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5031 - Adult Med/Surg > Exam 2 - VTE, DVT, PE > Flashcards

Exam 2 - VTE, DVT, PE Flashcards

(58 cards)

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1
Q

a blood clot due to endothelial injury, venous stasis, or hypercoagulability

A

venos thromboembolism

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2
Q

VTEs can be formed by…

A

collections of fat, air, cancer cells, or blood

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3
Q

____ is the most common blood clot

A

deep vein thrombosis

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4
Q

the two main complications that DVT can cause are…

A

disrupt perfusion, lead to PE

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5
Q

what is Virchow’s Triad?

A

(1) reduced blood flow
(2) blood vessel injury
(3) increased coagulability

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6
Q

name at least 3 causes of reduced blood flow

A

(1) A Fib
(2) immobility
(3) venous insufficiency
(4) bedrest
(5) prolonged sitting

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7
Q

name at least 3 causes of blood vessel (endothelial) injury

A

(1) trauma
(2) HTN
(3) surgery

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8
Q

name at least 3 causes of increased coagulability

A

(1) sepsis
(2) coagulation disorders
(3) increased viscosity r/t hypovolemia

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9
Q

s/s of DVT

A

(1) calf or groin tenderness and pain
(2) sudden onset of unilateral swelling of the leg
(3) Pos Homan sign (unreliable)
(4) skin red and warm, tight to touch

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10
Q

pain on the dorsiflexion of the foot is ___

A

Pos Homan sign

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11
Q

what tests are used to diagnose DVT?

A

(1) venous duplex ultrasound
(2) doppler flow study
(3) D-dimer test

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12
Q

positive D-dimer test is

A

> 250 ng/mL

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13
Q

negative D-dimer test is

A

<250 ng/mL

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14
Q

what are the main goals of DVT management?

A

(1) avoid increased size of thrombus
(2) avoid emboli
(3) prevent complications and injury

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15
Q

what are the 4 main medications for DVT?

A

(1) unfractionated heparin
(2) low molecular weight heparin (LMWH)
(3) warfarin
(4) DOACs

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16
Q

____ is the initial treatment for DVT

A

unfractionated heparin infusion

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17
Q

____ is a high-risk med that needs 2 nurse checks

A

heparin

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18
Q

what is the typical dose for unfractionated heparin?

A

(1) 5000 U/bolus
(2) 20-40,000 U/24 hours in 1L NS

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19
Q

LMWH route

A

SQ

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20
Q

why do we start warfarin while still on Heparin?

A

to bridge the heparin and then switch over to Warfarin - warfarin takes a few days to kick in

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21
Q

warfarin takes ____ days to reach therapeutic range

A

3-4

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22
Q

what is the initial dose of warfarin?

A

2-5 mg/daily

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23
Q

what is the maintenance dose of warfarin?

A

2-10 mg/daily

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24
Q

___ and ___ are examples of oral anticoagulants (DOACs)

Study These Flashcards
A

apixaban; rivaroxaban

25
what are the 4 main reasons we pull labs for DVT patients?
(1) adjust dosage (2) check kidney function (3) assess bleeding risk (4) estimate when we can switch to oral medication
26
what labs are drawn for DVT patients on meds?
(1) baseline PT (2) aPTT (3) INR (4) CBC (5) PLT (6) UA (7) Hemoccult (8) Creatinine
27
which labs are monitored daily for DVT pts?
PT aPTT INR
28
____ is a heparin-specific lab test
aPTT
29
___ is a warfarin-specific lab test
INR
30
_____ decreases clotting ability of the blood but does not dissolve the clot
heparin
31
____ blocks vitamin K in the clotting process
warfarin
32
___ inhibits platelet aggregation d/t reduced thrombin
oral anticoagulants
33
what do we do if we go over therapeutic range for heparin and aPTT > 100 sec?
(1) hold the medication (2) give protamine sulfate
34
what is the antidote for heparin?
protamine sulfate
35
what is the antidote for warfarin?
vitamin K
36
what is the antidote for fibrinolytic therapy?
clotting factors, fresh-frozen plasma, antifibrinolytic agents
37
what labs need to be checked daily for warfarin?
PT and INR
38
____ is the best form of treatment for VTE/DVT
prevention
39
name at least 3 forms of prevention for VTE/DVT
(1) passive and active ROM (2) ambulate ASAP (3) compression devices, like SCDs and stockings (4) anticoagulant therapy - prophylaxis (5) avoid pillows under knees (6) reposition q2h
40
name at least 3 signs to look for when monitoring for signs of bleeding
(1) hematuria, occult blood in stool (2) ecchymosis (3) altered mental status (4) abdominal pain (5) change in VS (decreased BP, increased HR and RR)
41
name 4 pieces of education for patients on oral Coumadin / warfarin
(1) use electric razors, not straight razors (2) apply manual pressure to venipuncture sites for at least 10 mins (3) monitor INR levels (4) administer dose at the same time each day
42
collections of X that enter venous circulation and lodge in the pulmonary vessels
pulmonary embolism
43
the 3 key physiologic impacts of a PE are
(1) ventilation to perfusion mismatch (V/Q) (2) reduced gas exchange and oxygenation (3) tissue hypoxia
44
the risk factors for DVT and PE are
Virchow's triad
45
s/s of impaired gas exchange
(1) sudden dyspnea (2) sharp, stabbing chest pain (3) feeling of impending doom (4) restlessness (5) diaphoresis (6) tachypnea (7) lightheadedness (8) cough (9) hemoptysis
46
s/s of impaired perfusion
(1) tachycardia (2) distended neck veins (3) crackles (4) hypoxia (5) cyanosis (6) acute pulmonary HTN) (7) systemic hypotension (8) dysrhythmias
47
what are the two diagnostics for PE?
D-dimer and CTPA
48
___ can be used if CTPA is contrainducated
V/Q scan
49
____ is NOT a confirmatory test
V/Q scan
50
what labs can be used to help diagnose PE?
(1) ABGs (2) CBC (3) Troponin (4) D-Dimer (5) BNP
51
the 5 main medications for PE are
(1) unfractionated heparin (2) LMWH (3) warfarin (4) DOACs (5) antifibrinolytics (alteplase)
52
nursing interventions for Hypoxemia in PE
(1) initiate RRT (2) supplemental O2 (3) semi-fowler's (4) IV access (5) ABGs (6) cardiac and resp assess (7) VS
53
nursing interventions for hypotension in PE
(1) IV fluids - crystalloids (2) monitor urine output (3) monitor s/s HR (4) vasopressors
54
how do we treat bleeding risk?
(1) antidotes like protamine sulfate or vit K (2) clotting factors (3) fresh-frozen plasma
55
describe the ABG changes in PE
(1) starts with respiratory alkalosis (low PaCO2) (2) respiratory acidosis as PaCO2 increases (3) metabolic acidosis from lactic acid buildup
56
the 3 nursing priorities for PE are
(1) hypoxemia d/t mismatch of lung perfusion (2) hypotension d/t right ventricular failure (3) potential for bleeding d/t anticoagulation therapy
57
how long do you continue both heparin and warfarin?
until INR level is between 2 and 3; then, continue heparin for 24 more hours
58
3 examples of vasopressors are
Epi, NE, Dopamine

5031 - Adult Med/Surg (20 decks)

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