PVD Flashcards
PVD
inadequate blood flow from extremities to heart d/t problem in vein
superficial and deep veins in lower extremities have valves to prevent backflow of blood as it returns to heart. PVD = disfunction of valves, not closing properly to prevent back flow leading to pooling of blood and dilation of veins
PVD: Risk Factors
- prolonged sitting or standing
- obesity
- pregnancy
- thrombophlebitis
PVD: Sx
- fullness/heaviness in legs
- stasis dermatitis extending up to calf
- edema
- wet stasis ulcer around ankles
PVD: Interventions (Pre-Surgery)
- elevate legs during day and night (6 inches)
- no crossing legs or constrictive stocking
- apply compression stocking when legs not swollen
- antibiotics for skin infection (cellulitis)
*compression stocking are not constrictive clothing b/c they apply even pressure throughout the entire extremity and encourage blood flow back to heart
DVT vs VTE
DVT: local coagulation (clot formed locally in one vein)
VTE: clot formed but has moved to different site
DVT/VTE: Cause
- venous stasis
- injury
- thrombus formation
- hypercoagability state
DVT/VTE: Risk Factors
- surgeries
- heart failure
- immobility
- pregnancy
- OCP (oral contraceptives)
DVT/VTE: Sx
- sudden onset of pain
- erythema
- swelling
- firmness
- compare circumference to other extremity
- assess for sx of PE (complication)
DVT/VTE: Interventions (Pre-Surgery)
-bed rest
-elevate extremity
-no massage
-medication to prevent further clots from forming, stop clots from getting bigger, try to clear existing clot:
Heparin IV: monitor aPTT and platelets (SE = bleeding, antidote = protamine sulfate)
Lovenox subQ bid: (SE = bleeding, antidote = protamine sulfate)
Coumadin (warfarin): monitor PT/INR (2-3 is therapeutic range) (antidote = vitamin K)
TPA: tissue plasminogen activator - thrombolytic & platelet inhibitor administered directly to the clot.
DVT/VTE: Interventions (Surgery)
Revascularization: bypass graft that reroutes circulation around occlusion
Graft is autologous (from another part of the body) or synthetic
Only done one limb at a time, never both
circulation returning after surgery can be very painful (may see warmth, redness, edema as it returns)
Nursing: assess 5 P’s and compare to other extremity
- Pain (severe and localized)
- Pallor (pale limb)
- Paresthesia (numbness)
- Pulselessness (mark distal pulse sites with pen so it’s easier to find again with doppler)
- Paralysis (can’t move toes or feet)
monitor CR and CMS
prevent hypotension: causes clot or graft collapse
prevent hypertension: causes bleeding at the site
educate on no crossing leg or above heart, wear loose clothing, no smoking or cold exposure
DVT/VTE Revascularization Surgery Complications
Graft occlusion
graft collapse
compartment syndrome
