Immobility Flashcards
What are the 3 parts of Virchow’s Triad?
Venous Stasis
Endothelial Damage
Blood Hypercoagulability
What medication is used to prevent DVT in the hospital?
Heparin SQ
What happens in thrombus formation
Platelets aggregate
Clotting factors stimulated to produce fibrin
Fibrin entraps RBCs, WBCs, and Platelets and it adheres to vessel wall
Chronic complications of DVT is known as…
Post thrombotic syndrome
What medication is used to prevent further clot formation?
Heparin IV
What test do you use to monitor Heparin?
aPT
Most common risk factors for VT
Having previous venous thrombosis, severe infection, heart failure, oral contraceptives (incr availability of clotting factors), estrogen therapy, pregnancy, immobility, surgery, cancer, and inherited thrombophilia
What are the clinical manifestations of someone has lower extremity venous thrombosis?
May experience unilateral leg pain, edema, paresthesia (thigh/calf)
What are the clinical manifestations of someone has inferior vena cava venous thrombosis?
Edema and cyanosis in both legs
Gold standard for diagnosing thrombosis?
Compression ultrasound, then repeated 5-7 days later
D-dimer test
Blood test that marks the presence of clotting factors
How can we physically prevent thrombosis in low risk, immobile patients?
OOB, ambulate 4-6x /day
Change positions q2 h
TEDs SCD
How can we medically prevent thrombosis in low risk, immobile patients?
Heparin or Enoxaparin SQ BID
What are the medication clot busters we use for a patient with acute thrombus? And when we do start the patient on this medication?
Streptokinase and Urokinase.
We start within 3 hours of suspected clot, after the clot is confirmed
What are the tests we use to monitor clots?
aPtt, Hgb, Hct, platelets (CBC), D-dimer
What do we monitor in patients with VT?
Monitor bleeding (gums, stool, urine, bruising)
Vital signs
CBC
Mental status changes (travel to brain)
Supply w soft tooth brush; Electric razor
Fall prevention
HYDRATE (stool softener)
Monitor aPtt and INR/PT
What is the antidote for Heparin
Protamine sulfate
What is the antidote for Warfarin?
Vitamin K
When do we notify a provider for a patient with thrombosis?
New bleeding, changes in vitals, LOC, respiratory changes, New pain in thrombotic extremity, absence of pulse
How long do patients have to wear TEDs after diagnosis of VT?
~2 years after the event
Occurs after recovery from DVT…
Post thrombotic syndrome
S/S of post thrombotic syndrome
Pain, aching, heaviness, swelling, cramps, itching, tingling.
Persistent edema, incr pigmentation, eczema, varicosities, lipodermatopigmentation
Tx of post thrombotic syndrome
You want venous return. Elevation of extremities, grade 2 compressions, weight loss, incr exercise, pain management, compression pump, vascular interventional radiology procedure (balloon to open vessel)
Define and describe Phlegmasia cerulean dolens
A severe form of VT, usually upper leg. Total blockage of blood flow. Found in late stages of CA, massive swelling w deep pain, cyanosis.
Can lead to arterial occlusion, gangrene, and amputation
Complications of immobility (respiratory, CV, skin, musculoskeletal, GI, renal, neuro)
Pneumonia, atelectasis, PE, cardiac muscle atrophy, venous thrombosis, pressure ulcer, osteoporosis, muscle atrophy, weakness, contractures, renal calculi, constipation, depression & anxiety
What are the 2 common ways decubitus ulcers form?
Immobility and poorly fitted casts
Risk factors for decubitis ulcer?
Immobility, nutrition, mental status, sedation, long procedures, incontinence, factors that prevent healing (e.g., diabetes)
Signs of systemic infection in decubitus ulcer?
fever and increased WBC
How do we prevent ulcers?
Movement, nutrition, heel and skin protectants, pressure redistribution, constant monitoring and assessment of patients that are immobile
How do we tx ulcers?
Wound vac, bladder/bowel management program, cleanse and periwound, water, antibiotics, debridement
When should we be alarmed for decubitus ulcers?
Smell, wound dimensions increase, reddened, dark, or black wound appearance, febrile
Norton Scale
Scale for predicting risk of pressure-induced injury
Braden Score
Observes sensory perception, moisture activity, mobility, nutrition, friction & shear
How do we tx decubitus ulcers?
Repositioning & keep them dry
Diseases that increased the risk of venous thrombus formation
Cancer, Respiratory infection, Diabetes, CAD
Clinical manifestations of patients with DVT
They complain of SOB, leg pain, swelling, and discoloration of the limb.
Wells criteria score
Performed by the provider to determine if someone is at an increased risk for developing DVT
When do you notify the provider …
new bleeding, changes in LOC, VS, breathing, new pain in the extremity, unable to detect a pulse
