HOMANS’ SIGN

VASCULAR
DISEASE
Prepared by: Rachelle Ann R. Recio
II-Nur7, RLE 1
HOMANS’ SIGN
physical examination technique taught in many
healthcare profession curriculums, typically as a
component of lower extremity vascular assessment.
John Homans
Use to assess Deep vein thrombosis
DVT
 is a blood clot occurring in a deep vein.
 occurs when a blood clot (thrombus) forms in one or more of the
deep veins in your body, usually in your legs. Deep vein
thrombosis can cause leg pain or swelling, but may occur without
any symptoms.
 Deep vein thrombosis can also happen if you don't move for a long
time, such as after surgery, following an accident, or when you are
confined to a hospital or nursing home bed.
 Serious condition because blood clots in your veins can break
loose, travel through your bloodstream and lodge in your lungs,
blocking blood flow (pulmonary embolism)
ANATOMY
 Pelvis
 Thigh
 Calf
 DEEP VEINS (popliteal vein)
ASSESS FOR SIGNS OF DVT BY THE
HOMAN’S SIGN

 A positive Homan’s sign is indicative of DVT, although it’s

not the most reliable indicator
 All of the characteristic changes to maternal clotting
factors are higher than any other point as the body prepares
for labor
 Combine this with being in bed, especially if mom
underwent a C-section, and it’s easy to see why the
postpartum woman is at such a huge risk for DVT!
 PERFORMING THE HOMAN’S
TEST
 Most commonly performed with the mom in a supine
position while laying in bed
 The calf is flexed at a 90° angle
 The nurse manipulates the foot in a dorsiflexion movement
 If pain is felt in the calf, the Homan’s Sign is said to be
positive
SIGNS OF DVT
• A sudden and unexplainable pain, usually in the
back of the leg or calf
• Tachycardia and shortness of breath or dyspnea
(from decreased oxygenation status)
• Edema, redness, and warmth localized over the area
of the DVT (from the vascular build-up around the
clot)
PREVENTING A DVT
 Dangle at the side of the bed within 6 hours
 Stand up within 8 hours
 Encourage ambulation at first and independent walking
when ready
POTENTIAL COMPLICATIONS OF A DVT

 Pulmonary embolism (PE) occurs when a clot breaks way

from the leg area and travels to the lungs
 A PE is medical emergency!
NURSING CARE PLAN FOR
DVT
 Desired Outcome:
 The client will not develop a deep vein thrombus as evidenced
by:
 absence of pain, tenderness, swelling, and distended superficial vessels in
extremities
 usual temperature of extremities
 negative Homans' sign.
NURSING ACTIONS AND
RATIONALES
 Assess for and report signs and symptoms of a deep vein
thrombus: pain or tenderness in extremity
 increase in circumference of extremity
 distention of superficial vessels in extremity
 unusual warmth of extremity
 positive Homans' sign (not always a reliable indicator).
Implement measures to prevent thrombus formation:

