A nurse is evaluating a patient who presents with unilateral leg swelling, warmth, and pain. Which of the following is the most appropriate initial step to assess the patient's risk for deep vein thrombosis (DVT)?
Apply sequential compression devices to the affected leg.
Apply a validated clinical prediction model like the Wells score.
Instruct the patient to ambulate to see if the pain worsens.
Perform Homans' sign by dorsiflexing the patient's foot.
Current evidence-based guidelines, such as those from the American College of Chest Physicians, recommend using a validated clinical prediction rule, like the Wells score, as the initial step in assessing the probability of a DVT. Performing Homans' sign is not recommended as it is an unreliable and non-specific physical finding. Applying sequential compression devices is a method of DVT prophylaxis and is contraindicated in a limb with a suspected or known DVT. Instructing the patient to ambulate could be dangerous and may risk embolization of a potential thrombus.
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