Pulmonary Embolism/DVT Flashcards
What is a pulmonary embolus ?
Thrombus (clot) that lodges in a segment of the pulmonary arterial system
What does a pulmonary embolus cause and what occurs in the body as a result?
Full/partial obstruction of pulmonary blood flow - causes a decrease in oxygenation
What are some of the risk factors associated with VTE (venous thromboembolism)
Age
Immobilisation
Surgery esp ortho surgery
Obesity
Pregnancy and post-partum
Acute CVA
Chronic lung disease
Post surgery/trauma
IV therapy, CV catheters
Hypercoagulability
Smoking
What is DVT (deep vein thrombosis)
Acute venous insufficiency caused by clot deep in venous system
What are some of the S and S associated with DVT
Oedema, pain , erythema + warmth, peripheral distension
When does a DVT become a pulmonary embolism
When the clot breaks off within the vein, enters circulation and ends up in the lungs
Varichow’s Triad include the 3 main categories that can cause blood clot formation. It also helps us identify those who are at risk of forming these clots. Name these categories.
Stasis of Venous circulation
Hypercoagulability
Endothelial damage (anything that causes damage to vein vessel)
What are some of the things that can cause stasis of venous circulation?
Immobilisation
Varicose veins
Surgery
Travelling for a long time w/o moving
Heart failure, A-fib
Obstruction - late pregnancy, obesity
What are some of the things that increases blood coagulation ?
Cancer
Severe illness- sepsis
Dehydration
Usage of oestrogen ( birth control)
Heparin induced thrombocytopenia (HIT)
Post partum
What are some of the things that can cause endothelial damage ?
IV therapy - venipuncture
Central line cath, heart valve - in dwelling devices
Meds
Trauma/ injury to vessel eg. Surgery
What are some of the S+S of PE
Tachypnoea- RR > 20 bpm
Hypotension
Signs of DVT- red, swollen calf
Pleural rub- squeezing/grating sound caused by ischemic lung tissues coming in contact with pleura
Cyanosis
SOB
Cough
Tachycardia- >100bpm
Pleuritic chest pain
Coughing up blood (haemoptysis)
Dizziness/fainting
What are some of the tests done for PE/DVT
Pt hx and phys exam
US (DVT)
Chest x-ray w contrast dye
ECG
ABG
D- dimer test
MRI
ECHO
CT pulmonary angiography
Familial/genetic testing
What does a d-dimer test assess for ?
Assess blood for fibrin degradation fragment
What is a fibrin degradation fragment ?
Protein fragment that hangs out in blood when clot has presented and started to break down
What does a d-dimer test do and not do ?
Can diagnose blood clots
Does not tell location of clot
Sometimes gives false positive result
With pts at high risk of developing a PE/DVT, what is the preventative nursing mgt?
Reduce immobility time- up and out of bed whenever they can
Avoid too much bed rest
Early mobilisation after surgery etc
Leg and lower extremity exercises why lying/sitting down
Good fluid intake
TED stocking
Anticoagulants- heparin, clexane
Pneumatic compression devices
What is the pneumonic that can be used to help with the nursing management of DVT
DEEP CLOT
What does the D stand for in DEEP CLOT
Don’t massage/rub affected extremity
What does the first E stand for in DEEP CLOT
Elevate affected extremity above heart lvl - promotes blood flow and reduces swelling
What does the second E stand for in DEEP CLOT
Ensure bed rest
What does the P stand for in DEEP CLOT
Pharmacological measures: anticoagulants do not break up existing clot but helps prevent clot from getting bigger + new clots forming
What does the C stand for in DEEP CLOT
Compress (warm +moist) to affected extremity
What does the L stand for in DEEP CLOT
Leg circumference measurement (calf)
What does the O stand for in DEEP CLOT
Observe for S+S of PE:
-SOB (coughing)
- reduced O2 sats
- ^ HR
- chest pain
- anxiety
What does the T stand for in DEEP CLOT
Tight compression socks (TEDs) :
Promotors blood flow and reduces swelling
What is the function of heparin
Slows the progression of thrombosis :
-works fast
-given IV or SubQ
- wgt based
-monitor aPTT on blood results
When is anticoagulation therapy stopped ?
If a PE is ruled out
Name some anticoagulant meds
Apixaban (clexane)
Rivaroxaban
Warfin
What is the function of warfarin?
Inhibits clotting factors from using vit K:
-works slow
- given PO
- monitor INR ( 2-3 - therapeutic)
