The clinician should be aware of the Wells' Criteria when ...

[Ebrown]

The clinician should be aware of the Wells' Criteria when evaluating a patient for deep vein thrombosis (DVT). Wells' Criteria are risk factors that are assigned points toward the likelihood of DVT. Wells' Criteria include:
 
  A. Active cancer
  B. Recent bedridden condition
  C. Pitting edema
  D. All of the above

Question 2

Your pregnant patient is at 8 weeks' gestation and complains of pain that radiates from the wrist into the fingers in the right hand. She is a computer programmer and uses a keyboard daily for 6 hours or more. The clinician should:
 
  A. Ask the person to place dorsal surfaces of hands together to check for Phalen's sign
  B. Teach the patient that carpal tunnel syndrome is common during pregnancy
  C. Tap the patient's right wrist to try to elicit tingling in the fingers for Tinel's sign
  D. All of the above

[wshriver]

Answer to Question 1

ANS: D
Wells' Criteria Possible score: 2 to 9
1. Active cancer (treatment within last 6 months or palliative): +1 point
2. Calf swelling greater than or equal to 3 cm compared to asymptomatic calf (measured 10 cm below tibial tuberosity): +1 point
3. Swollen unilateral superficial veins (nonvaricose in symptomatic leg): +1 point
4. Unilateral pitting edema (in symptomatic leg): +1 point
5. Previous documented deep vein thrombosis: +1 point
6. Swelling of entire leg: +1 point
7. Localized tenderness along the deep venous system: +1 point
8. Paralysis, paresis, or recent cast immobilization of lower extremities: +1 point
9. Recently bedridden 3 days or more, or major surgery requiring regional or general anesthetic in the past 12 weeks: +1 point
10. Alternative diagnosis at least as likely: 2 points

Answer to Question 2

ANS: D
Carpal tunnel syndrome results from compression of the median nerve in the carpal tunnel, which results in paresthesias or weakness of the thumb, index, and middle fingers (Viera, 2003). Carpal tunnel syndrome occurs in 20 to 60 of pregnant women and often causes these women to awake with burning, numbness, and tingling in the median nerve distribution (Padua et al., 2001; Weimer et al., 2002). However, these symptoms usually tend to occur during the last trimester. Tinel's sign and Phalen's test should be performed. Upper extremity, grip, and finger strength should be assessed along with the ability to oppose the thumb to the fingers. An evaluation for thenar atrophy and dry skin on the thumb as well as index and middle fingers (median nerve distribution) should be completed. The size and shape of joints, skin color, pulses, and capillary refill should be noted.

[Ebrown]

Correct answers!

[wshriver]

Great! Please up vote