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NU318 Exam 5 > venous thromboembolism > Flashcards

venous thromboembolism Flashcards

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1
Q

hemostasis

A

regulated process of preserving vascular integrity by balancing clotting formation and excessive bleeding

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2
Q

regular process of hemostasis

A

activated by injury to blood vessel

hemostatic system seals off injury through platelet plug and fibrin formation

allows injured endothelium to heal

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3
Q

hypercoagulability

A

more risk for clotting
multiple coagulation factors
extra blood clot forming - thrombus can obstruct blood vessels and interfere with blood flow

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4
Q

coagulation cascade

A

terminal steps (each step is dependent on one before)
activation of factor x
conversion of prothrombin to thrombin
conversion of fibrinogen to fibrin

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5
Q

intrinsic side

A

look at this to measure PTT

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6
Q

extrinsic side

A

look at this to measure PT

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7
Q

vasoconstriction

A

reduces blood loss

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8
Q

platelet plug

A

platelets form onto injury along with fibrin plug

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9
Q

clotting cascade

A

clotting factors are activated

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10
Q

virchow’s triad

A

endothelial damage, hypercoagulability, stasis

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11
Q

endothelial dysfunction can be caused by

A

smoking, HTN

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12
Q

endothelial damage can be caused by

A

surgery, catheter (PICC lines), trauma

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13
Q

hypercoagulability can be caused by

A

cancer, chemo, pregnancy, obesity, HIT, oral contraceptives, hormone replacement

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14
Q

stasis can be caused by

A

immobility, polycythemia (excess platelets)

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15
Q

DVT

A

impede venous return, create inflammatory response, risk for pulmonary embolism

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16
Q

acute DVT

A 
redness
unilateral swelling
uncomfortable
difficulty with walking
half of DVTs are asymptomatic
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17
Q

clinical manifestations of DVT depend on

A

location and size of thrombus

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18
Q

clinical manifestations of DVT

A 
edema
warmth
tenderness to pain
functional impairment
may be asymptomatic
signs and symptoms of inflammation (fever, malaise, increase in WBC)
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19
Q

D-dimer level

A

positive is greater than 500

serum blood test that shows breakdown of fibrin in the blood

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20
Q

compression ultrasonography

A

shows that a clot exists, pushing down on veins

shows restriction of blood flow

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21
Q

complications of DVT

A 
clot extension (more platelets joining clot)
pulmonary embolism
postphlebitic syndrome 
venous valve damage
recurrent DVT formation
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22
Q

goal of managing DVT

A

prevent further thrombosis and complications

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23
Q

strategies to manage DVT

A

anticoagulant therapy
patient education
endovascular management
symptom management

