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The Acutely Ill Adult > Pulmonary Embolism/DVT > Flashcards

Pulmonary Embolism/DVT Flashcards

1
Q

What is a pulmonary embolus ?

A

Thrombus (clot) that lodges in a segment of the pulmonary arterial system

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2
Q

What does a pulmonary embolus cause and what occurs in the body as a result?

A

Full/partial obstruction of pulmonary blood flow - causes a decrease in oxygenation

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3
Q

What are some of the risk factors associated with VTE (venous thromboembolism)

A

Age
Immobilisation
Surgery esp ortho surgery
Obesity
Pregnancy and post-partum
Acute CVA
Chronic lung disease
Post surgery/trauma
IV therapy, CV catheters
Hypercoagulability
Smoking

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4
Q

What is DVT (deep vein thrombosis)

A

Acute venous insufficiency caused by clot deep in venous system

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5
Q

What are some of the S and S associated with DVT

A

Oedema, pain , erythema + warmth, peripheral distension

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6
Q

When does a DVT become a pulmonary embolism

A

When the clot breaks off within the vein, enters circulation and ends up in the lungs

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7
Q

Varichow’s Triad include the 3 main categories that can cause blood clot formation. It also helps us identify those who are at risk of forming these clots. Name these categories.

A

Stasis of Venous circulation
Hypercoagulability
Endothelial damage (anything that causes damage to vein vessel)

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8
Q

What are some of the things that can cause stasis of venous circulation?

A

Immobilisation
Varicose veins
Surgery
Travelling for a long time w/o moving
Heart failure, A-fib
Obstruction - late pregnancy, obesity

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9
Q

What are some of the things that increases blood coagulation ?

A

Cancer
Severe illness- sepsis
Dehydration
Usage of oestrogen ( birth control)
Heparin induced thrombocytopenia (HIT)
Post partum

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10
Q

What are some of the things that can cause endothelial damage ?

A

IV therapy - venipuncture
Central line cath, heart valve - in dwelling devices
Meds
Trauma/ injury to vessel eg. Surgery

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11
Q

What are some of the S+S of PE

A

Tachypnoea- RR > 20 bpm
Hypotension
Signs of DVT- red, swollen calf
Pleural rub- squeezing/grating sound caused by ischemic lung tissues coming in contact with pleura
Cyanosis
SOB
Cough
Tachycardia- >100bpm
Pleuritic chest pain
Coughing up blood (haemoptysis)
Dizziness/fainting

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12
Q

What are some of the tests done for PE/DVT

A

Pt hx and phys exam
US (DVT)
Chest x-ray w contrast dye
ECG
ABG
D- dimer test
MRI
ECHO
CT pulmonary angiography
Familial/genetic testing

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13
Q

What does a d-dimer test assess for ?

A

Assess blood for fibrin degradation fragment

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14
Q

What is a fibrin degradation fragment ?

A

Protein fragment that hangs out in blood when clot has presented and started to break down

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15
Q

What does a d-dimer test do and not do ?

A

Can diagnose blood clots
Does not tell location of clot
Sometimes gives false positive result

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16
Q

With pts at high risk of developing a PE/DVT, what is the preventative nursing mgt?

A

Reduce immobility time- up and out of bed whenever they can
Avoid too much bed rest
Early mobilisation after surgery etc
Leg and lower extremity exercises why lying/sitting down
Good fluid intake
TED stocking
Anticoagulants- heparin, clexane
Pneumatic compression devices

17
Q

What is the pneumonic that can be used to help with the nursing management of DVT

A

DEEP CLOT

18
Q

What does the D stand for in DEEP CLOT

A

Don’t massage/rub affected extremity

19
Q

What does the first E stand for in DEEP CLOT

A

Elevate affected extremity above heart lvl - promotes blood flow and reduces swelling

20
Q

What does the second E stand for in DEEP CLOT

A

Ensure bed rest

21
Q

What does the P stand for in DEEP CLOT

A

Pharmacological measures: anticoagulants do not break up existing clot but helps prevent clot from getting bigger + new clots forming

22
Q

What does the C stand for in DEEP CLOT

A

Compress (warm +moist) to affected extremity

23
Q

What does the L stand for in DEEP CLOT

A

Leg circumference measurement (calf)

24
Q

What does the O stand for in DEEP CLOT

A

Observe for S+S of PE:
-SOB (coughing)
- reduced O2 sats
- ^ HR
- chest pain
- anxiety

25
Q

What does the T stand for in DEEP CLOT

A

Tight compression socks (TEDs) :
Promotors blood flow and reduces swelling

26
Q

What is the function of heparin

A

Slows the progression of thrombosis :
-works fast
-given IV or SubQ
- wgt based
-monitor aPTT on blood results

27
Q

When is anticoagulation therapy stopped ?

A

If a PE is ruled out

28
Q

Name some anticoagulant meds

A

Apixaban (clexane)
Rivaroxaban
Warfin

29
Q

What is the function of warfarin?

A

Inhibits clotting factors from using vit K:
-works slow
- given PO
- monitor INR ( 2-3 - therapeutic)

The Acutely Ill Adult (10 decks)

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