Exam 2 - VTE

Question 1

2 primary venous disorders

Answer 1

occlusive

ineffective venous blood flow

Question 2

s/sx of SVT

Answer 2

firm
palpable
chord like vein
itchy
tender, painful
reddened, warm vein area
mild temperature
mild edema

Question 3

SVT treatment for large clots, lower leg

Answer 3

lovenox

arixtra

Question 4

SVT treatment for small clots

Answer 4

NSAIDS
elastic compression hose
mild walking

Question 5

s/sx of DVT

Answer 5

silent (no s/sx)
edema
redness
heat/warmth
tenderness
paresthesia
feeling of fullness
fever

Question 6

what occurs with varicose veins?

Answer 6

veins stretch, then valves won’t close completely

Question 7

varicose vein risk factors

Answer 7

family hx
BC or HRT
previous thrombophlebitis
pressure causing blockage
female
weak veins

Question 8

DVT and varicose veins can lead to __ __ __

Answer 8

chronic venous insufficiency (CVI)

Question 9

what is CVI?

Answer 9

leg valves are not competent and blood pools in the lower legs causing increased venous pressure

Question 10

s/sx of CVI

Answer 10

edema
thick fibrous skin (brown)
stasis dermatitis
pain
ulcers

Question 11

venous ulcers are located on the ___ whereas arterial ulcers are located on the ___.

Answer 11

V: legs

A: feet

Question 12

s/sx of venous ulcers

Answer 12

irregular shape
real wet

*warm, moist dressing needed

Question 13

What is included in Virchow’s Triad?

Answer 13

stasis
vessel wall injury
hyercoagulability

Question 14

DVT complications

Answer 14

CVI (post thrombotic syndrome)

PE

Question 15

DVT dx testing

Answer 15

D-dimer
duplex US (visualize vein; measure blood flow)
CT
MRI
contrast venography (most accurate)

Question 16

D-dimer should be less than what?

Answer 16

250

Question 17

PT

*lab value

Answer 17

11-16

Question 18

PT therapeutic

*lab value

Answer 18

46-70

Question 19

INR therapeutic

*lab value

Answer 19

2-3

Question 20

ACT therapeutic

*lab value

Answer 20

> 300

Question 21

bleeding time

Answer 21

2-7 minutes

Question 22

Platelet count

*lab value

Answer 22

150,000-400,000

Question 23

heparin lab

Answer 23

PTT

Question 24

warfarin lab

Answer 24

PT / INR

Question 25

most common DVT meds

Answer 25

``` UH LMWH fondaparinux rivaroxaban warfarin x3 months ```

Question 26

preferred terminology over DVT

Answer 26

VTE venous thromboembolism

Question 27

VTE/DVT prophylaxis

Answer 27

``` initial protocol reposition q2h flex, extend feel q2h up to chair, ambulate at least 6 times daily elastic compression hose SCD ```

Question 28

how long does it take for warfarin to become therapeutic?

Answer 28

3 days

Question 29

heparin antidote

Answer 29

vitamin k

Question 30

herapin allergic rxn

Answer 30

heparin induced thrombocytopenia occurs 4-10 days after heparin exposures

Question 31

heparin antidote

Answer 31

protamine sulfate

Question 32

heparin is aka

Answer 32

unfractionated heparin (UH)

Question 33

s/sx of heparin induced thrombocytopenia

Answer 33

``` skin lesions at site chills fever dyspnea chest pain after injection decreased Plt count thrombosis ```

Question 34

heparin induced thrombocytopenia treatment

Answer 34

DC heparin, start another anticoag

Question 35

LMWH drugs

Answer 35

enoxaprin (lovenox) | dalteparin (fragmin)

Question 36

LWMH antidote

Answer 36

protamine sulfate

Question 37

labs required for LMWH

Answer 37

none

Question 38

direct thrombin inhibitor drugs

Answer 38

argatroban (acova) - IV | dabigatran (pradaxa) - PO

Question 39

direct thrombin inhibitor drugs lab requirement

Answer 39

PTT

Question 40

direct thrombin inhibitor drugs antidote

Answer 40

none

Question 41

factor Xa inhibitors

Answer 41

fondaparinux (Arixtra) - SQ rivaroxaban (Xarelto) - PO apixaban (eliquis) - PO

Question 42

labs to monitor with factor Xa inhibitors

Answer 42

CBC | Crt

Question 43

caution using factor Xa inhibitors in __ and those with impaired __ function

Answer 43

elderly; renal

Question 44

factor Xa inhibitors may cause

Answer 44

thrombocytopenia

Question 45

factor Xa inhibitors antidote

Answer 45

none

Question 46

nursing management if VTE /DVT is present

Answer 46

calf circumference tissue perfusion pain knowledge

Question 47

primary cause of varicose veins

Answer 47

congenital vein weakness

Question 48

secondary cause of varicose veins

Answer 48

result from previous VTE

Question 49

small varicose veins are considered

Answer 49

cosmetic

Question 50

telangiectasis is aka

Answer 50

spider veins

Question 51

etiology of varicose veins

Answer 51

weakened walls > incompetent valves > backward blood flow

Question 52

varicose veins prevention

Answer 52

``` support hose frequent postion changes elastic compression hose exercise weight management ```

Question 53

varicose vein treatment

Answer 53

surgical, meds only indicated with risk factors for CVI endovenous ablation

Question 54

nonsurgical/cosmetic treatment for varicose veins

Answer 54

sclerotherapy - inject caustic substance light therapy laser therapy

Question 55

pt education after varicose vein treatment

Answer 55

risk factors reduction elevate legs frequently the first few days elastic compression hose

Question 56

s/sx of CVI

Answer 56

``` brownish discoloration dermatitis, eczema skin is thick, fibrous venous ulcers heavy drainage ```

Question 57

what occurs with CVI

Answer 57

serous fluid, RBC leak into tissue

Question 58

CVI treatment

Answer 58

``` prevention compression (in absence of PAD) moist dressings good nutrition for wound healing debridement with abx skin grafting amputation (sometimes necessary) ```

Question 59

CVI pt teaching and monitoring

Answer 59

``` compression hose use avoid trauma to limb daily moisturizing proper position of limb activity guidelines dressing changes monitor for s/sx of infection, complications when to call for help ```