Deep Vein Thrombosis & Pulmonary Embolism

Question 1

Complications of Bed Rest

Answer 1

a. pressure sores (decubitus ulcers)
b. pneumonia
c. DVT
d. constipation/UTI
e. atrophy
f. stiffness/contractures
g. deconditioning
h. fatigue
i. edema

Question 2

What is thrombosis? Where is it often found?

Answer 2

• • blood clot, blood flow slowing
• • most frequently occurs in the calf
• • attaches to vessel wall –> can detach and travel downstream

Question 3

What is a risk factor of DVT?

Answer 3

venous stasis (pooling of blood)

Question 4

Causes of venous stasis

Answer 4

a. long flights
b. immobility due to anesthesia
c. birth control
d. paralysis
e. pressure to the calf
f. septicemia
g. cancer
h. clotting disorders
i. A-fib
j. damage to vessels
k. CHF
l. genetics/age
m. dehydration

Question 5

Where can DVT occur in the body?

Answer 5

a. peroneal vein in calf
b. femoral vein of the thigh
c. axillary or subclavian vein of arm

Question 6

Prevention of DVT

Answer 6

a. compression hose
b. SCD’s (sequential compression device)
c. preventative anticoagulation (Coumadin)
d. mobilizing

Question 7

What are the ways to diagnose DVT?

Answer 7

1. ultrasound
2. Wells DVT criteria
3. Homan’s sign (dorsiflex foot w/ knee straight, pain or discomfort in calf = positive test)
4. D-Dimer (if d-dimer is present in blood it means a clot is degraded – rules out thrombosis)

Question 8

Well’s DVT Criteria

Answer 8

1. active cancer (+1)
2. bed rest > 3 days or recent major surgery (+1)
3. calf’s swelling > 3cm compared to other leg (+1)
4. entire leg swollen (+1)
5. calf tenderness along deep veins (+1)
6. pitting edema in the symptomatic leg )+1)
7. paralysis, paresis, or immobilization of the lower extremity (+1)
8. previous DVT (+1)
9. alternative diagnosis to DVT likely (-2)

Question 9

point and risk system according to Well’s DVT Criteria

Answer 9

a) >3 points = 75% risk
b) 1-2 points = 17% risk
c)

Question 10

Symptoms of DVT

Answer 10

• pain in calf
• calf swelling
• positive Homan’s sign
• part of clot may detach (pulmonary embolus)

Question 11

What is a pulmonary embolus? How does it occur?

Answer 11

• blockage to pulmonary artery
• clot breaks off, travels thru the R side of the heart into the pulmonary artery & then lodges in one of the smaller pulmonary capillaries

Question 12

Pulmonary embolus is most common with what?

Answer 12

DVT above the knee

Question 13

Signs and symptoms of Pulmonary embolism?

Answer 13

• shortness of breath
• cough
• sudden sharp chest pain
• rapid pulse
• hypotension
• sweating
• tachypnea
• O2 sats drop

Question 14

Pulmonary embolism diagnosis

Answer 14

VQ mismatch (vetnilation-perfusion mismatch)
-- blockage = no circulation to alveoli = blood can't get perfused into blood

Question 15

Prevention of pulmonary embolism

Answer 15

Greenfield filter

• • introduced thru jugular vein & is lodged in inferior vena cava
• • catches emboli

Question 16

Pharmacological treatment for pulmonary embolism

Answer 16

Anticoagulation (increased clotting time):

• • enoxaparin (lovanox) aka low molecular weight heparin
• • standard unfractionated heparin
• • Coumadin aka warfarin

Question 17

Ambulation of someone with a pulmonary embolism

Answer 17

• • walk as soon and as much as possible with good compression therapy
• • encourage walking after anti-coagulation
• • leads to better outcomes: decreased pain, decreased swelling, and decreased occurrence/severity of post-thrombotic syndrome

Question 18

What increases the size of DVT?

Answer 18

Bed rest