VTE/PE

Question 1

Usual location of SVT

Answer 1

superficial arm veins or leg veins

Question 2

Usual location of VTE

Answer 2

deep veins of arm (axilla, subclavian)

legs (femoral)

pelvis (iliac/inferior vena cava)

pulmonary system

Question 3

Clinical findings of SVT

Answer 3

tenderness, redness, warmth, pain, inflammatin, palpable cord

Question 4

Clinical findings of VTE

Answer 4

tenderness to pressure over involved vein

venous distention

edema

mild pain

deep brown color

Question 5

Complications of SVT

Answer 5

usually benign but can become VTE if spreads to deep veins

Question 6

Complications of VTE

Answer 6

PE, potential death

Question 7

What 3 things cause VTEs?

Answer 7

1. venous stasis
2. endothelial damage
3. blood hypercoaguability

Question 8

What 3 things cause venous stasis?

Answer 8

dysfunctional valves, change in blood flow, or inactive muscle

Question 9

What individuals are at risk for venous stasis?

Answer 9

1. obese/pregnant
2. heart failure
3. atrial fibrillation
4. long trips
5. prolonged immobilization

Question 10

Why are obese/pregnant clients at risk for venous stasis?

Answer 10

1 mile of capillaries for every pound of weight

Question 11

Why are patients in heart failure at risk for venous stasis?

Answer 11

heart pump slower - blood doesn’t move through the system as fast

Question 12

Why are patients with atrial fibrillation at risk for venous stasis?

Answer 12

• blood pools and can become clots in the atria
• upper chambers of the heart (atria) beat irregularly and too fast, causing inefficient blood flow.

Question 13

What are the two types of endothelial damage and examples of both?

Answer 13

Direct: surgery, trauma, burns (damage from outside)

Indirect: chemo, diabetes, sepsis (something from inside)

Question 14

How does endothelial damage increase VTE risk?

Answer 14

Damage/vasoconstriction stimulate platelets and release of clotting factors

Question 15

What is blood hypercoaguability

Answer 15

Imbalance in clotting mechanisms (fibrin production) leading to increasing coagulation

Question 16

Who is at risk for endothelial damage?

Answer 16

• Surgical repair - pelvic, abdomen, ortho
• Trauma
• Burns
• Chemotherapy
• Diabetes
• Sepsis
• Individuals with prior VTE are at risk for another

Question 17

What individuals are at risk for blood hypercoagulability?

Answer 17

• Women on BCP/ERT especially over 35
• Person with sepsis
• Malignancies
• Clotting disorders (genetic)
• Dehydration
• Malnourished
• Severe anemia
• Sepsis

Question 18

Half of VTE patients are:

Answer 18

Asymptomatic

Question 18

3 effects of smoking for VTE risk

Answer 18

1. nicotine causes vasoconstriction
2. increases plasminogen activates intrinsic coagulation pathway
3. increase homocysteine levels causing vascular inflammation

Question 19

Symptoms of VTE:

Answer 19

1. tenderness with palpation
2. low grade fever
3. chills/lethargy
4. unilateral leg pain
5. altered symmetry, size, color, temperature
6. venous insufficiency

Question 20

Symptoms of venous insufficiency

Answer 20

1. swelling/heaviness related to pooling of blood
2. decreased cap refill
3. edema
4. more pronounced varicose veins

Question 21

Describe the pain associated with a VTE

Answer 21

dull, aching, fulllness, ‘pulled muscle’

Question 22

What does ultrasound imaging show you r/t VTE

Answer 22

• color flow techniques to identify areas of insufficiency
• bilateral comparison of blood flow
• dependent on area of clot

Question 23

What is a CT scan imaging show r/t VTE

Answer 23

for soft tissues only (wouldn’t be ordered if concern is just with calves)

For concern with PE

Question 24

What does d-dimer bloodwork show

Answer 24

D-dimer is a product of the breakdown of blood clots. Elevated levels of D-dimer can indicate the presence of abnormal blood clot formation in the body

Question 25

What does CT angiography show?

