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N160 exam 3 > DVT and PE > Flashcards

DVT and PE Flashcards

1
Q

clot formed in a vessel

A

thrombus

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2
Q

a thrombus that moves through the blood stream

A

Embolus

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3
Q
  • inflammation associated with a clot
A

Thrombophlebitis

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4
Q

thrombus in a deep vein with inflammation

A

DVT

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5
Q

What is virchow’s triad?

A

 Vascular injury-
 Alteration of blood flow-
 Hypercoagulability

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6
Q

What is a vascular injury?

A

Endothelial damage

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7
Q

What occurs when there are alterations in blood flow?

A

venous stasis

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8
Q

How does hypercoagulability occur?

A

◦ Sudden withdrawal anticoagulant meds
◦ Oral contraceptive use
◦ Clotting factor abnormalities-genetic
◦ Pregnancy

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9
Q

What signs and symptoms should you look for when assessing for DVT?

A 
◦ Dull ache
◦ Tenderness
◦ Pain
◦ Cramping
◦ Erythema
◦ Warmth
◦ Edema
◦ Measure affected extremity daily
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10
Q

What are the diagnostic test done for DVT?

A

 D Dimer
 ESR
 Venous Duplex
 Venogram

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11
Q

What are the nursing interventions?

A 
 Activity-rest, elevate, walk after anticoagulated
 Leg exercises – elevate extremity
◦ Avoid prolonged sitting or standing
 Anti-embolism stockings
 Sequential Compression Devices (SCD)
 IV fluids
 Medications – anti coagulants
◦ Monitor: Heparin – PTT = 1.5-2.5x control
 Usually PTT=over 60-under100 per protocol
◦ Coumadin – PT/INR = 2-2.5x control
 Usually between INR 2.0-3.0
◦ Analgesics – pain relief
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12
Q

What are the complications of DVT?

A

 Pulmonary Embolus (PE)
 Cerebrovascular Accident (CVA)
 Re-occuring DVT
 Venous stasis ulcers

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13
Q

What are the priority nursing diagnosis for DVT?

A

 Pain
 Impaired mobility
 Ineffective tissue perfusion
Risk for embolism

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14
Q

 Obstruction of the pulmonary artery or one of its branches by a thrombus
 Thrombus usually originates elsewhere in the venous system

A

Pulmonary Embolism

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15
Q

What is the ideal location for pulmonary emboli? Why?

A

Lungs are ideal location for emboli to lodge because of extensive capillary network & arterial blood flow

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16
Q

What part of the lungs are more frequently affected?

A

Lower lobes are most frequently affected because they have a higher blood flow

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17
Q

What is the etiology (causes) of pulmonary embolism?

A

 Thrombi in the deep veins can dislodge spontaneously
 Mechanical events (ie injury, sudden standing) can break off a clot & send it into cardiovascular network
 Clot partially or completely obstructs the pulmonary artery or its branches

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18
Q

What is the physiologic presentation of pulmonary embolism?

A

 Pulmonary alveolar space that is near the occluded vessel gets little or no O2
 Substances released from the clot cause surrounding blood vessels & bronchioles to constrict
 Gas exchange is impaired or absent
◦ Due to little or no blood flow to area

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19
Q

Less common causes of pulmonary emboli besides blood clots include:

A

 Fat emboli
 Air emboli
 Amniotic fluid
 Tumors emboli – break off of tumor tissue

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20
Q

What are the risk factors for pulmonary embolism?

A 
 Trauma or surgery
 Heart failure
◦ Right side heart pathology
 Atrial fibrillation (irregular heart rhythm)
 Hyper-coagulable states=DVT
 Prolonged immobility
 Over age 50
 Long term use of oral contraceptives
21
Q

What are the signs & symptoms of pulmonary embolism?

A 
 Sudden onset of unexplained dyspnea
 Tachypnea
 Tachycardia
 Chest pain – sudden, sharp & pleuritic
 Cough - may be dry
 Secretions - clear or blood tinged
 Crackles
 Fever
 Accentuation of pulmonic heart sound
 Change in mental status
◦ Secondary to hypoxemia
 Anxiety
 Apprehension – feeling of impending doom
22
Q

What are the signs & symptoms of massive emboli?

A

 Sudden collapse
 Shock
 Massive emboli patients may not have chest pain
 EKG indicates right ventricular strain with acute cor pulmonale
◦ Right ventricle can no longer pump blood into the lungs
 Death occurs in > 60% of patients

23
Q

 May go undetected
 Produce vague transient symptoms
 May cause cardiac compromise

A

small pulmonary emboli

24
Q

What are the complications of a pulmonary embolism?

