venous insufficiencies

Question 1

venous thromboembolism (DVT)

Answer 1

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

Question 2

dvt contributing factors

Answer 2

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

Question 3

dvt clinical manifestations

Answer 3

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

Question 4

venous ulcers s/s

Answer 4

Usually around ankle
Reddened/bluish
Edema often present

Question 5

nursing interventions for dvt

Question 6

meds for dvt

Answer 6

• 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

Question 7

s/s of pe

Answer 7

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

Question 8

prevention of VTE

Answer 8

• 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)

Question 9

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.

Answer 9

b

Question 10

anticoagulants

Answer 10

Heparin Sodium
- Subq
- IV (higher risk)

Enoxaparin (Lovenox)
- Subq

Warfarin
- Oral

Question 11

use for heparin and lovenox

Answer 11

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

Question 12

disorders for use of heparin and lovenox

Answer 12

Evolving stroke
DVT
Cardiac catherization
MI
DIC

Question 13

precuations for h&l

Answer 13

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

Question 14

side effects of h&l

Answer 14

Hemorrhage
Heparin induced thrombocytopenia
Toxicity/overdose

Question 15

heparin nursing interventions

Answer 15

• 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

Question 16

reversal of heparin

Answer 16

Administer protamine sulfate for toxicity

Question 17

warfarin

Answer 17

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

Question 18

therapeutic use of warfarin (coumadin)

Answer 18

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

Question 19

warfarin (coumadin) contraindicated in patients with

Answer 19

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

Question 20

side effects of warfarin

Answer 20

Hemorrhage
Toxicity/Overdose

Question 21

nursing interventions for warfarin

Answer 21

• 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.

Question 22

vitamin k

Answer 22

antidote for toxicity

Question 23

avoid eating or drinking

Answer 23

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

Question 24

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.”

Answer 24

c

Question 25

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.

Answer 25

a,b,c

Question 26

varicose veins

Answer 26

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

Question 27

varicose veins caused by

Answer 27

Prolonged standing Pregnancy Obesity Heredity - can end up affecting perfusion

Question 28

nursing interventions for varicose veins

Answer 28

- 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!!!

Question 29

Sclerotherapy

Answer 29

chemical injection

Question 30

ligation and stripping

Answer 30

surgery

Question 31

thermal ablation

Answer 31

non surgical use of energy or lasers

Question 32

Raynaud’s Syndrome

Answer 32

- 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.

Question 33

raynaud syndrom clinical manifestations

Answer 33

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

Question 34

diagnostic procedure raynaud syndrome

Answer 34

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

Question 35

nursing intervention raynaud syndrome

Answer 35

- 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)

Question 36

buerger disease (thrombonangtiis obliterans)

Answer 36

- Recurring inflammation of the arteries and veins of the lower and upper extremities, resulting in thrombus with occlusion. - Cause unknown

Question 37

buergers disease contributing factors

Answer 37

Genetic predisposition Smoking and chewing tobacco Men ages 20-35

Question 38

buerger disease clinical manifestation

Answer 38

- 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

Question 39

nursing interventions for buergers disease

Answer 39

- Promote smoking cessation. - Avoid cold or constrictive clothing.

Question 40

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

Answer 40

d