PICOT Problem Statement: One Of The Health Risks For Immobil ✓ Solved

5 PICOT Problem Statement One of the health risks for immob

One of the health risks for immobile post-surgical patients is the development of deep vein thrombosis (DVT). DVT occurs due to poor venous return or stasis and is predominant in the extremity. In the United States, approximately 1 in 10 people die due to DVT complications (Manici, Alemanno, & Nuzzaco, 2018). The risk of developing DVT increases in people with predisposing factors such as sedentary lifestyle, obesity, liver complications, immobilization, advanced age, and cancer. However, immobile post-surgical patients are at higher risk of DVT due to medications for cholecystectomy, staying in one position for long periods, and contraindications of cholecystectomy.

Over the years, the established methods of DVT prophylaxis are mechanical devices such as sequential compression device (SCD) and leg exercises to improve blood circulation. Manici, Alemanno, & Nuzzaco (2018) states that novel leg exercises and the SCDs are effective methods of DVT prophylaxis since they facilitate active ankle movement. The general problem is the impact of immobility on the effectiveness of both leg exercises and SCDs in post-surgical clients. According to Dhakal et al. (2019), SCDs have a negligible effect in reducing the prevalence of DVT in hospitalized postoperative patients in the short-term due to the long periods of bed rest and less physical activity. Due to the limited physical activity for post-operative patients, SCDs may be ineffective in reducing preventing DVT in immobile post-surgical patients.

The specific problem is that post-operative patients are reluctant to engage in physical activities due to the health risks associated with the surgery; hence, recommending leg exercises for patients recovering from cholecystectomy remains questionable as they are immobile and careful to avoid post-surgery injuries. Manici, Alemanno, & Nuzzaco (2018) found that single motion leg exercise improved post-exercise venous flow volumes in lower extremities among post-operative patients. Snyder et al. (2017) stated that SCD and leg exercises are appropriate methods of DVT prophylaxis, but it is crucial to assess the physiological effects of the interventions. Optimum protection for patients is the primary consideration in determining the appropriate DVT prophylaxis to realize positive outcomes and better quality of care.

Snyder et al. (2017) affirmed the disadvantages of mechanical DVT prophylaxis methods such as active leg movement in post-operative patients emanate from the patient’s immobility and bedridden conditions. SCDs are popularly used because patients report better outcomes, especially aged, hospitalized, and post-operative patients. Tanaka et al. (2016) stated that post-operative patients experience difficulties with leg movements due to pain, weakness, fatigue, and bedridden conditions. As such, it is important to factor in the wellbeing of the patients and provide unbiased information about the effectiveness of methods of mechanical DVT prophylaxis to clear doubts about any misinformation. Similarly, Tanaka et al. (2016) claimed that leg exercises are ineffective in the prevention of DVT since post-operative patients experience extended periods of bedtime during hospitalization.

Post-operative patients are less likely to make individual efforts to practice leg exercises compared to healthy patients with DVT due to body weaknesses and poor physical health. This study will investigate the effectiveness of both SCDs and leg exercise and compare the most effective mechanical methods of DVT prophylaxis. It is crucial to establish the most effective treatment plan for bedridden and post-operative patients because they are at a higher risk of DVT or Pulmonary Embolism (PE). The evaluation considers the difficulties that face immobile post-surgical patients as a result of the surgery and the risks associated with immobility regarding the prevention of DVT. Examining the effectiveness of SCDs and leg exercises as interventions of reducing the prevalence of DVT in immobile post-surgical patients could have a significant influence on the recommendations for an evidence-based treatment plan for post-operative patients.

PICOT question: For an immobile post-surgical client who is at an increased risk for deep venous thrombosis (P), how effective is the application of sequential compression devices (SCDs) (I) in comparison to leg exercises (C) in reducing the prevalence of deep vein thrombosis (O) within one month time (T)?

Paper For Above Instructions

Introduction

Deep vein thrombosis (DVT) is a significant health risk for immobile post-surgical patients, leading to severe complications, including pulmonary embolism and death. Immobility after surgery, especially in conditions such as cholecystectomy, exacerbates the risk factors for DVT, making it crucial for healthcare providers to identify effective prophylaxis strategies. This paper will evaluate the effectiveness of sequential compression devices (SCDs) versus leg exercises in reducing the prevalence of DVT in immobile post-surgical patients within one month post-surgery.

