before reapplication
Bluish, cool toes indicate compromised circulation from the tourniquet effect of the rolled stocking. This requires immediate intervention to prevent tissue damage. Complete removal allows proper circulation assessment and safe reapplication. A: Repositioning without circulation assessment could miss serious compromise. C: Loosening doesn't address the underlying circulatory compromise. D: Documentation shouldn't delay urgent intervention.
