Test #5 - DVT & Vericose Veins Flashcards Preview

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Flashcards in Test #5 - DVT & Vericose Veins Deck (33):
1

What are some risk factors for Deep Vein Thrombosis?

Surgery
(Esp orthopedic, trauma & fractures, esp hip and lower extremity, infections, dyhydration, abrupt withdrawal of anticoagulants)

Increased Age

Smoking

Birth Control Pills

IV Drug Use

Bedrest, immobilization, prolonged sitting or standing

Blood Dyscrasias

Diabetes

2

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

3

What are some S&S of superficial Thromboplebitis?

Redness

Warmth

Tenderness/Pain along vein

Induration
(Close enough to the surface you can touch it, and it's hard)

Cramping

@ LOW RISK FOR PE

4

What are some S&S of Deep Vein Thrombophlebitis?

Redness

Warmth

Inflammation

Pain

Unilateral Swelling

Low grade fever

dilated veins

MOST COMMON IN LEG

Most are asymptomatic b/c s&s are less distinct

* CAN CAUSE PE *

5

What are signs and symptoms of pulmonary emboli?

Tachypnea

Coughing

Dyspnea

Crackles

Wheezing

Sweating

Anxiety (Sudden can be fatal)

6

What are some Non-invasive Vascular Tests for DVT?

Dopple
Hand held can be put on legs where we check pulses to hear weak PP

Venouse ultrasound Duplex Scanning

MRI/MRA

7

what are some invasive tests for DVT?

Fluoroscopy w/ contrast media
To visualize abnormalities 

Arteriography
Arterial

Venography
Venous

D-Dimer
Blood Test that measures clot breakdown

8

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

TREAT HYPERCOAGULABILITY
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

9

How do you treat the clot?

Heparin

Coumadin

aspirin

Plavix
Contraindicated if bleeding anyway

Thrombolytic Therapy
injected to dissolve clot
(Contraindicated in trauma, surgery, stroke from hemorrhage)

Surgical Intervention
Thrombocytoenia - Surgical removal or insertion of vena cava filter

10

What are the goals of DVT treatment?

Prevent extension of Thrombus
(keep from getting bigger)

Prevent Embolization
(prevent it from moving)

Prevent NEW thrombus formation
(prevent a new one forming)

 

11

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

 

12

What are the critical values for aPTT, PTT, PT, and INR?

aPTT - >70 sec

PTT - >100 sec

PT - >20 sec

INR - >5.5

13

What is some health promotion for a pt with DVT?

Sleep

Rest with legs elevated above head

14

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

15

What are some nursing interventions for pt with DVT?

Complete bedrest

Elevate xtremity

TEDs

Moist heat

NO MASSAGE

measure circumference

Heparin

Assess for bleeding:
Stools black and tarry, bruises, petechiae, gums, mucosal linings, nose bleeds, blood in urine

Watch for PE

Hospitalized for anticoagulation therapy

16

What are some nursing interventions for superficial thombus?

Anti-inflammatory

Elevate Extremity

moist heat

TED hose

Rest

NOT hospitalized

(Swelling localized in one area)

17

What are varicose veins?

Abnormally dilated veins with incompetent valves, occuring most often in the lower extremities

18

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

Obesity

Pregnancy

Age

Female Gender

Tight Garments (KNEE HIGH HOSE)

19

what are some S&S of varicose veins?

Asymptomatic

Dull aching pain or discomfot and heaviness that worsens in warm weather

Muscle cramps

Itching

Swelling

Ankle Edema

Will observe and palpate nodular protrusions

20

What are some nursing interventions for Varicose Veins?

TEDs or support hose

Elevate legs

Ensure that feet touch the floor when sitting

Move Every hour

Wash skin and pat dry DO NOT RUB

Increase fiber

Teach to:
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

21

What are some surgical interventions for vericose veins?

Laser - burns to occlude vein

Vein Ligation and Stripping - Tying off and removing

Vein Ablation 

22

What is some pre-op and post-op nursing care for surgery?

Pre-Op: 
Help mark beins and baseline pulses

Post-Op: 
Assess for complications

Stasis ulcers

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

23

What is some pharmacology for vericose veins?

Sclerotherapy:

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

24

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
Increased pain/temp

25

What is a clot called?

Thrombus

26

What is a moving clot?

Embolous

27

What is a vein called?

Phlebo

28

What is inflammation of the vein called?

Phebitis

29

What is a clot & inflammation called?

Thombophlebitis

30

what is an intraluminal clot with minimal or NO inflammation called?

Phlebothrombosis

31

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

32

What is PE stand for and what is it?

Pulmonary Emoli

Moving clot in the lungs

33

What does VTE stand for and what is it?

Venous Thromboembolism

Moving clot in venous system

Includes DVT and PE