1.encourage and assist client to perform active foot and leg exercises every
1 - 2 hours while awake
2.instruct client to avoid positions that compromise blood flow (e.g. pillows
under knees, crossing legs, sitting for long periods)
3.elevate foot of bed for 20-minute intervals several times a shift unless
contraindicated
4.consult physician about an order for antiembolism stockings or an
intermittent pneumatic compression device
5.maintain a minimum fluid intake of 2500 ml/day unless contraindicated to
prevent increased blood viscosity
6.administer anticoagulants (e.g. low- or adjusted-dose heparin, warfarin,
low-molecular-weight heparin) if ordered
7.progress activity as allowed.
If signs and symptoms of a deep vein thrombus
occur:
1.maintain client on bed rest until activity orders are received
2.elevate foot of bed 15 - 20º above heart level if ordered
3.discourage positions that compromise blood flow (e.g.
pillows under knees, crossing legs, sitting for long periods)
4.prepare client for diagnostic studies (e.g. venography, duplex
ultrasound, impedance plethysmography) if indicated
5.administer anticoagulants (e.g. continuous intravenous
heparin, low-molecular-weight heparin, warfarin) as ordered
6.prepare client for injection of a thrombolytic agent (e.g.
streptokinase) if planned.
VASCULAR
DISEASES
VASCULAR DISEASE
 any condition that affects your circulatory system.
 form of cardiovascular disease primarily affecting the
blood vessels.
 This ranges from diseases of your arteries, veins and
lymph vessels to blood disorders that affect circulation
CONDITIONS
UNDER
VASCULAR
DISEASE
 PERIPHERAL ARTERY
DISEASE:
 Atherosclerosis
 the build-up of fat and cholesterol deposits,
called plaque, on the inside walls.
 hardening and narrowing of the arteries
 no symptoms until middle or older age. causes pain on
walking and poor wound healing. Severe disease may
lead to amputations.
Ischemia
 when blood flow to your heart
muscle is decreased by a partial or
complete blockage of your heart's
arteries (coronary arteries). The
decrease in blood flow reduces your
heart's oxygen supply.
 A sudden, severe blockage of a
coronary artery may lead to a heart
attack
 may also cause serious abnormal
heart rhythms.
 ANEURYSM
 abnormal bulge in the wall of a blood vessel.
 can form in any blood vessel, but they occur most commonly in the
aorta (aortic aneurysm) which is the main blood vessel leaving the
heart:
 Thoracic aortic aneurysm (part of aorta in the chest)
 Abdominal aortic aneurysm - include one or more of the following:
 Suprarenal aneurysm (involving the arteries above the kidneys)
 Juxtarenal aneurysm (involving the main renal arteries)
 Infrarenal aneurysm (involving the arteries below the kidneys)
RENAL ARTERY DISEASE
 commonly caused by
atherosclerosis of the renal arteries
 occurs in people with generalized vascular
disease.
 can be caused by a congenital (present at
birth) abnormal development of the tissue
that makes up the renal arteries.
 BUERGER'S DISEASE
 most commonly affects the small and medium sized arteries, veins, and
nerves.
 Cause is unknown but , there is a strong association with tobacco use or
exposure.
 arteries of the arms and legs become narrowed or blocked, causing lack
of blood supply (ischemia) to the fingers, hands, toes and feet.
 Pain occurs in the arms, hands, and more frequently the legs and feet,
even at rest.
 With severe blockages, the tissue may die (gangrene), requiring
amputation of the fingers and toes.
 PERIPHERAL VENOUS
DISEASE
 *Veins are flexible, hollow tubes with flaps inside, called
valves. When your muscles contract, the valves open, and
blood moves through the veins. When your muscles relax,
the valves close, keeping blood flowing in one direction
through the veins.
 If the valves inside your veins become damaged, the valves may not
close completely. This allows blood to flow in both directions. When
your muscles relax, the valves inside the damaged vein(s) will not be
able to hold the blood. This can cause pooling of blood or swelling
in the veins. The veins bulge and appear as ropes under the skin. The
blood begins to move more slowly through the veins, it may stick to
the sides of the vessel walls and blood clots can form.
 VARICOSE VEINS
 bulging, swollen, purple, ropy veins, seen just under
your skin, caused by damaged valves within the
veins. They are more common in women than men
and they often run in families. They can also be
caused by pregnancy, being severely overweight, or
standing for long periods of time. The symptoms
include:
 Bulging, swollen, purple, ropy, veins seen under the skin
 Spider veins - small red or purple bursts on your knees,
calves, or thighs, caused by swollen capillaries (small
blood vessels)
 Aching, stinging, or swelling of the legs at the end of the day
 VENOUS BLOOD CLOTS
 Blood clots in the veins are usually caused by:
 Long bedrest and/or immobility
 Damage to veins from injury or infection
 Damage to the valves in the vein, causing pooling near the valve
flaps
 Pregnancy and hormones (such as estrogen or birth control pills)
 Genetic disorders
 Conditions causing slowed blood flow or thicker blood, such as
inflammatory bowel disease, congestive heart failure (CHF), or
certain tumors
DEEP VEIN THROMBOSIS
 is a blood clot occurring in a deep vein.
 occurs when a blood clot (thrombus) forms in one or more of the deep veins in
your body, usually in your legs. Deep vein thrombosis can cause leg pain or
swelling, but may occur without any symptoms.
 Deep vein thrombosis can also happen if you don't move for a long time, such
as after surgery, following an accident, or when you are confined to a hospital
or nursing home bed.
 Serious condition because blood clots in your veins can break loose, travel
through your bloodstream and lodge in your lungs, blocking blood flow
(pulmonary embolism)
PULMONARY EMBOLISM

is a blood clot that breaks loose from a

vein and travels to the lungs.