Chapter 11: Venous Thrombosis and Pulmonary Embolism

Question 1

Venous Thromboembolic Diseases

Answer 1

include superficial and deep vein thrombosis (DVT), pulmonary embolus (PE), septic pelvic thrombophlebitis, and thrombosis

Question 2

Pathophysiology of thrombosis

Answer 2

thrombosis is thought to be the consequence of alterations in the vessel wall, slowing of blood flow (or stasis), and changes in blood components

• trauma to the vessel wall may occur during childbirth with alterations in the clot-inhibiting endothelial surface
• blood flow from the legs and the pelvic veins are slowed during pregnancy because of pressure exerted on the iliac veins by the gravid uterus and by the relaxation of smooth muscles in response to increased progesterone
• changes in blood components occur during pregnancy whereby some clotting factors are increased while other anticoagulant and fibrinolytic system factors are decreased

Question 3

Risk Factors for thromboembolic diease

Answer 3

• most important individual risk factor: personal hx of thrombosis
• medical factors: (hemoglobinopathies, obesity, hypertension, smoking, advanced age, increased parity)
• pregnancy complications: (preeclampsia, multiple gestation, dehydration)

Question 4

Diagnosis

Answer 4

doppler ultrasound technique for proximal vein occlusion

• when results are negative and iliac vein thrombosis is suspected, confirmatory imaging with magnetic resonance imaging (MRI) is recommended
• if suspicion of PE, ventilation-perfusion scanning or CT angiography results in minimal radiation exposure to the fetus

Question 5

Management

Answer 5

• medications (anticoagulant therapy with heparin)
• bedrest with elevation of the involved extremity
• application of warm, moist heat

Question 6

S/S Indicative of Thromboembolism

Answer 6

• pain, tenderness, warmth
• swelling of the lower extremity, which is asymmetric with a difference greater than 0.8 in (2 cm) between the normal and affected leg; swelling of the thigh is relevant b/c the risk of PE is associated with femoral or iliac phlebitis
• color change, especially in left leg
• a palpable cord underlying the region of pain and tenderness

Question 7

S/S of Pulmonary Embolism (PE)

Answer 7

• tachypnea
• dyspnea
• pleuritic chest pain
• atelectatic rales
• cough
• fever
• diaphoresis
• tachycardia
• hemoptysis (traces of blood while coughing)
• cyanosis
• heart gallop or murmur
• anxiety
• apprehension