Peripheral Venous Disorder Flashcards
What is PVD?
Disorder of the veins that interfere with blood flow back to the heart from the extremities
What are 3 PVD’s that nurses should be aware of?
- Venousthromboembolism (VTE)
- Venous Insufficiency
- Varicose Veins
What is VTE?
A blood clot that forms as a result of venous stasis, endothelial injury, or life-threatening complications
What is thrombophlebitis?
Thrombus associated with inflammation
What is Venous Insufficiency?
Occurs secondary to incompetent valves in deeper veins of lower extremities.
Pulling of blood & dilation of veins.
Vein is unable to carry fluid & wastes from the lower extremities which precipitates
In venous insufficiency what are some s/s results of excess fluid & wastes in the extremities?
- Swelling
- Venous Stasis
- Ulcers
- Cellulitis
What are Varicose Veins?
Enlarged, twisted & superficial veins that occur in any part of the body but most commonly in lower extremities.
What are some Risk Factors r/t VTE?
1* Hip-Surgery or Total Knee Surgery*
- HF
- Immobility
- Pregnancy
r/t VTE, What is Virchow’s Triad?
- Hypercoagubility
- Impaired Blood Flow
- Damage to Blood Vessels
Risk Factors r/t Venous Insufficiency?
- Sitting or Standing for Prolonged Periods
- Obesity
- Pregnancy
- Thrombophlebitis
Risk Factors r/t Varicose Veins?
- Sex (Women)
- Age (>30 yrs with occupation)
- Pregnancy
- Obesity
- Systemic Diseases
- Family Hx
Subjective Data r/t PVD: Chief Complaint
Limb pain =
Aching Pain
Feeling of Fullness or Heaviness in legs After Standing
Clinical Manifestations r/t DVT?
- Asymptomatic
- Calf/groin pain. tenderness
- Sudden onset of edema
- Warmth, Induration, hardness
- SOB & chest pain
Clinical Manifestations r/t Venous Insufficiency
- Stasis Dermatitis = Brown Discoloration
- Edema
3Stasis Ulcers
Clinical Manifestations r/t Varicose Veins
- Distended, Superficial, Tortuous Veins
- Muscle Cramping & Aching
- Pain After Sitting & Pruritis
*What is major Lab test r/t PVD?
D-dimer
Measures fibrin degredation products present in blood.
Positive test indicates thrombus formation
What are some Diagnostic Procedures r/t DVT?
Venous duples ultrasound
Impedence plethysmography - determines amount of blood passing through vessel
Venogram with contrast
What are some Diagnostic Tests performed for Varicose Veins?
Trendelenburg Test
Place pt. in supine with legs elevated
Veins will fill from proximal end if positive for varicose
Nursing Care r/t DVT?
- Encourage pt. to rest
a. elevation of extremity above level of heart (No pillow under knees, no knee gatch)
b. Intermittent warm, moist compress
c. DO NOT MASSAGE
d. Thigh high compression or antiembolism stockings - Prepare pt. for Inferior Vena Cava Surgery
Nursing Care r/t Venous Insufficiency?
- Elevate legs several times/day @ least 15 - 30 min
- Elevate feet @ night.
- Avoid crossing legs & wearing constrictive clothing or stockings
- Pt. should wear elastic compression stockings & apply them after the legs have been elevated & when swelling is @ a minimum.
What are some medications to treat DVT?
- Anticoagulants - HEPARIN IV to:
a. Prevent formation of other clots
b. Prevents enlargement of existing clot - Enoxaparin (Lovenox)
a. Prevention & treatment of DVT - Warfarin (Coumadin)
a. Inhibits synthesis Vit. K clotting factors
b. 3 - 4 Days for therapeutic effects
What are the nursing actions r/t Heparin therapy?
- Monitor aPTT - Normal = 25 - 35 sec
a. If 60 sec is critical deficiency in coagulability - Monitor PLT count - Normal = 150,000 - 450,000
a. <50,000 is critical - Protamine Sulfate = ANTIDOTE
What are some nursing actions r/t Enoxaparin therapy?
- Instruct pt. to observe for bleeding
- Instruct on bleeding precautions
a. electric razor
b. soft bristle tooth brush
What are some nursing actions r/t Coamadin?
- Monitor pt. for bleeding
- Monitor PT & INR - Normal Levels = 11 - 15 sec & 0.9 - 1.2 respectively.
a. Critical PT >30 sec (deficient)
b. Critical INR >5 - Vitamin K = ANTIDOTE
- Instruct on food sources high in Vitamin K (green leafy)
- Teach to observe for bleeding
What is the Major Complication r/t PVD?
Venous Stasis Ulcers
Chronic & difficult to heal & they often recur.
Can lead to amputation or death
Pt. with neuropathy (DM) may not feel as much discomfort.
What are some nursing actions r/t Venous Stasis Ulceration?
- Treatments to improve circulation
a. Wound Vacuum
b. Hyperbaric Chamber - Apply oxygen-polyethylene films to superficial tissue
- Apply dressings - Change Q3 - 5 Days
- Chemical debridement, eliminate necrotic tissue
- Antibiotics
- Diet high in zinc, protein, iron, VIT. A & C.
- Compression Stockings
