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Med Surg 2 > venous insufficiencies > Flashcards

venous insufficiencies Flashcards

1
Q

venous thromboembolism (DVT)

A

The collective condition of deep-vein thrombosis(DVT) and pulmonary embolism (PE)

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2
Q

dvt contributing factors

A

Immobility
Surgery
Trauma
Obesity
Age greater than 65
Spinal cord injury
Disorders of coagulation
Pregnancy
Oral contraceptives

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3
Q

dvt clinical manifestations

A
  • Edema of affected limb
  • Local swelling
  • Redness of affected limb
  • Tender, local induration
  • Venous ulcers
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4
Q

venous ulcers s/s

A

Usually around ankle
Reddened/bluish
Edema often present

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5
Q

nursing interventions for dvt

A
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6
Q

meds for dvt

A
  • Heparin: Monitor PTT.
  • Warfarin (Coumadin): Monitor INR. (advoid vitamin K)
  • Thrombolytic therapy: alteplase.
  • Assess for bleeding and thrombocytopenia.
  • Elevate affected extremity and apply warm, moist compresses
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7
Q

s/s of pe

A
  • Shortness of breath
  • Chest pain
  • Tachycardia
  • Anxiety (rapid feeling/dome)
  • long bone fracture at risk for this
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8
Q

prevention of VTE

A
  • Early mobilization
  • Leg exercises
  • Compression stockings
  • Intermittent pneumatic compression devices
  • Prophylactic subcutaneous heparin (5,000U q2 daily)
    Lovenox (given once 30/40mg) 1 time shot in stomach)
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9
Q

A nurse is caring for a client who has chronic venous insufficiency and a prescription for thigh‑high compression
stockings. Which of the following actions should the nurse take?
a. Massage both legs firmly with lotion prior to applying the stockings.
b. Apply the stockings in the morning upon awakening and before getting out of bed.
c. Roll the stockings down to the knees to relieve discomfort on the legs.
d. Remove the stockings while out of bed for 1 hr, four times a day, to allow the legs to rest.

A

b

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10
Q

anticoagulants

A

Heparin Sodium
- Subq
- IV (higher risk)

Enoxaparin (Lovenox)
- Subq

Warfarin
- Oral

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11
Q

use for heparin and lovenox

A
  • Modifies or inhibits clotting factors prevent clot formations.
  • Lovenox prevents conversion of prothrombin to thrombin by inactivating coagulation enzymes.
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12
Q

disorders for use of heparin and lovenox

A

Evolving stroke
DVT
Cardiac catherization
MI
DIC

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13
Q

precuations for h&l

A
  • Must be given subcutaneous or IV.
  • Incompatible with many medications.
  • Avoid NSAIDS, ASA, or salicylates
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14
Q

side effects of h&l

A

Hemorrhage
Heparin induced thrombocytopenia
Toxicity/overdose

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15
Q

heparin nursing interventions

A
  • Monitor PTT every 4-6 hours for IV administration.
  • Monitor for signs of bleeding
  • Safety precautions to prevent bleeding.
  • Administer subcutaneous in abdomen, 2 inches from umbilicus
  • Do NOT aspirate or massage
  • Rotate injection sites and assess for hematoma
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16
Q

reversal of heparin

A

Administer protamine sulfate for toxicity

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17
Q

warfarin

A
  • Given orally
  • Prevents the syntheses of coagulation factors VII, IX,X, and prothrombin
18
Q

therapeutic use of warfarin (coumadin)

A
  • Venous thrombosis
  • Thrombus prevention for patients with afib or prosthetic heart valves
  • Prevention of recurrent MI
  • Transient ischemic attacks (TIAs)
19
Q

warfarin (coumadin) contraindicated in patients with

A
  • Not safe during pregnancy
  • Thrombocytopenia
  • Vitamin K deficiency
  • Liver disease
  • Alcohol abuse
  • Food sources with high vitamin K may decrease the effects of medication
20
Q

side effects of warfarin

A

Hemorrhage
Toxicity/Overdose

21
Q

nursing interventions for warfarin

A
  • Administer once daily.
  • Monitor INR or PT.
  • Teach patient that bleeding risk remains up to 5 days after therapy is discontinued.
  • Teach patients to avoid NSAIDS and ASA. (too much blood thinning)
  • Teach safety measures to prevent injury and bleeding.
22
Q

vitamin k

A

antidote for toxicity

23
Q

avoid eating or drinking

A
  • Kale.
  • Spinach.
  • Brussels sprouts.
  • Parsley.
  • Collard greens.
  • Mustard greens.
  • Chard.
  • Green tea.
24
Q

