Module 4A: Venous Thromboembolism

Question 1

DVT risk factors

Answer 1

blood stasis, vessel wall injury, altered blood coagulation

Question 2

virchow’s triad

Answer 2

endothelial damage, venous stasis, altered coagulation

Question 3

DVT prevention

Answer 3

↑ mobility, compression stockings, intermittent pneumatic compression devices, prophylactic anticoagulation therapy, lifestyle changes (normal BMI, no smoking, regular exercise)

Question 4

DVT s/s

Answer 4

swelling, pain, cool or warm to touch, often asymptomatic

Question 5

PE s/s

Answer 5

dyspnea, tachypnea, ↓ SpO2, chest pain of “pleuritic” nature (worsened by breathing), cough, hemoptysis, anxiety

Question 6

VTE diagnostic tests

Answer 6

D-Dimer, PTT, PT-INR, platelets (GFR + creatinine if CT w/ contrast is ordered d/t contrast secreted via kidneys), ultrasound - deep veins in legs, CT chest w/ contrast, chest x-ray (CXR)

Question 7

d-dimer

Answer 7

body’s natural reaction to clot development is fibrinolysis & is produced by action of plasmin on fibrin polymer clot

Question 8

VTE non-pharmacological interventions

Answer 8

monitor CWMS, measure limb, monitor SpO2, monitor resp status, OPQRSTUV assessment

Question 9

VTE pharmacological interventions

Answer 9

monitor and treat pain, administer anticoagulants, thrombolytics, PE = administer O2

Question 10

reasons someone is on an anticoagulant

Answer 10

immobility, history of VTE/pulmonary embolism, dysrhythmias (a-fib), mechanical heart valve, post iM or stroke

Question 11

anticoagulants

Answer 11

increase clotting time to prevent thrombi from forming or growing larger, inhibit specific clotting factors in coagulation cascade, do not breakdown clot

Question 12

heparin

Answer 12

IV or SQ, brief-half life (90 mins), increase risk of thrombocytopenia

Question 13

IV heparin

Answer 13

rapid onset, weight-based, frequent monitoring of PTT and signs of bleeding

Question 14

SQ heparin

Answer 14

non or infrequent monitoring of PTT, monitor signs of bleeding, usually given BID/TID

Question 15

heparin antidote

Answer 15

protamine sulfate

Question 16

low-molecular-weight eparin

Answer 16

duration = 2-3 times longer than heparin, SC injection daily, produces more stable response than heparin, decrease risk of thrombocytopenia, dosages based on weight, decrease follow up labs, pt/family can be taught to self-administer, monitor for signs of bleeding (bruising, bleeding gums, blood in urine/stool)

Question 17

warfarin

Answer 17

PO only, 3-5 days to reach therapeutic level, 1-3 days half-life, monitor PT-INR, lots of interactions, not safe in pregnancy (causes birth defects)

Question 18

warfarin antidote

Answer 18

vitamin K

Question 19

oral anticoagulants

Answer 19

direct thrombin inhibitors (dabigatran) & direct factor Xa inhibitors (rivaroxaban, apixaban)

Question 20

antiplatelets

Answer 20

interfere w/ platelet aggregation, best way to prevent arterial thrombosis, common meds: ASA & clopidogrel, anticoagulant properties can last up to a week after one single dose

Question 21

nursing considerations for administering anticoagulants

Answer 21

monitor s/s of bleeding (hematuria, epistaxis, blood stools, bruising), monitor VS and labs (PTT, PT-INR), drug to drug interactions, avoid/limit IM injections, limit procedures/are that increase risk of bleeding, pt teaching

Question 22

thrombolytic drugs

Answer 22

alteplase, used in EMERG and ICU, dissolves clots