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Nursing care in deep vein thrombosis and pulmonary embolism: recognising them, the first response and mobilisation

  • Safe practice

A swollen, painful, warm leg can be a clot; sudden breathlessness or chest pain can mean it reached the lung. The nurse recognises it and calls for help.

Updated

What it is

Deep vein thrombosis often gives few signs, and a pulmonary embolism can appear without any warning in the leg. The nurse looks for one-sided swelling, pain, warmth and redness of a limb, and for sudden breathlessness, chest pain that worsens on breathing, coughing blood, a fast pulse, dizziness or low blood pressure. A suspected embolism is an emergency: the nurse stays with the patient, calls for help and supports breathing and monitoring while the team decides. Once anticoagulation has started, the team usually lets the patient walk early: a meta-analysis found no more embolism with early walking than with bed rest. Prevention is on the VTE prevention page.

What it requires

  • Recognising a DVT and a PE, and escalating without delay.
  • Supporting the patient during the first response: position, oxygen as ordered, monitoring and IV access.
  • Safe anticoagulation with its checks and bleeding watch.
  • Mobilisation when the team allows it, and leg care.
  • Teaching about the anticoagulant, stockings and the warning signs.

How it is applied (and why)

  1. Compare both legs for swelling, warmth, redness and tenderness each shift — a one-sided change can be a clot.
  2. Report a suspected DVT at once — the diagnosis needs tests that only the medical team can order.
  3. If breathlessness, chest pain or coughing blood appears suddenly, stay with the patient and call for help — PE is an emergency.
  4. Measure saturation, pulse, breathing and pressure, and give oxygen as ordered — they show how severe it is.
  5. Prepare IV access and help with the ordered tests — the team needs a fast diagnosis.
  6. Give the anticoagulant with its checks and watch for bleeding — the treatment itself carries a risk.
  7. Help the patient walk as soon as the team allows — early walking with anticoagulation is safe and eases pain.
  8. Raise a swollen leg at rest and apply prescribed stockings smoothly — less swelling and discomfort.
  9. Teach the signs of a new clot or PE and of bleeding — they can appear after discharge.

In nursing practice

  • Call at once for sudden breathlessness, chest pain on breathing, coughing blood, fainting, a fast or irregular pulse or falling saturation.
  • Call for a leg that becomes much more swollen, or pale, blue or cold.
  • Call for bleeding of any kind in a patient on anticoagulants.
  • Report fever or chills.
  • Remember that a PE can occur without any earlier leg signs.

Common mistakes

  • Waiting to see if the breathlessness goes away.
  • Leaving the patient alone to go and look for help.
  • Waiting for leg symptoms before thinking of a PE.
  • Keeping a patient in bed for days on anticoagulation without an order to do so.
  • Letting stockings roll down or wrinkle and form a tight band.

Test yourself

Think of the answer, then tap the question to see it.

Which signs suggest a deep vein thrombosis?

Swelling, pain or tenderness, warmth and redness of one leg or arm; many people have no symptoms at all.

What does the nurse do if a patient suddenly becomes breathless with chest pain on breathing?

Stays with the patient, calls for help at once, and monitors saturation and vital signs while the team decides.

Is early walking safe in DVT once anticoagulation has started?

A meta-analysis found no more PE or DVT progression than with bed rest, and less leg pain; the team decides for each patient.

How are prescribed compression stockings used?

Smooth, not too tight and without wrinkles, washed daily; the patient tells the provider if they feel too tight instead of stopping them alone.

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Educational content for students; it does not replace your institution's protocols, supervised clinical training or a prescriber's order. Dose-calculation examples use made-up numbers: they are educational, not a clinical order.

Sources: About Venous Thromboembolism (Blood Clots) (Centers for Disease Control and Prevention (CDC), 2025); Pulmonary embolus: MedlinePlus Medical Encyclopedia (MedlinePlus, US National Library of Medicine, 2026); Deep vein thrombosis - discharge: MedlinePlus Medical Encyclopedia (MedlinePlus, US National Library of Medicine, 2026); Liu Z et al. Bed rest versus early ambulation with standard anticoagulation in the management of deep vein thrombosis: a meta-analysis. PLoS One 10(4):e0121388 (PLoS One (PubMed Central, open access), 2015).

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