Chapter 16: Thrombophlebitis and Thrombosis

Question 1

Thrombophlebitis and Thrombosis

Answer 1

terms that describe an inflammation of the venous circulation and blood clot formation that typically occur in the lower extremities

Question 2

Superficial Venous Thrombosis

Answer 2

involves the superficial saphenous venous system

Question 3

Deep Vein Thrombosis

Answer 3

extend from the foot to the ileofemoral region

Question 4

Pulmonary Embolism

Answer 4

complication of deep vein thrombosis
-occurs when a part of a blood clot dislodges and travels to the pulmonary artery, where it causes vessel occlusion and obstruction of blood flow to the lungs

Question 5

DVT pathophysiology

Answer 5

develops from a hypercoagulable state, venous stasis, and vein injury (Virchow’s triad)

• a hypercoagulable state and venous stasis routinely exist in a normal pregnancy
• vessel injury can occur from trauma to an extremity, from birth events such as operative vaginal deliveries or cesarean births, and from simple invasive procedures such as an IV catheter insertion or venous blood sample; once vessel injury occurs, platelets begin to clump, then stick to one another; thrombus formation follows

Question 6

Superficial Venous Thrombosis Signs and Symptoms

Answer 6

pain and tenderness in the lower extremity

Question 7

Deep Vein Thrombosis Signs and Symptoms

Answer 7

unilateral leg pain, calf tenderness, and swelling
-classic presentation: pain, tenderness, edema, redness, and localized heat
-presence of a palpable cord, changes in skin color (“milk” or “Blue leg”), decreased peripheral pulse, and a circumference that is 2 cm larger (or more) in the affected extremity
>dorsiflexing the woman’s foot while knee is extended may elicit a positive Homans sign; but there are other causes of calf pain upon dorsiflexion; negative Homans sign does not rule out DVT

Question 8

Recognizing signs and symptoms indicative of DVT

Answer 8

elevated temperature, cough, tachycardia, hemoptysis, pleuritic chest pain, and increasing apprehension

• presence of dyspnea and tachypnea may signal pulmonary embolism; complication of DVT that occurs when part of a blood clot breaks away and travels to the pulmonary artery, where it occludes the vessel and obstructs blood flow to the lungs
• iliofemoral venous thrombosis is manifested by coolness of the entire extremity, with edema and pain

Question 9

Diagnostic Tests

Answer 9

D-dimer (a product of the degradation of fibrin by the circulating enzyme plasmin) assays may be ordered

• noninvasive methods: venous duplex ultrasonography (real-time imaging and doppler flow studies)
• magnetic resonance imaging (MRI); to determine the extent of any pelvic vein involvement

Question 10

Routine Interventions for Superficial Venous Thrombosis

Answer 10

• administration of analgesics (nonsteroidal anti-inflammatory agents)
• rest with elevation of affected extremity
• graduated compression stockings
• intermittent pneumatic compression devices
• increased fluid intake
• local application of moist, warm packs; make sure the weight of the ice pack does not rest on the leg causing obstruction of blood flow

Question 11

Avoiding Extremity Massage when DVT is suspected

Answer 11

refrain from massage; this could loosen the clot and result in a pulmonary or cerebral embolism

Question 12

Interventions for Deep Vein Thrombosis

Answer 12

• usually given bathroom privileges for elimination needs
• if located in a deep vein, hospitalization for IV or subcutaneous heparin therapy
• usually on bedrest until anticoagulation therapy is effective

Question 13

Primary purpose of Heparin Therapy

Answer 13

prevent extension of the current clot and prevent new clot formation

Question 14

Heparin Therapy

Answer 14

• administered via infusion pump
• placed on bedrest until anticoagulation therapy is effective
• Activated Partial Thromboplastin Time (aPTT) monitors unfractionated heparin therapy

Question 15

Nurse Responsibilities

Answer 15

• monitor for signs of unusual bleeding and make certain that the antidote for heparin (protamine sulfate) is readily available
• vitals signs measured q 4 to 6 hours
• analgesics administered as needed
• circulation of the affected extremity checked during every shift
• circumference of affected extremity should be measured and recorded daily
• as therapy continues, assist in increasing level of activity and self-care activities
• assess patient and family for signs and symptoms of depression, anger, or decreased attachment to the newborn

Question 16

Warfarin sodium (Coumadin)

Answer 16

oral anticoagulant, is introduced before patients discharge, and during the time heparin is being tapered
-this is continued for a minimum of 3 months after birth and is safe for lactating mothers

Question 17

Teaching Patients about aspirin and anticoagulants

Answer 17

nurse cautions the patient on anticoagulant therapy to avoid medications that contain aspirin (acetylsalicylic acid) and nonsteroidal agents such as naproxen and ibuprofen
-aspirin, which acts as an antiplatelet agent and prevents blood clotting, can lead to a prolonged clotting time and an increased risk of bleeding