A nurse is caring for a client who has a deep‑vein thrombosis (DVT) and has been taking unfractionated heparin for 1 week. Two days ago, the provider also prescribed warfarin. The client asks the nurse about receiving both heparin and warfarin at the same time. Which of the following statements should the nurse give?
a. “I will remind your provider that you are already receiving heparin.”
b. “Your laboratory findings indicated that two anticoagulants were needed.”
c. “It takes 3 to 4 days before the therapeutic effects of warfarin are achieved, and then the heparin can be discontinued.”
d. “Only one of these medications is being given to treat your deep‑vein thrombosis.”

A

c

25
Q

A nurse is teaching a client who has a new prescription for clopidogrel. Which of the following instructions should the nurse include in the teaching?
(Select all that apply.)
a. Avoid the consuming grapefruit while taking this medication.
b. Monitor for the presence of black, tarry stools.
c. Use an electric razor when shaving.
d. Schedule a weekly PT test.
e. Limit food sources containing vitamin K while taking this medication.

A

a,b,c

26
Q

varicose veins

A

Enlarged, tortuous veins in lower extremities that cause pain and edema

27
Q

varicose veins caused by

A

Prolonged standing
Pregnancy
Obesity
Heredity
- can end up affecting perfusion

28
Q

nursing interventions for varicose veins

A
  • Avoid prolonged sitting or standing.
  • Teach patient to wear supportive anti-embolism stockings, especially during long flights and during pregnancy.
  • Avoid crossing legs.
  • Engage in daily exercise.
  • Maintain ideal body weight.
  • Elevate lower extremities.
  • Promote circulation with thigh-high anti-embolism stockings, ambulation and elevation!!!
29
Q

Sclerotherapy

A

chemical injection

30
Q

ligation and stripping

A

surgery

31
Q

thermal ablation

A

non surgical use of energy or lasers

32
Q

Raynaud’s Syndrome

A
  • Vaospastic or obstructive condition of the arteries/arterioles of upper and lower extremities resulting from exposure to cold/stress.
  • More common in women.
  • Causes are not clearly understood.
  • Blood vessels in hands and feet appear to overreact to cold or stress.
33
Q

raynaud syndrom clinical manifestations

A
  • Coldness, pallor, and pain in extremities secondary to vasospasm
  • Occasional ulceration of fingertips
  • Color changes from white to blue to red
    Bilateral or symmetrical
34
Q

diagnostic procedure raynaud syndrome

A

Cold stimulation test: place hands in cold water or expose to cold air to trigger episode.

35
Q

nursing intervention raynaud syndrome

A
  • Teach patient to avoid the cold and keep extremities warm.
  • Wear warm but nonconstructive gloves.
  • Encourage smoking cessation.
  • Teach patient to limit caffeine intake.
  • Administer medications
    +nifedipine (Procardia)
36
Q

buerger disease (thrombonangtiis obliterans)

A
  • Recurring inflammation of the arteries and veins of the lower and upper extremities, resulting in thrombus with occlusion.
  • Cause unknown
37
Q

buergers disease contributing factors

A

Genetic predisposition
Smoking and chewing tobacco
Men ages 20-35

38
Q

buerger disease clinical manifestation

A
  • Intermittent pain in legs, feet, arms, hands.
  • Pain stops when activity is stopped.
  • Inflammation along a vein below the skin’s surface (due to blood clot).
  • Cold sensitivity in hands.
  • Painful open sores on fingers and toes.
  • Ulcerations and gangrene with amputation are common.
  • infection will spread
39
Q

nursing interventions for buergers disease

A
  • Promote smoking cessation.
  • Avoid cold or constrictive clothing.
40
Q

A nurse is completing the admission assessment of a client who will undergo peripheral bypass graft surgery on the left leg. Which of the following findings should the nurse expect?

a. Redness of the affected leg when elevated
b. 3+ dorsal pedal pulse in left foot
c. Thin, peeling toenails of left foot
d. Report of intermittent claudication in the affected leg

A

d

Med Surg 2 (35 decks)

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