Disorders of the Veins Flashcards
1
Q
venous thrombosis
A
formation of thrombus in association with inflammation of vein.
- most common disorder of veins and is classified as either superficial (SVT) or deep (DVT)
2
Q
Virchows triad
A
- the etiology of venous thrombosis
1) venous stasis- immobility, dysfunctional valves, obesity, chronic heart failure, atrial fib, age, varicose veins
2) damage of endothelium- trauma, external pressure, prolonged IV drug therapy, IV cath in place for more than 72-96 hours, diabetes, contaminated IV equipment.
3) hypercoagulability of blood- hematologic disorders, malignancies, sepsis, hormone therapy
3
Q
clinical manifestations of superficial venous thrombosis (SVT)
A
- superficial thrombosis- palpable, firm, subcutaneous cord-like veins; tenderness, redness, warmth, mild systemic temp and leukocytosis
- may be dx with venous duplex ultrasound
- rarely leads to PE
4
Q
Treatment for SVT
A
- lower leg SVT: elevate affected extremity warm, moist heat remove known causes apply TEDs and SCDs aspirin and pain meds low molecular weight heparin for 45 days or a prophylactic dose of Arixtra antibiotics if severe infection or inflammation of vein are present
5
Q
Deep Vein Thrombosis (DVT)
A
- sometimes associated with unilateral leg edema, extremity pain, warm skin, erythema, temp greater than 100.4
- positive homan sign (pain on dorsiflexion of food) classic but unreliable
- may lead to PE, which is potentially fatal
6
Q
nursing management for DVT
A
- Prevent–> recognize patients at risk, early mobilization, dorsiflex and rotate feet in bed, TEDs, SCDs, preventative anticoagulation with low molecular weight heparin (lovenox)
- bed rest with extremity elevated 2-4 days
- anti-coagulation
- warm moist heat applications
- once edema is resolved, patient should wear TEDs for 3-6 months
- vitamins B6, B12 and folic acid are given to reduce homocysteine levels and decrease risk
7
Q
what are the surgical intervetions for DVT
A
- vena cava devices such as Greenfield, Simon nitinol, Vena Tech, Trap Ease are filters that are inserted percutaneously through the right femoral or jugular veins to filter clots before they reach the heart
8
Q
complications of DVT
A
- PE (blockage of pulmonary artery with thrombus)
- most common sx are sudden onset of anxiety, dyspnea, tachypnea, or tachycardia
- classic sx are dyspnea, chest pain, hemoptysis, but only occur in 20% of patients.
- other sx are cough, pleuritic chest pain, hemoptysis, crackles in lungs, fever, sudden change in mental status
- massive emboli can cause sudden collapse of patient with shock, pallor, severe dyspnea, hypoxemia, and crushing chest pain
9
Q
Diagnosing PE
A
- diagnosed with ventilation-perfusion lung scan that uses radioactive iodine
- d-dimer testing- identified degradation product rarely found in healthy patients (less than 250), elevated in any condition where there is degradation of fibrin.
- ABGs are important but not diagnostic.
10
Q
nursing management of PE
A
- high fowlers position
- start o2 therapy
- T, C, DB, incentive spirometer to prevent/treat atelectasis.
- prepare to administer anticoagulant therapy
- Low molecular weighs heparin are most commonly used agents to treat PE (Lovenox)
- warfarin (coumadin) initiated within 24 hrs and is typically administered for 3-6 months
11
Q
Low molecular weight heparin
A
- Lovenox
- routine anti-coagulation tests not required
- monitor CBC regularly to detect bleeding
- antidote- Protamine sulfate
12
Q
Heparin
A
- fractionated
- prevents the conversion of prothrombin to thrombin
- short onset, peak, and duration
- monitor activated partial thromboplastin time (aPTT)- normal is 24-36 seconds- and monitor signs of bleeding
- therapeutic aPTT is 1.5-2 times the control (46-70 seconds)
- antidote= protamine sulfate
13
Q
Warfarin
A
- Inhibits the synthesis of vitamin K in the liver
- onset is 3-5 days
- monitor the international normalized ratio (INR- system of reporting the prothrombin time) and signs of bleeding.
therapuetic INR level is 2-3 - requires dietary teaching and other aspects of teaching due to drug interactiosn with herbal supps, vitamins, minerals.
- antidote- vitamin K (aquamephyton)
- dont give NSAIDS or antiplatelets with warfarin
14
Q
Varicose Veins
A
dilated, tortous veins
- most frequently found in saphenous system
- results in back flow of blood
15
Q
risk factors for varicose veins
A
- congenital weakness, female, obesity, pregnancy, venous obstruction, tumors, occupations w/ long periods on feet
