Transition DVT

Question 1

Virchow’s Triad

Answer 1

1. Hypercoagulability
2. Venous stasis
3. Tissue damage

Question 2

6 risk factors for DVT

Answer 2

1. Venous stasis:
   lengthy surg
   immob
   older age
   preggo
   afib aflutt
   HF
   obesity
   stroke
   denervated limb
   orthopedic surg
2. Venous endothelial injury
   prev dvt
   iv cath
   bone fracture
   chemical injury (smoking)
   high CBG chronic
   trauma
   vericose
   HTN
   pacing wires
   Central lines
   dialysis cath
   chemotherapy
3. hypercoagulability
   tumor
   cancer
   dehydration
   oral contraception
   estrogen
   sepsis
   blood dyscratias
   burns
   genetic predisp
   preggo

Question 3

Deep veins are thin or thick walled

Answer 3

thin

Question 4

Venous system is high pressure or low pressure?

Answer 4

low = clots

Question 5

LJ’s risk factors

Answer 5

smoking
decreased mobility
A fib and flutter
previous DVT
70 years old
bus driver (sedentation)

Question 6

Most important assessments for LJ

Answer 6

1. Cardiovascular
   baseline vitals
   heart sounds
   compare extremities
2. Vascular
   venous assessment
   warmth
   redness
   pain
   edema
   distal pulses
   cap refil
   baseline calf and thigh girth
   Homan’s sign (not fool proof)
3. Respiratory system
   breath sounds
   dyspnea
   chest pain
   baseline pulmonary ass
4. Neuro exam
   LOC
   CNFS
   restlessness
   lethargy
   AOX?

Question 7

Most serious side effect of DVT

Answer 7

PE AND CVA

Question 8

8 assessments to monitor (PE syptoms)

Answer 8

• crackles
• cough
• tachycardia
• restless
• dyspnea/tachypnea
• pleuritic chest pain
• fear/apprehension
• hemoptysis
• fever
• N/V
• Cyanosis

NEED BASELINE ASSESSMENT to be able to recognize right away

Question 9

VTE

Answer 9

venous thromboembolism = PE

Question 10

Which systems are abnormal?
Neuro
Resp
Cardiov
Genitour
Skin
Psychosocial
Pain

Answer 10

crackles
cough
HTN
tachycard
3+ edema
erythem
calf pain
O2 92%
SOB
anxious

Neuro
Resp
Card
Skin
Pain
psychosocial

Question 11

Why Lovenox instead of Coumadin?

Answer 11

Coumadin onset 12-24 hours, peak 1-2 days

Needs rapid:
Enoxaparin (3-5 hours peak)

Question 12

Enoxaparin dosage

Answer 12

1 mg per kilogram

Question 13

Special techniques for subQ Enoxaparin

Answer 13

rotate sites
love handles (lovenox)
DON’T expel air bubble
DON’T aspirate
DON’T massage

Question 14

T/F lovenox monitored by aPTT

Answer 14

False: anti Xa

Question 15

Bed rest?

Answer 15

Nah

But if can’t move:
change pos freq
dorsiflex/plantar flex
foot pumps
ankle circles
knee to chest
don’t cross legs
don’t massage area
right leg elevated, NO pressure under knee
no sudden muscle movements
SCD on unaffected leg
Ted hose unaffected leg

Question 16

What labs to order

Answer 16

PLT (HIT)
CBC
chest xray
d-dimer
ct scan chest
ABGs
Occult blood