Answer 25

fluoroscopy under x-ray with contrast to visualize blood vessels to evaluate blockages, aneurysms, and vascular abnormalities

Question 26

Prevention of VTE

Answer 26

1. early mobilization 2. leg exercises 3. anti-embolic stockings 4. fluids for good circulating volume 5. preventative anticoagulation (heparin)

Question 27

What subjective information would you want to assess for a VTE patient?

Answer 27

1. lifestyle (smoking, sedentary, high BMI) 2. prolonged immibility (sedentary, recent hospitalization) 3. medications (birth control, steroids, chemo)

Question 28

Symptoms of bleed

Answer 28

tarry stools, bleeding in gums, bruising

Question 29

What are your priority assessments for a patient with a VTE

Answer 29

1. peripheral vascular and skin (redness and warmth BILATERALLY) 2. peripheral pulses 3. pain 4. cardio and resp for changes 5. bleeding with anticoagulation therapy

Question 30

What are the key things to monitor for a patient on anticoagulant therapy?

Answer 30

1. cardiopulmonary 2. peripheral vascular assessment 3. CBC and coagulation panel

Question 31

What vitamin k antagonist is used for anticoagulant therapy and what are its considerations?

Answer 31

warfarin PO long term use intrinsic pathway frequent lab work and titration

Question 32

Advantages of heparin:

Answer 32

* less likely to cause allergic reaction * better bioavailability * decreased risk of bleeding * prevents conversion of fibrin * antidote is protamine * Patients can go home on it

Question 33

What indirect thrombin inhibitors are used in anticoagulant therapy?

Answer 33

heparin (unfractionated and LMWH) IV and SC

Question 34

Who are direct thrombin inhibitors (Hirudin derivatives - Angiomax, Refludan Synthetic - Argatroban (no antidote) IV) used for?

Answer 34

Those with heparin induced thrombocytopenia (HIT); similar to allergic reaction

Question 35

Considerations of Factor Xa inhibitors

Answer 35

no bloodwork monitoring not for use in patients with renal failure

Question 36

What surgical therapies are available for VTE?

Answer 36

Open venous thrombectomy: Physical removal when ineligible for thrombolytic therapy or really large occlusion Inferior vena cava interruption: filter placed percutaneously via femoral

Question 37

Describe pleuritic chest pain

Answer 37

Stabby pain that changes with movement

Question 37

Symptoms of PE

Answer 37

1. dyspnea 2. tachypnea 3. Pleuritic pain 4. cough 5. wheezing 6. unilateral leg pain/swelling 7. crackles r/t atelectasis 8. tachycardia 9. anxiety

Question 38

What are the priority assessment for a patient with PE?

Answer 38

1. pulmonary 2. cardiac 3. peripheral

Question 39

Prevention of PE

Answer 39

1. mobility and ROM 2. pneumatic compression 3. anticoagulation 4. avoidance of restrictive clothing and importance of mobility

Question 40

Treatment of PE

Answer 40

1. ABCs 2. Oxygen therapy 3. anticoagulation 4. thrombolytics 5. labs (PTT/INR/d-dimer/factor xa)

Question 41

What are important patient teaching for a VTE/PE?

Answer 41

1. having one predisposes you to lifelong risk 2. frequent mobility 3. refrain from restrictive clothing 4. no crossing legs 5. encourage smoking cessation 6. adequate hydration 7. change birth control

Question 42

A high INR means

Answer 42

It takes your blood a longer time to clot - extrinsic/tissue pathway High = Risk for bleed Low = Risk for clots Normal 0.8-1.2 Someone on anticoagulants 2-3

Question 42

How soon can you mobilize someone with a DVT?

Answer 42

As soon as they have had their first dose of SC heparin

Question 43

If someone is at risk for a clot they should have a _______ INR

Answer 43

higher - so it takes them a longer time to clot decreasing risk

Question 44

What does aPTT assess

Answer 44

How long it takes to clot - intrinsic/contact pathway of coagulation