Understanding Deep Vein Thrombosis

DVT is the formation of blood clots in the deep veins, predominantly occurring in the legs and can be further complicated by the clot's dislodgement, leading to pulmonary embolism (Manici, Alemanno, & Nuzzaco, 2018). Post-surgical patients face extended periods of immobilization, which increases venous stasis—one of the primary causes of DVT. Risk factors such as obesity, advanced age, and certain medications associated with surgeries like cholecystectomy can further elevate the risk of developing DVT.

Interventions for DVT Prophylaxis

The main interventions for preventing DVT include mechanical devices like SCDs and physical activity such as leg exercises. SCDs apply intermittent pneumatic compression, which facilitates blood flow in the lower limbs, thereby diminishing the likelihood of thrombus formation (Dhakal et al., 2019). On the other hand, leg exercises promote active movement, enhancing venous return and ultimately reducing the risk of DVT.

Effectiveness of Sequential Compression Devices

Studies indicate that SCDs can significantly reduce the incidence of DVT, particularly in high-risk surgical populations (Snyder et al., 2017). According to Snyder et al. (2017), patients using SCDs demonstrated better outcomes than those relying solely on standard postoperative care. However, effectiveness may vary depending on the duration of use and compliance, especially as immobile patients may not consistently wear SCDs due to discomfort or pain.

Effectiveness of Leg Exercises

Active leg movements can be challenging for immobile post-surgical patients due to pain, weakness, and fear of re-injury. Tanaka et al. (2016) found that while leg exercises could improve venous blood flow, their efficacy may be limited in bedridden patients experiencing significant discomfort. Nonetheless, incorporating simple and safe movements, such as ankle pumps or flexions, can still be advantageous by encouraging circulation.

Comparative Effectiveness

To determine the most effective method of DVT prophylaxis, a comparative study is essential. The current landscape suggests that while both interventions hold merit, SCDs may offer a more passive yet consistent approach to preventing DVT in patients unwilling or unable to perform leg exercises (Carvalho, Zheng, & Butwick, 2017). Conversely, as post-operative recovery progresses, integrating leg exercises might strengthen overall outcomes when employed alongside SCDs.

Conclusion

In conclusion, both sequential compression devices and leg exercises offer beneficial interventions for reducing DVT prevalence in immobile post-surgical patients. However, considering patient compliance and comfort, SCDs may provide a safer option during the immediate post-operative period. Understanding the patient's unique situation, preferences, and health status is vital to devising an evidence-based DVT prevention plan that promotes optimal post-surgical recovery.

References

• Carvalho, B., Zheng, L. L., & Butwick, A. (2017). Comparative Effectiveness of Lower Leg Compression Devices Versus Sequential Compression Devices to Prevent Postspinal Hypotension During Cesarean Delivery. Anesthesia & Analgesia, 124(2), 696–697.
• Dhakal, P., Wang, L., Gardiner, J., Shrotriya, S., Sharma, M., & Rayamajhi, S. (2019). Effectiveness of Sequential Compression Devices in Prevention of Venous Thromboembolism in Medically Ill Hospitalized Patients: A Retrospective Cohort Study. Turkish Journal of Hematology.
• Kozier, B., & Berman, A. (2012). Kozier & Erb's fundamentals of nursing: concepts, process, and practice. Pearson.
• Manici, M., Alemanno, G., & Nuzzaco, M. I. (2018). Venous Thromboembolism Prevention and Prophylaxis. In Nursing in Critical Care Setting (pp. ). Springer, Cham.
• Snyder, M. A., Sympson, A. N., Scheuerman, C. M., Gregg, J. L., & Hussain, L. R. (2017). Efficacy in deep vein thrombosis prevention with extended mechanical compression device therapy and prophylactic aspirin following total knee arthroplasty: a randomized control trial. The Journal of arthroplasty, 32(5).
• Tanaka, K., Kamada, H., Shimizu, Y., Aikawa, S., Nishino, T., Ochiai, N., ... & Yamazaki, M. (2016). The use of a novel in-bed active Leg Exercise Apparatus (LEX) for increasing venous blood flow. Journal of Rural Medicine, 11(1), 11-16.