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24
Q

DVT nursing management

A 
anticoagulant therapy
monitor complications
provide comfort
graduated compression stockings
positioning and activity
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25
graduated compression stockings
``` decrease swelling prevent venous insufficiency wear them all day remove at night check pulses pain will decrease can apply warm, moist heat ```
26
positioning and activity
have legs up and do not want them to cross legs (avoid severe flexion)
27
initial anticoagulation (first 10 days)
subcutaneous low molecular weight heparin (enoxaparin) Xa inhibitors oral factor Xa inhibitors unfractionated heparin
28
long term anticoagulation (10 days-3 months)
direct factor Xa inhibitors thrombin inhibitors vitamin K antagonists (warfarin)
29
nursing considerations for AC therapy
``` safety lab monitoring close observation for bleeding patient teaching med safety ```
30
lab monitoring for heparin
``` monitor PTT (1.5-2.5 x regular number) has a short half-life ```
31
lab monitoring for warfarin
monitor PT (64 secs) and INR (2-3) above 3 - very high bleeding times below 2 - slow and at risk for clot
32
heparin antidote
protamine sulfate
33
warfarin antidote
if INR is 7 | vitamin K
34
side effects of heparin
heparin-induced thrombocytopenia (HIT) monitor platelets, baseline CBC before administration if platelets are low, notify provider and stop infusion - start anticoagulant
35
action of heparin/enoxaparin
inhibits thrombus and clot production by blocking the conversion of prothrombin to thrombin and fibrinogen t fibrin (inhibit formation of additional clots)
36
adverse effects of heparin
loss of hair, bruising, chills, fever, osteoporosis, suppression of renal function (long term use), thrombocytopenia, hyperkalemia
37
teaching points that are priority for a patient receiving AC therapy
brush teeth gently with soft bristle brush wear or carry med alert notification use an electric razor when shaving obtain follow-up lab work regularly as ordered
38
if a patient is on a heparin infusion and exhibits bleeding, nursing interventions include
stop the heparin infusion (first) obtain coagulation labs monitor BP hourly
39
meds that can affect the action of anticoagulants
``` vitamins cold meds antibiotics aspirin mineral oil anti-inflammatory agents ```
40
report symptoms to health provider
``` faintness dizziness increased weakness severe headaches abdominal pain reddish/brownish urine any bleeding bruises/nosebleeds red or black bowel movements rash ```
41
thrombectomy
getting rid of thrombus by inserting catheter
42
vena cava filter
done for patients at high risk for clotting but not appropriate for AC therapy seen in orthopedic surgeries threaded through femoral vein into vena cava
43
DVT prevention
``` prophylactic meds (heparin) graduated compression stockings pneumatic compression devices positioning - avoid flexion hydration activity and passive limb exercises ambulation avoid sitting/standing for long time ```
44
pulmonary embolism
thrombus that originated in venous system and turns into emboli, breaks off, and gets into the right side of the heart
45
pathophysiology of PE
thrombus obstructing pulmonary artery increase in alveolar dead space increase in pulmonary vascular resistance and pulmonary artery pressure may lead to ischemic necrosis
46
perfusion without ventilation
obstruction within airway normal blood flow blood is going to be not oxygenated
47
ventilation without perfusion
blocking flow of blood | air is going to lungs but blood is not getting to alveoli
48
clinical manifestations of PE
``` dyspnea and tachypnea chest pain (pleuritic pain) anxiety and apprehension (impending sense of doom) fever tachycardia hemopytsis cough ```
49
symptoms will depend on ____ of PE and _____ of obstruction
size; location
50
complications of PE
hemodynamic instability (syncope, weak rapid breath) shock death
51
vitals for PE
tachypnea, tachycardia, low BP
52
ABGs for PE
can start off with respiratory acidosis and progress to alkalosis
53
EKG for PE
inverted T-waves | no presence of ST elevation
54
chest XR for PE
infiltrates present
55
V/Q scan for PE
mismatch between perfusion and ventilation
56
pulmonary angiography for PE
gold standard | direct visualization of obstructed artery
57
diagnostic tests that are related to PE
d-dimer assay V/Q scan spiral CT pulmonary angiography
58
objectives of managing PE
restore pulmonary perfusion prevent further DVT/PE protect lungs from thromboemboli
59
management strategies for PE
``` AC therapy symptom management surgical management Pt education thrombolytic therapy ```
60
AC vs. thrombolytic therapy
AC therapy used for non-massive PE | thrombolytic therapy used for massive PE
61
general management for PE
``` O2 therapy managing pain relieving anxiety monitor complications AC or thrombolytic therapy patients should have IV access (meds and fluids) ```
62
action of urokinase
activating plasminogen to plasmin which breaks down fibrin threads in a clot to dissolve a formed clot
63
indications of urokinase
acute MI, massive pulmonary emboli, ischemic stroke
64
pharmacokinetics of urokinase
drug must be injected and are cleared from the body after liver metabolism pregnancy and lactation
65
prior to administration of urokinase
monitor coagulation status (CBC)
66
after administration of urokinase
monitor bleeding and LOC
67
contraindications of urokinase
allergy and bleeding disorders
68
adverse effects of urokinase
bleeding (do invasive procedures beforehand) cardiac dysrhythmias hypotension hypersensitivity (rash, flushing, bronchospasm, anaphylactic reaction)
69
embolectomy
catheter through vena cava to pull out clot; not common because PE can happen too quickly
70
administration of enoxaparin (LMWH)
IV and subcutaneous (can take it home)
71
administration of heparin
IV and subcutaneous
72
signs of enoxaparin overdose
hemorrhagic complications
73
signs of heparin overdose
bleeding, nosebleeds, hematuria, tarry stools, bruising, petechial formations
74
signs of warfarin overdose
blood in stools/urine, excessive bruising, persistent oozing from superficial injuries, excessive menstrual bleeding, melena, petechiae

NU318 Exam 5 (4 decks)

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