DEEP VEIN THROMBOSIS (DVT)

Question 1

❖ It refers to thrombus formation in the deep veins.

Answer 1

DEEP VEIN THROMBOSIS (DVT)

Question 2

____ carries more blood compared to ___

Answer 2

VEIN - ARTERY

Question 3

These veins have valves because the blood should only flow in ___ direction and to prevent ___ of blood.

With the help of muscular contraction, the muscles push the _______.

Answer 3

one - backflow

blood towards the heart

Question 4

DVT usually occurs in the ____

Answer 4

lower leg

Question 5

EXPLAIN

Women are 3x more likely than men to have venous ulcer

Answer 5

▪ The estrogen weakens the veins and is a food for cancer cells (99%).
▪ Estrogen increases the HDL production and help s the kidneys in removing uric acid.
▪ After menopause estrogen decreases.

Question 6

RISK FACTORS – collectively known as

Answer 6

Virchow’s Triad

Question 7

RISK FACTOR

→ Vascular Wall Injury Examples

Answer 7

▪ Surgery
▪ Trauma (burns)
▪ Indwelling Catheters
▪ Infection
▪ Drug Abuse
▪ Injection of irritating substances such as
antibiotics, steroids, and NSAIDs.

Question 8

RISK FACTOR

→ Venous Stasis

Answer 8

▪ Immobilization for more than 3 days.
▪ Obstruction or compression of the iliac or femoral vends from:
➢ Abdominal or Pelvic Tumors
➢ Obesity
➢ Pregnancy
▪ Lengthy surgery (more than 30mins)

Question 9

RISK FACTOR

→ Venous Stasis

▪ Congestive Heart Failure

Answer 9

Right-sided heart failure prevents deoxygenated blood from the vena cava from entering the right atrium. Consequently, it flows downward, leading to an enlargement of the liver (hepatomegaly), and it can result in the accumulation of fluid in the peritoneal cavity (ascites). It can also cause swelling in the legs (dependent edema).

Question 10

RISK FACTOR

→ Venous Stasis

▪ Shock

Answer 10

Sepsis shock is a condition where an infection triggers the release of chemical mediators. One of the effects is increased capillary permeability, causing plasma to shift into the interstitial space, leaving blood cells within the vessels. This can lead to increased blood viscosity and the potential for clot formation.

➢ Blood consists of plasma and blood cells.

Question 10

RISK FACTOR

→ Venous Stasis

▪ Varicose Veins

Answer 10

Valves in the veins are not closing completely causing backflow of blood in the lower extremities making the blood stagnant.

Question 11

❖ COMPLICATIONS OF DVT

Answer 11

→ Pulmonary Embolism
▪ Trouble catching breath
▪ Chest pain
▪ Coughing up blood
▪ Tachycardia
▪ Dizziness or fainting
++ thrombus dislodge from vein and goes with blood going to the lungs
++ lessen oxygenation of the blood

→ CVA or Stroke

Question 12

❖ MEDICAL MANAGEMENT FOR DVT

Anticoagulants

Answer 12

▪ It inhibits blood coagulation and serve to weaken already formed clots, preventing formation of new clotted blood.

▪ Heparin is given parenterally (IV or SUB-Q)
➢ has short life span and is given frequently

▪ Low-Molecular-Weight Heparin is the drug of choice for patients with DVT.

▪ Enoxaparin (Clexane S.C.) has less bleeding, and the duration of action is longer; given via sub-q.

▪ Oral Warfarin (Coumadin) – 3 to 6 months
➢ AquaMEPHYTON (Vitamin K) is the antidote for Warfarin Toxicity.
➢ Therapeutic Range for the INR is 2-3.
➢ With an INR of 5.9, this client is at great risk for hemorrhage and should be given the vitamin K.

Question 13

❖ MEDICAL MANAGEMENT FOR DVT

Thrombolytics

Answer 13

▪ It dissolves new clotted blood (within 3 hours).

▪ Thrombolytics are typically administered for a limited duration, typically up to 24 hours, due to the risk of bleeding. After this initial treatment, thrombolytics are discontinued, and heparin is often prescribed as the ongoing anticoagulant therapy.

▪ It is for patients with hemodynamically unstable PE or massive iliofemoral thrombosis.

▪ Tissue Plasminogen Activator (TPA)
➢ common drug used

▪ Assess for internal bleeding: check the IV site for signs of blood, look for bruises, examine for hematuria (blood in the urine), and check for the presence of blood in the stool (black/dark brown).

Question 14

❖ MEDICAL MANAGEMENT FOR DVT

Antiplatelet

Answer 14

▪ It decreases activation of platelets and prevent new clots from being formed.

▪ Assess a patient who’s receiving anticoagulant therapy for signs and symptoms of bleeding, such as:
➢ bleeding gums
➢ nose bleeds
➢ unusual bruising
➢ bloody urine
➢ black, tarry stools

▪ Advise the patient not to take any medication containing Aspirin of NSAIDs.

Question 15

❖ NURSING MANAGEMENT FOR DVT

Answer 15

→ Elevate the legs 18cm (7inches) above the heart for 2 to 4 hours during the day and night to reduce edema.
→ Bed rest for 5-7 days and is continued until signs and symptoms particularly edema subside.
→ Avoid strenuous activities because the blood is not yet adhered to the wall of the vein and can immediately become an embolus if activities are done. By bed resting the clotted blood will organize itself and will adhere to the wall of vein to prevent embolus.
→ Practice deep breathing exercises to help return blood to the heart. Deep breathing causes a change in thoracic pressure, which facilitates the movement of blood toward the right side of the heart.
→ Use elastic compression stockings because they compress the muscles, causing the veins to contract and aiding in the push of blood toward the heart.
→ Anti-embolic Exercises – performed if patient is bedridden.
▪ Flexion, Extension
▪ Abduction, Adduction
▪ Ankle Pumps – moving the feet up and
down

→ Early ambulation should be considered for DVT or PE patients as soon as a level of effective
anticoagulation has been reached.

→ Beginner Walking Program
▪ Try to choose a route that is close to home, relatively flat, and has plenty of places to rest along the way.

▪ Warm up by walking slowly for 5 minutes.
▪ Week 1 – walk for 5 mins, 4-5x/day
▪ Week 2 – walk for 10 mins, 4x/day
▪ Week 3 - walk for 20 mins, 3x/day
▪ Week 4 - walk for 30 mins 2x/day
▪ Week 5 - walk for 40 mins, OD
▪ Cool down by walking slowly for 5 mins