A
  • Pulmonary infarction

* Pulmonary hypertension

25
Q

occurs death of lung tissue occurs with medium or large sized pulmonary vessels are occluded

A

pulmonary infarction

26
Q

occurs when there is insufficient collateral blood flow as well as pre-existing lung disease is present

A

pulmonary infarction

27
Q

Occurs when more than 50% of area of normal pulmonary bed compromised

A

pulmonary hypertension

28
Q

occurs when there is dilation & hypertrophy of the right

ventricle from multiple Pulmonary Emboli

A

pulmonary hypertension

29
Q

What are the diagnostic test for pulmonary emboli?

A
  • Spiral CT (also called helical)
  • Ventilation/Perfusion lung scan
  • Coagulation studies
  • Platelets
  • Venous doppler
  • Duplex scanning
  • Venogram
  • Pulmonary angiogram
  • EKG
  • CBC
  • ABGs
30
Q

 Supplies definitive diagnosis
 Most recently developed
 Most accurate method
 beam remains on continuously & rotates around patient
 More efficient technique
◦ Reduces scanning time of entire chest to 20- 30 seconds
 3 dimensional images

A

spiral CT

31
Q

◦ Injection of a radioisotope

◦ Scanning device detects ability of the body to pick up the isotope

A

perfusion scanning

32
Q

◦ Inhalation of a radioactive gas (xenon)
◦ Patient is then scanned for the lung pick-up of the gas
◦ Must be cooperative for this test
◦ May be omitted for intubated patients

A

ventilation scanning

33
Q

◦APTT, PT, INR:

◦Use to monitor the anticoagulation medication used for treatment of PE

A

Coagulation studies

34
Q

 Although not a diagnostic for PE

 This test may R/O blood dyscrasia which may be causative factor for PE

A

platelets

35
Q

◦ Assesses blood flow in veins

A

venous doppler

36
Q

◦ Ultrasound imaging & Doppler to determine location & extent of thrombus within the veins

A

duplex scanning

37
Q

X-ray determination of location & extent of clot using contrast media to outline filling defects
Development of collateral circulation is defined

A

venogram

38
Q

A contrast is injected
 Patient is then x-rayed to determine location & size of
pulmonary emboli

A

pulmonary arteriogram

39
Q

What type of conservative care should be done for mild pulmonary embolism?

A 
Elevate HOB when SOB = High Fowlers
 Patients receive oxygen based on ABGs
 IV site maintenance
 Activity-rest, elevate, walk after anticoagulated
 Pain relief - analgesics
 EKG
 Anti-coagulation
40
Q

◦ Initial treatment = Heparin
◦ May be omitted in the following patients:
 Blood dyscrasias, history of hemorrhagic CVA, neurologic conditions or hepatic dysfunction

A

Anti-coagulation

41
Q

What should be included in the discharge plan for anti-coagulation: heparin administration?

A

 SQ Heparin
◦ Injection instructions may be part of the nurse’s role
 Bleeding precautions
 Avoidance of drugs that increase risk of bleeding

42
Q

What are the treatments for pulmonary embolism?

A
  • low molecular weight heparin
  • warfarin
  • dabigatran
  • rivaroxaban
  • Thrombolytic Therapy
43
Q

 Interfers with liver synthesis of the vitamin K
dependent clotting factors
 Depress synthesis of factor X, IX, VII, & II
prothrombin
 Agent does not affect established clots
 Prevents further extension of formed clots
 Taken 1X a day, after maintenance dose
established
 Coumadin cannot be given to pregnant patients

A

warfarin (Coumadin)

44
Q

Side effects:
 Hemorrhage – bleeding precautions
 Antidote = Vitamin K
 Coagulations Studies: must be routinely monitored
to avoid excessive anti coagulation
 PT / INR – must be in therapeutic range, monitored
in “Coumadin Clinic”

A

warfarin (Coumadin)

45
Q

Patient Teaching:
 Bleeding precautions
 Recommend pt limit-avoid green/leafy veggies &
any food high in vitamin K – decreases effectiveness

A

warfarin (Coumadin)

46
Q

Actions:
 Inhibits thrombin, blocks last step in clot
formation
 Approved prevent clots in Afib - drug of choice

A

dabigatran (Pradaxa)

47
Q

Side Effects:
 Hemorrhage – bleeding precautions
 Used with caution due to lack of antidote
 No dietary restrictions

A

dabigatran (Pradaxa) and rivaroxaban (Xarelto)

48
Q

Actions:
 Blocks an earlier step in clot formation
 Approved to prevent DVT that might lead to
PE in pts with knee or hip replacement

A

rivaroxaban (Xarelto)

49
Q 
 Actions:
◦ Used for severely compromised pts
◦ Helps restore hemodynamic stability
 Side effects: Severe bleeding
 Contraindications:
◦ Less than 2 months since CVA
◦ Less than 10 days post op
◦ Recent child birth, trauma, or severe HTN
A

Thrombolytic Therapy:
 Medications:
◦ Urokinase, Streptkinase, Reteplase

N160 exam 3 (7 decks)

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