Peripheral Venous Disease

Question 1

Venous thromboembolism (VTE) is a blood clot believed to form as a result of

Answer 1

Virchow’s triad

Question 2

Factors contributing to Virchow’s triad

Answer 2

hypercoagulable state
circulatory stasis
vascular wall injury

Question 3

Thrombus formation can lead to __________ __________ which is a life threatening complication.

Answer 3

pulmonary embolism

Question 4

Thrombus that is associated with inflammation

Answer 4

thrombophlebitis

Question 5

Enlarged, twisted and superficial veins that can occur in any part of the body; however, they are commonly observed in the lower extremities and in the esophagus

Answer 5

Varicose veins

Question 6

Occurs secondary to incompetent valves in the deeper veins of the lower
extremities, which allows pooling of blood and dilation of the veins.

The veins’ inability to carry fluid and wastes from the lower extremities precipitates the development of swelling, skin color/texture changes, venous stasis ulcers, and in advanced cases, cellulitis.

Answer 6

venous insufficiency

Question 7

Associated with deep leg pain of sudden onset, which occurs secondary to the occlusion.

A dull ache is more commonly associated with varicose veins. If the thrombus is large enough, it will cause pain. A tingling sensation is associated with an alteration in arterial blood flow.

Answer 7

DVT

Question 8

Unilateral swelling

Answer 8

DVT

Question 9

o stasis dermatitis (brown discoloration) along the ankles that extends up the calf relative to the level of insufficiency
o Edema
o Stasis ulcers (typically found around ankles)

Answer 9

Venous insufficiency

Question 10

Risk factors for DVT (VTE)

Answer 10

-associated w/Virchow’s triad
-surgery: hip, TKR, open prostate
-HF
-immobility
-pregnancy/oral contraceptives
-active cancer

Question 11

Risk factors for Venous insufficiency

Answer 11

-sitting or standing in one place for a long time
-obesity
-pregnancy
-thrombophlebitis

Question 12

Risk factors for Varicose veins

Answer 12

-female, age >30, family hx
-occupations w/ lots of standing
-pregnancy
-obesity
-heart disease

Question 13

D-dimer measures fibrin degradation products present in the blood produced from fibrinolysis. A positive test indicates that thrombus formation has possibly occurred. Is it specific?

Answer 13

D-dimer is not specific. It just tells us clotting is happening somewhere.

Question 14

Meds

Answer 14

Anticoagulants & prophylaxis
-unfractionated heparin, low-molecular weight heparin, enoxaparin, fondaparinux, warfarin

Thrombolytics & platelet inhibitors
-TPA

Question 15

Enoxaparin (Lovenox) is administered subcutaneously and can cause

Answer 15

bruising

Question 16

IVC filters are used to treat DVTs. What do they do?

Answer 16

Catches the clot. Blocks it from going up to the lungs.

Question 17

Procedures for varicose veins

Answer 17

sclerotherapy, vein stripping, endovenous laser treatment, application of radio frequency energy

Question 18

Nursing care for DVT

Answer 18

• Encourage the client to rest.
• Facilitate bed rest and elevation of the extremity above the level of the heart as prescribed. (Avoid using a knee gatch or pillow under knees.)
• Administer intermittent or continuous warm moist compresses as prescribed.
• Do not massage the affected limb.
• Provide thigh-high compression or antiembolism stockings.
• Prepare the client for an inferior vena cava interruption surgery (a filter traps emboli and prevents them from reaching the heart) as indicated.

Question 19

Nursing care for venous insufficiency

Answer 19

• Elevate legs for at least 20 min, four to five times a day.
• Elevate the legs above the heart when in bed.
• Instruct clients to avoid crossing legs and wearing constrictive clothing or stockings.
• Instruct clients to wear elastic compression stockings and apply them after the legs have been elevated and when swelling is at a minimum

Question 20

Prophylaxis for DVT & venous insufficiency

Answer 20

• Assessment
• Early ambulation
• Active/passive ROM
• Extremity elevation
• SCD’s
• Teaching
• Core Measures

Question 21

Characteristics of peripheral VENOUS disease

Answer 21

Peripheral pulses: PRESENT, MAY BE DIFFICULT TO PALPATE W/ EDEMA
Cap refill: LESSTHAN 3 SEC
Ankle brachial index: GREATER THAN TO 0.90
Edema: LOWER LEG EDEMA
Hair growth: HAIR MAY BE PRESENT OR ABSENT
Ulcer location: NEAR MEDIAL MALLEOLUS
Ulcer margin: IRREGULARLY SHAPED
Ulcer drainage: MODERATE TO LARGE AMOUNT
Ulcer tissue: YELLOW SLOUGH OR DARK RED, “RUDDY” GRANULATION
Pain: DULL ACHE OR HEAVINESS IN CALF/THIGH; ULCER OFTEN PAINFUL
Nails: NORMAL OR THICKENED
Skin color: BRONZE-BROWN PIGMENTATION; VARICOSE VEINS MAY BE VISIBLE
Skin texture: THICK, HARDENED, & INDURATED
Skin temp: WARM, NO TEMP GRADIENT
Dermatitis & pruritis: FREQUENTLY OCCURS