Exam 2 - VTE, DVT, PE Flashcards
a blood clot due to endothelial injury, venous stasis, or hypercoagulability
venos thromboembolism
VTEs can be formed by…
collections of fat, air, cancer cells, or blood
____ is the most common blood clot
deep vein thrombosis
the two main complications that DVT can cause are…
disrupt perfusion, lead to PE
what is Virchow’s Triad?
(1) reduced blood flow
(2) blood vessel injury
(3) increased coagulability
name at least 3 causes of reduced blood flow
(1) A Fib
(2) immobility
(3) venous insufficiency
(4) bedrest
(5) prolonged sitting
name at least 3 causes of blood vessel (endothelial) injury
(1) trauma
(2) HTN
(3) surgery
name at least 3 causes of increased coagulability
(1) sepsis
(2) coagulation disorders
(3) increased viscosity r/t hypovolemia
s/s of DVT
(1) calf or groin tenderness and pain
(2) sudden onset of unilateral swelling of the leg
(3) Pos Homan sign (unreliable)
(4) skin red and warm, tight to touch
pain on the dorsiflexion of the foot is ___
Pos Homan sign
what tests are used to diagnose DVT?
(1) venous duplex ultrasound
(2) doppler flow study
(3) D-dimer test
positive D-dimer test is
> 250 ng/mL
negative D-dimer test is
<250 ng/mL
what are the main goals of DVT management?
(1) avoid increased size of thrombus
(2) avoid emboli
(3) prevent complications and injury
what are the 4 main medications for DVT?
(1) unfractionated heparin
(2) low molecular weight heparin (LMWH)
(3) warfarin
(4) DOACs
____ is the initial treatment for DVT
unfractionated heparin infusion
____ is a high-risk med that needs 2 nurse checks
heparin
what is the typical dose for unfractionated heparin?
(1) 5000 U/bolus
(2) 20-40,000 U/24 hours in 1L NS
LMWH route
SQ
why do we start warfarin while still on Heparin?
to bridge the heparin and then switch over to Warfarin - warfarin takes a few days to kick in
warfarin takes ____ days to reach therapeutic range
3-4
what is the initial dose of warfarin?
2-5 mg/daily
what is the maintenance dose of warfarin?
2-10 mg/daily
___ and ___ are examples of oral anticoagulants (DOACs)
apixaban; rivaroxaban
what are the 4 main reasons we pull labs for DVT patients?
(1) adjust dosage
(2) check kidney function
(3) assess bleeding risk
(4) estimate when we can switch to oral medication
what labs are drawn for DVT patients on meds?
(1) baseline PT
(2) aPTT
(3) INR
(4) CBC
(5) PLT
(6) UA
(7) Hemoccult
(8) Creatinine
which labs are monitored daily for DVT pts?
PT
aPTT
INR
____ is a heparin-specific lab test
aPTT
___ is a warfarin-specific lab test
INR
_____ decreases clotting ability of the blood but does not dissolve the clot
heparin
____ blocks vitamin K in the clotting process
warfarin
___ inhibits platelet aggregation d/t reduced thrombin
oral anticoagulants
what do we do if we go over therapeutic range for heparin and aPTT > 100 sec?
(1) hold the medication
(2) give protamine sulfate
what is the antidote for heparin?
protamine sulfate
what is the antidote for warfarin?
vitamin K
what is the antidote for fibrinolytic therapy?
clotting factors, fresh-frozen plasma, antifibrinolytic agents
what labs need to be checked daily for warfarin?
PT and INR
____ is the best form of treatment for VTE/DVT
prevention
name at least 3 forms of prevention for VTE/DVT
(1) passive and active ROM
(2) ambulate ASAP
(3) compression devices, like SCDs and stockings
(4) anticoagulant therapy - prophylaxis
(5) avoid pillows under knees
(6) reposition q2h
name at least 3 signs to look for when monitoring for signs of bleeding
(1) hematuria, occult blood in stool
(2) ecchymosis
(3) altered mental status
(4) abdominal pain
(5) change in VS (decreased BP, increased HR and RR)
name 4 pieces of education for patients on oral Coumadin / warfarin
(1) use electric razors, not straight razors
(2) apply manual pressure to venipuncture sites for at least 10 mins
(3) monitor INR levels
(4) administer dose at the same time each day
collections of X that enter venous circulation and lodge in the pulmonary vessels
pulmonary embolism
the 3 key physiologic impacts of a PE are
(1) ventilation to perfusion mismatch (V/Q)
(2) reduced gas exchange and oxygenation
(3) tissue hypoxia
the risk factors for DVT and PE are
Virchow’s triad
s/s of impaired gas exchange
(1) sudden dyspnea
(2) sharp, stabbing chest pain
(3) feeling of impending doom
(4) restlessness
(5) diaphoresis
(6) tachypnea
(7) lightheadedness
(8) cough
(9) hemoptysis
s/s of impaired perfusion
(1) tachycardia
(2) distended neck veins
(3) crackles
(4) hypoxia
(5) cyanosis
(6) acute pulmonary HTN)
(7) systemic hypotension
(8) dysrhythmias
what are the two diagnostics for PE?
D-dimer and CTPA
___ can be used if CTPA is contrainducated
V/Q scan
____ is NOT a confirmatory test
V/Q scan
what labs can be used to help diagnose PE?
(1) ABGs
(2) CBC
(3) Troponin
(4) D-Dimer
(5) BNP
the 5 main medications for PE are
(1) unfractionated heparin
(2) LMWH
(3) warfarin
(4) DOACs
(5) antifibrinolytics (alteplase)
nursing interventions for Hypoxemia in PE
(1) initiate RRT
(2) supplemental O2
(3) semi-fowler’s
(4) IV access
(5) ABGs
(6) cardiac and resp assess
(7) VS
nursing interventions for hypotension in PE
(1) IV fluids - crystalloids
(2) monitor urine output
(3) monitor s/s HR
(4) vasopressors
how do we treat bleeding risk?
(1) antidotes like protamine sulfate or vit K
(2) clotting factors
(3) fresh-frozen plasma
describe the ABG changes in PE
(1) starts with respiratory alkalosis (low PaCO2)
(2) respiratory acidosis as PaCO2 increases
(3) metabolic acidosis from lactic acid buildup
the 3 nursing priorities for PE are
(1) hypoxemia d/t mismatch of lung perfusion
(2) hypotension d/t right ventricular failure
(3) potential for bleeding d/t anticoagulation therapy
how long do you continue both heparin and warfarin?
until INR level is between 2 and 3; then, continue heparin for 24 more hours
3 examples of vasopressors are
Epi, NE, Dopamine
