Week 6 - Venous Conditions

Question 1

What does the Padua scale assess?

Answer 1

Need for anticoagulation

Question 2

When is Wells used?

Answer 2

ONLY if DVT is suspected
- Mobilize <2
- Hold PT > or equal to 2

Question 3

Arteries

Answer 3

Thick walls that are muscular and elastic - can handle higher pressure and absorb pressure while moving the blood along down stream
Have pulse

Question 4

Veins

Answer 4

Thinner walls and lower BP
Reside at the end of the system furthest from the pump and the heart
No pulse
Need assistance pumping the blood against gravity and back to the heart

Question 5

What prevents backflow?

Answer 5

One way valves
Counteract gravitational forces

Question 6

Smooth muscle contraction in veins

Answer 6

Directs blood flow where needed

Question 7

How much blood do veins hole at rest?

Answer 7

65%

Question 8

Skeletal muscle pumping in veins

Answer 8

Prevents pooling and edema
Directs blood back towards the heart

Question 9

Venous conditions

Answer 9

Venous insufficiency = varicose veins, phlebitis
VTE (venous thrombosis embolism) —> DVT/PE

Question 10

Varicose veins

Answer 10

One way valves become defective —> blood pools
Visible in surface veins
Most frequently in legs

Question 11

Phlebitis

Answer 11

Varicose veins w inflammation

Question 12

Signs and symptoms of venous insufficiency

Answer 12

Swelling
Varicose veins
Pain and heaviness
Restless leg syndrome
Leg cramps
Itchy skin
Darkened, hard, leathery skin

Question 13

Risk factors for venous insufficiency

Answer 13

Age
Genetics
Obesity
Prolonged standing
Sedentary lifestyle
Smoking
Female hormones
Factors that increase hydrostatic pressure in veins

Question 14

Considerations for PT with venous insufficiency

Answer 14

Obtain history of risk factors
Signs and symptoms
Interventions for venous insufficiency

Question 15

Interventions for venous insufficiency

Answer 15

Exercise
Elevation of affected extremity
Avoiding long periods of standing or sitting
Compression garments
Wound management

Question 16

Venous thromboembolism (VTE

Answer 16

Formation of blood clot (thrombus) in a vein
Deep vein thrombosis
Embolism: pulmonary, CVA or MI
Block blood flow —> tissue damage

Question 17

DVT locations

Answer 17

Calf
Thigh - popliteal area
Pelvis - femoral
Upper extremities

Question 18

Pulmonary embolism

Answer 18

Life-threatening, acute complication of DVT
- DVT clot dislodges, travels through venous system - through the R side of the heart - blockage in the pulmonary circulation

Question 19

Classification of severity of PE

Answer 19

• Based on clinical symptoms and degree of effect on R ventricle
  Massive, submissive and non massive
  High, intermediate (low and high) and low risk

Question 20

Why do DVTs form?

Answer 20

Coagulation cascade is activated when injury to blood vessels occurs

Question 21

When do DVTs occur?

Answer 21

When there is the result in a state of Hypercoagulability for at least 5-6 weeks
- Surgeries
- Other trauma — MVA, falls
- Active cancer

Question 22

What do anticoagulants do?

Answer 22

Help lower the risk of future clots and cal stop the growth of the present thrombus

Question 23

What is used in emergency’s with PE ?

Answer 23

Thrombolytics

Question 24

What is the Padua prediction score?

Answer 24

It assesses VTE risk
Score > or equal to 4 is high risk
Used to justify use of anticoagulants
Used to identify presence of VTE

Question 25

Signs and symptoms of PE

Answer 25

Dyspnea
Chest pain
Presyncope or syncope
Hemoptysis
HR elevated > 95 at rest

Question 26

Increased risk for PE

Answer 26

Elevated Padua score
Signs of DVT - unilateral LE swelling or pain

Question 27

Signs and symptoms of VTE/DVT

Answer 27

Entire leg swollen
Tenderness, redness and heat in area
Unilateral calf swelling
Unilateral pitting edema

Question 28

What happens if Wells Criteria is > or equal to 2?

Answer 28

Wells is gold standard for screening for DVT assessment
Greater than or equal 2 probably DVT
If likely - referred for d-dimer lab test
If d-dimer positive, sent for follow up diagnostic tests

Question 29

When patient has positive DVT: prior to mobilization

Answer 29

Check for anticoagulation medications
Heparin
“Early” ambulation safe as soon as level of effective anticoagulation has been reached
Pts can assess most current aPTT levels and mobilize patients when they achieve a therapeutic level
Monitor/observe signs of increased bleeding or bruising in pts who are taking anticoagulants
When established LE DVT below the knee is NOT anticoagulated and has NO IVD filter, consult w the medical team prior to mobilization

Question 30

Therapeutic range aPTT

Answer 30

1.5 to 2.5 times the control value (in seconds)

Question 31

When is it sage to mobilize with no DVT diagnosed?

Answer 31

Safe to begin/return to normal if no signs of DVT or PE, wells is < 2, already anticoagulated

Question 32

When is it sage to mobilize if DVT found?

Answer 32

After initiation of coagulation - check aPTT time (1.5-2.5(
NO MOB < 3 hours
> 5 hours safe to mobilize
Check with physician if 3 to 5 hours

Question 33

Post thrombotic syndrome - venous insufficiency

Answer 33

Residual problem that persists after a patient is diagnosed with a DVT
Associated with high morbidity and lower quality of life

Question 34

Signs and symptoms of post thrombotic syndrome

Answer 34

Edema and swelling, chronic arm or leg pain
Skin changes, heaviness of affected limb

Question 35

WITH signs and symptoms of post thrombotic syndrome

Answer 35

Recommend mechanical compression or graduated compression stockings
Additional education (VTE): maintain adequate hydration, use of mechanical compression, importance of mobility

Question 36

True or false: it’s better to mobilize early even with fall risk

Answer 36

True - helps minimize DVT progression/severity and maximizes outcomes