class 1 (DVT/PE)

Question 1

perfusion

Answer 1

the flow of blood through the arteries and capillaries delivering nutrients and oxygen to cells

Question 2

what is a deep vein thrombosis (DVT)

Answer 2

-disorder involving a thrombus in a deep vein (in the legs)
-commonly the iliac and femoral veins

Question 3

risk factors for thromboembolism

Answer 3

-fracture of large bones
-prolonged immobility
-heart disease, trauma, post-op or postpartum condition, diabetes mellitus, COPD, dehydration, chemo, CVAD
-pregnancy, obesity, oral B/C, constrictive clothing
-previous Hx

Question 4

why is fracture of large bones a risk factor for DVTs

Answer 4

high risk d/t decreased mobility and endothelial damage,

Question 5

why is heart disease a risk factor for DVTs

Answer 5

-issues with valves
-issues with blood pooling (stasis=inc risk for clot)

Question 6

if someone is high risk for DVTs what can you do to decrease risk?

Answer 6

-educate on mobility within 24h post-op/while hospitalized
-TED stockings
-rotation of ankles/flexion of feet while on bedrest hourly
-intermittent compression devices (ICD) (remove for only 30min at a time for mobilization/assessment)

Question 7

what is the triad of virchow

Answer 7

-it is needed for a clot to form
1.venus stasis
2.hypercoagulability
3.venous endothelial damage

Question 8

causes of venous stasis

Answer 8

-dysfunctional vein valves
-inactive extremity muscles
-change in unidirectional blood flow

Question 9

causes of endothelial damage

Answer 9

-release of clotting factors
-activation of platelets

Question 10

causes of blood hypercoagulabilioty

Answer 10

-imbalance in clotting mechanism (coagulation)
-increase in fibrin production

Question 11

clinical manifestations of DVTs

Answer 11

-firm edema and swelling of the extremity (unilateral)
-extremity may feel warmer than the unaffected extremity (may have redness)
-superficial veins may be more prominent
-tenderness (do not massage)
-low grade fever
-homan’s sign (calf pain with dorsiflexion of the foot, not a great test and may dislodge the clot)

Question 12

diagnostic testing for DVTs

Answer 12

-venous doppler ultrasound (used to assess for blockage)
-venogram (x-ray to vie blood flow/block)
-D-dimer (blood test) protein fragment elevated if body cannot dissolve the clot

Question 13

treatment to prevent DVTs

Answer 13

-prevention from growing and fragmenting (PE)
-prevent recurrent thromboemboli
-prevent post-thrombotic syndrome

Question 14

what is post-thrombotic syndrome

Answer 14

when an individual has a DVT for a long time= causes chronic pain, inflammation, and swelling

Question 15

treatment for DVTS

Answer 15

anticoagulant therapy (continuous heparin infusion and taper off to warfarin)
-thrombolytic therapy

Question 16

goal of treating a DVT

Answer 16

-increase blood flow & reduce the clot so the body can dissolve it (may take months)
-usually not removed surgically

Question 17

what is a vena cava filter (IVC filter)

Answer 17

-can be placed at the time of a thrombolectomy
-traps large emboli and doesn’t allow it to travel
-placed at the level of the diaphragm in the inferior vena cava via the femoral vein
-prevents pulmonary embolism
-used w/anticoagulant therapy or for people w/ dec platelets (can’t use anticoags)

Question 18

therapeutic range for IV heparin infusion in anticoag therapy

Answer 18

levels must be 1.5-2x therapeutic range for anticoagulant therapy

Question 19

what labs should be monitored during anticoag therapy

Answer 19

PTT and INR

Question 20

what is a pulmonary embolism

Answer 20

an occlusion of a portion of the pulmonary blood vessels by an embolus, usually develop from a thrombi
-the obstructed area has to have diminished or absent blood flow

Question 21

inflammatory process with a PE

Answer 21

regional blood vessels and bronchioles constrict, which further increases pulmonary vascular resistence, pulmonary arterial pressure, & right ventricular workload

Question 22

clinical manifestations of PE

Answer 22

-depends on size and location of clot
-sudden onset; dyspnea, syncope, pleurisy, tacypnea, tachycardia, hypoxemia, and hypotension
-chest pain (sudden and pleuritic)
-anxiety, fever, apprehesion, cough, diaphoresis, and hemoptysis
-DVT is associated with development of PE
-may have fever, cough up blood, impending doom
-death can occur within 1hr of s&s onset

Question 23

PE assessment & diagnostic testing

Answer 23

-early recognition & diagnosis is a priority
-chest x-ray, ECG, peripheral vascular studies, arterial blood gas, ventilation-perfusion scan
-spiral CT of lung
-D-dimer assay

Question 24

treatments for PE

Answer 24

-elevate HOB & check o2
-heparin protocol (anticoag therapy)
-may give thrombolytic
-thromboectomy depending on size
-may give morphine
-surgical intervention (pulmonary embolectomy, vena cava filter)

Question 25

medications for anticoag tx

Answer 25

heparin
warfarin sodium
enoxaparin

Question 26

medication for thrombolytic tx

Answer 26

urokinase
streptokinase
alteplase

Question 27

nursing management for PE

Answer 27

-assess vitals & lung sounds
-monitor for hypoxemia, & resp distress
-assess for edema & liver enlorgment
-elevate HOV
-alleviate fear & anxiety
-monitor PT, PTT, INR
-treat pain (morphine)

Question 28

PE prevention strategies

Answer 28

-active leg exercises
-early ambulation
-elastic compression stockings
-anticoagulant therapy (weight based, lovenox might not be strong enough)
-sequential compression devices (SCDs)