Assessment

HISTORY. Although almost half of the patients with deep and superficial thrombophlebitis are asymptomatic, patients with DVT may have complaints of calf muscle or groin tenderness, pain, fever (rarely above 101°F), chills, general weakness, and lethargy.

PHYSICAL EXAMINATION. Observe both legs, noting alterations in symmetry, color, and temperature of one leg compared with the other. In DVT, the affected limb may reveal redness, warmth, swelling, and discoloration when compared with the contralateral limb. In addition, superficial veins over the area may be distended. Note the presence of calf pain with dorsiflexion of the foot of the affected extremity, which is a positive Homans' sign. This positive finding occurs in 33% of patients with DVT and is considered an inconsistent and unreliable physical sign.

Superficial vein thrombosis may be asymptomatic or may lead to pain, redness, induration, and swelling in the local area of the thrombus. Note the presence of local redness and nodules on the skin or extremity edema, which is rare. Palpate over the suspected vein involved. It may feel like a cord or thickness that extends upward along the entire length of the vein.

PSYCHOSOCIAL. The patient has not only an unexpected, sudden illness but also an increased risk for life-threatening complications such as pulmonary embolism. Assess the patient's ability to cope. In addition, assess the patient's degree of anxiety about the illness and potential complications.

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