What are some risk factors for Deep Vein Thrombosis?
(Esp orthopedic, trauma & fractures, esp hip and lower extremity, infections, dyhydration, abrupt withdrawal of anticoagulants)
Birth Control Pills
IV Drug Use
Bedrest, immobilization, prolonged sitting or standing
What is the pathophysiology for DVT? (Conditions that allow thrombi to form VIRCHOWS TRIAD)
1. Venous Stasis: Veins not moving blood prolonged bedrest, crossing legs, being paralyzed
2. Hypercoagulability: Diet, Smoking, birth control pills, dehydration, certain meds, any type of hormone
3. Vessel injury: Surgery, Trauma, extended pressure (bedsores), hypertension, diabetes, obesity
2 of 3 MUST be present for thrombus to form
What are some S&S of superficial Thromboplebitis?
Tenderness/Pain along vein
(Close enough to the surface you can touch it, and it's hard)
@ LOW RISK FOR PE
What are some S&S of Deep Vein Thrombophlebitis?
Low grade fever
MOST COMMON IN LEG
Most are asymptomatic b/c s&s are less distinct
* CAN CAUSE PE *
What are signs and symptoms of pulmonary emboli?
Anxiety (Sudden can be fatal)
What are some Non-invasive Vascular Tests for DVT?
Hand held can be put on legs where we check pulses to hear weak PP
Venouse ultrasound Duplex Scanning
what are some invasive tests for DVT?
Fluoroscopy w/ contrast media
To visualize abnormalities
Blood Test that measures clot breakdown
What are some medical interventions for DV that address Virchows Triad?
PROMOTE VENOUS RETURN
Leg exercises, ambulation, SCD's, TEDs, Post Op deep breathing, elevate FOB
Anticoagulants (Heparin, coumadin)
Antiplatelets (ASA, Plavix)
Avoid pillows under knees & sitting too long
AVOID VESSEL INJURY
Avoid Infiltration of IV's, encourage use of PICC's & ports for long term use
How do you treat the clot?
Contraindicated if bleeding anyway
injected to dissolve clot
(Contraindicated in trauma, surgery, stroke from hemorrhage)
Thrombocytoenia - Surgical removal or insertion of vena cava filter
What are the goals of DVT treatment?
Prevent extension of Thrombus
(keep from getting bigger)
(prevent it from moving)
Prevent NEW thrombus formation
(prevent a new one forming)
What is the Partial Thoomboplastin Time, activated, PT and INR and what happens if pt are on anticoagulant therapy??
aPTT - 30-40 sec
PTT - 60-70 sec
PT - 11.0-12.5 sec (85-100%)
INR - 0.8 - 1.1
1.5-2.5 times control value in seconds
What are the critical values for aPTT, PTT, PT, and INR?
aPTT - >70 sec
PTT - >100 sec
PT - >20 sec
INR - >5.5
What is some health promotion for a pt with DVT?
Rest with legs elevated above head
What are some health promotions for a pt on Coumadin? (Bleeding Precautions)
Take a stool softner PRN to preven retal bleeding
Avoid bumps, falls, sharp things (knives, razors)
don't take extra ASA or NSAIDS unless ordered
Don't take extra Vit K foods like KALE
Have lab checked as ordered (It takes a while for PT/INR to be stable)
Eat more fiber
What are some nursing interventions for pt with DVT?
Assess for bleeding:
Stools black and tarry, bruises, petechiae, gums, mucosal linings, nose bleeds, blood in urine
Watch for PE
Hospitalized for anticoagulation therapy
What are some nursing interventions for superficial thombus?
(Swelling localized in one area)
What are varicose veins?
Abnormally dilated veins with incompetent valves, occuring most often in the lower extremities
What are some risk factors for varicose veins?
Family hx of incompetent valves/cogenital absence of valve or acquired valve incompetence
Prolonged standing or sitting
Tight Garments (KNEE HIGH HOSE)
what are some S&S of varicose veins?
Dull aching pain or discomfot and heaviness that worsens in warm weather
Will observe and palpate nodular protrusions
What are some nursing interventions for Varicose Veins?
TEDs or support hose
Ensure that feet touch the floor when sitting
Move Every hour
Wash skin and pat dry DO NOT RUB
Avid tight clothes esp girdles and garters
Avoid knee highs that bind at the knee
Avoid Crossing legs
Avoid dangling legs
Avoid chairs that don't fit
What are some surgical interventions for vericose veins?
Laser - burns to occlude vein
Vein Ligation and Stripping - Tying off and removing
What is some pre-op and post-op nursing care for surgery?
Help mark beins and baseline pulses
Assess for complications
Monitor for bleeding, edema, warmth, color, pulses
Elevate legs above the heart even when sitting
Avoid dangling or long sitting
Encourage ROM of leg
Maintain ACE bandages
Wear TEDs when ACE is removed
What is some pharmacology for vericose veins?
Injection of sclerosing agent into caricosity; agen damages the vessel and causes aseptic thrombosis, which results in vein closure=with no blood there is no distension
What is some health promotion for vericose veins?
Avoid: Long sitting, standing or dangling
Wear support/TED hoses
Encourage daily, regular exercise
Report S&S of nerve damage
What is a clot called?
What is a moving clot?
What is a vein called?
What is inflammation of the vein called?
What is a clot & inflammation called?
what is an intraluminal clot with minimal or NO inflammation called?
What is DVT stand for and where does it occur?
Deep Vein Thrombosis
Can be anywhere but primarily in larger venis moving towards heart and lungs
What is PE stand for and what is it?
Moving clot in the lungs
What does VTE stand for and what is it?
Moving clot in venous system
Includes DVT and PE