class 1 (DVT/PE) Flashcards
Jan 9th
perfusion
the flow of blood through the arteries and capillaries delivering nutrients and oxygen to cells
what is a deep vein thrombosis (DVT)
-disorder involving a thrombus in a deep vein (in the legs)
-commonly the iliac and femoral veins
risk factors for thromboembolism
-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
why is fracture of large bones a risk factor for DVTs
high risk d/t decreased mobility and endothelial damage,
why is heart disease a risk factor for DVTs
-issues with valves
-issues with blood pooling (stasis=inc risk for clot)
if someone is high risk for DVTs what can you do to decrease risk?
-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)
what is the triad of virchow
-it is needed for a clot to form
1.venus stasis
2.hypercoagulability
3.venous endothelial damage
causes of venous stasis
-dysfunctional vein valves
-inactive extremity muscles
-change in unidirectional blood flow
causes of endothelial damage
-release of clotting factors
-activation of platelets
causes of blood hypercoagulabilioty
-imbalance in clotting mechanism (coagulation)
-increase in fibrin production
clinical manifestations of DVTs
-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)
diagnostic testing for DVTs
-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
treatment to prevent DVTs
-prevention from growing and fragmenting (PE)
-prevent recurrent thromboemboli
-prevent post-thrombotic syndrome
what is post-thrombotic syndrome
when an individual has a DVT for a long time= causes chronic pain, inflammation, and swelling
treatment for DVTS
anticoagulant therapy (continuous heparin infusion and taper off to warfarin)
-thrombolytic therapy
goal of treating a DVT
-increase blood flow & reduce the clot so the body can dissolve it (may take months)
-usually not removed surgically
what is a vena cava filter (IVC filter)
-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)
therapeutic range for IV heparin infusion in anticoag therapy
levels must be 1.5-2x therapeutic range for anticoagulant therapy
what labs should be monitored during anticoag therapy
PTT and INR
what is a pulmonary embolism
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
inflammatory process with a PE
regional blood vessels and bronchioles constrict, which further increases pulmonary vascular resistence, pulmonary arterial pressure, & right ventricular workload
clinical manifestations of PE
-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
PE assessment & diagnostic testing
-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
treatments for PE
-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)
medications for anticoag tx
heparin
warfarin sodium
enoxaparin
medication for thrombolytic tx
urokinase
streptokinase
alteplase
nursing management for PE
-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)
PE prevention strategies
-active leg exercises
-early ambulation
-elastic compression stockings
-anticoagulant therapy (weight based, lovenox might not be strong enough)
-sequential compression devices (SCDs)
