Peripheral Venous Disease FINAL Flashcards
Venous thromboembolism (VTE) is a blood clot believed to form as a result of
Virchow’s triad
Factors contributing to Virchow’s triad
hypercoagulable state
circulatory stasis
vascular wall injury
Thrombus formation can lead to __________ __________ which is a life threatening complication.
pulmonary embolism
Thrombus that is associated with inflammation
thrombophlebitis
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
Varicose veins
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.
venous insufficiency
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.
Unilateral swelling
DVT
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)
Venous insufficiency
Risk factors for DVT (VTE)
-associated w/Virchow’s triad
-surgery: hip, TKR, open prostate
-HF
-immobility
-pregnancy/oral contraceptives
-active cancer
Risk factors for Venous insufficiency
-sitting or standing in one place for a long time
-obesity
-pregnancy
-thrombophlebitis
Risk factors for Varicose veins
-female, age >30, family hx
-occupations w/ lots of standing
-pregnancy
-obesity
-heart disease
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?
D-dimer is not specific. It just tells us clotting is happening somewhere.
PVD Meds
Anticoagulants & prophylaxis
-unfractionated heparin, low-molecular weight heparin, enoxaparin, fondaparinux, warfarin
Thrombolytics & platelet inhibitors
-TPA
Enoxaparin (Lovenox) is administered subcutaneously and can cause
bruising
IVC filters are used to treat DVTs. What do they do?
Catches the clot. Blocks it from going up to the lungs.
Procedures for varicose veins
sclerotherapy, vein stripping, endovenous laser treatment, application of radio frequency energy
Nursing care for DVT
- 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.
Nursing care for venous insufficiency
- 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
Prophylaxis for DVT & venous insufficiency
- Assessment
- Early ambulation
- Active/passive ROM
- Extremity elevation
- SCD’s
- Teaching
- Core Measures
Characteristics of peripheral VENOUS disease
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
