DVT/Atelectasis/Atherosclerosis

Question 1

What is the patho of a DVT?

Answer 1

DVT is formed when red blood cells, fibrin and platelets bind together and create a clot. Increased numbers of fibrin and blood cells build up behind the thrombus and attach to it increasing the size of the clot

Question 2

What is the aetiology of a DVT?

Answer 2

Three factors (Known as Virchow’s triad)::
- Venous stasis
- Hyper-coagulability
- Vessel wall injury

Question 3

What is Venous stasis?

Answer 3

Occurs with decreased blood flow, immobility, medications and in HF

Question 4

What is Hyper-coagulability?

Answer 4

Occurs with deficient fluid volume, pregnancy, oral contraceptive use and smoking

Question 5

What is Vessel wall injury?

Answer 5

May occur due to venipuncture, medications, trauma and surgery

Question 6

What are some signs and symptoms of DVT?

Answer 6

Pain and tenderness (commonly in calf), Redness and swelling

Question 7

What are some nursing interventions for DVT?

Answer 7

• Maintain bed rest to reduce risk of thrombus dislodging
• Administer anticoagulants to breakdown clot and prevent further clot formation
• Elevate legs above heart to reduce stasis and decrease swelling
• Apply TED stockings as prescribed as compression stocking enhance circulation by providing a graduated pressure on the leg to help return the venous blood to the heart

Question 8

What is Atelectasis?

Answer 8

The collapse of lung tissue which occurs due to the lack of lung expansion, often after surgery. There are two types of atelectasis: Compression and Absorption

Question 9

What is the aetiology of Atelectasis?

Answer 9

1. Reduced Alveolar ventilation due to compression or absorption
2. Trapped 02 is absorbed in the blood stream
3. No further 02 is absorbed because of blockage
4. Alveoli collapse leading to acute respiratory distress

Question 10

What are some signs and symptoms of Atelectasis?

Answer 10

Dyspnoea, cough, fever, in pain with shallow breathing, reluctant to change position, produce thick secretions which often pool in portions of the lung. Increased HR and RR, hypoxia and decreased Sp02

Question 11

What are some nursing interventions for Atelectasis?

Answer 11

• Sit pt upright to improve air entry to the lungs and facilitate gas exchange
• Administer 02 as prescribed to prevent hypoxia
• Encourage breathing/coughing techniques to clear secretions
• Administer prescribed antibiotics to treat the infection
• Refer to physio for breathing techniques
• Encourage DBE and slow breathing to promote deep inspiration which increases oxygenation and prevents atelectasis

Question 12

What is the patho of Atherosclerosis?

Answer 12

1. An irritant is present (eg. lipids (LDL Cholesterol), high blood pressure, toxins (cigarette smoking), diabetes)
2. Damage occurs to the endothelium - a crack or fissure is formed
3. LDL Cholesterol deposits accumulate in the artery wall (Tunica Intima) known as fatty streaks
4. LDL oxidises (changes), sends a signal to the immune system and monocytes (White blood cells) arrive
5. Monocytes convert into macrophages and consume the cholesterol
6. Macrophages fill up on cholesterol and die = foam cells
7. Formation of foam cells - release of cytokines (inflammatory response = vicious circle)
8. Smooth muscle cells migrate into expanding fatty plaque forming a lipid cap (using collagen and elastin)
9. Smooth muscle cells also deposit calcium into the fatty plague, hardening it and causing bulging into the artery lumen
10. Blood flow is decreased (resistance is increased) and compliance is reduced (less flexibility)
11. Ongoing inflammation = plague rupture, thrombogenic material inside the cap is exposed = arriving platelets form a thrombus
12. A thrombus is formed (either partially or fully) and occludes the artery causing ischaemia or ultimately infarction

Question 13

What is Atherosclerosis?

Answer 13

The build-up of fats, cholesterol and other substances in and on the artery walls causing obstruction of blood flow. Plaques may rupture, causing acute occlusion of the artery by clot

Question 14

What is the aetiology for Atherosclerosis?

Answer 14

Plague build up. Risk factors may include high cholesterol and triglyceride levels, high blood pressure, smoking, diabetes, obesity, little physical activity, and eating saturated fats.

Question 15

What are some signs and symptoms of Atherosclerosis?

Answer 15

• Chest pain or pressure (angina)
• Sudden arm or leg weakness or numbness.
• Slurred speech or difficulty speaking.
• Brief loss of vision in one eye.
• Drooping facial muscles.
• Tachycardia
• Pain when walking.
• Hypertension.
• There is usually no symptoms until the plague ruptures or the built up plague occludes blood flow

Question 16

What are some nursing interventions for Atherosclerosis?

Answer 16

• Administer asprin as prescribed to reduce the ability of the blood to clot and so the blood flows easier through narrowed arteries
• Administer oxygen as prescribed to keep Sp02 levels within target and to increase oxygen levels
• Reassurance to decrease the SNS response and therefore decrease HR
• Educate around stress and relaxation techniques. Stress causes a persistent increase in cortisol levels, which is linked to cardiac function as well as increase adrenaline levels which increases HR and RR.