Venous Thromboembolism

Question 1

How a thrombus is formed

Answer 1

• Once the factors of Virchow’s triad are present, a thrombus is formed.
• as the thrombus enlarges, blood cells and fibrin collect behind it, producing a larger clot with a “tail” that eventually occludes the lumen of the vein.
• If a thrombus only partially blocks the vein, the thrombus becomes covered by endothelial cells and the thrombotic process stops.
• If the thrombus does not detach, it undergoes lysis or becomes firmly organized and adherent within five to seven days.
• The organized thrombus may detach and result in an embolus that flows through the venous circulation to the heart and lodges in the pulmonary circulation, resulting in pulmonary embolism (PE).

Question 2

symptoms of Superficial Vein Thrombosis

Answer 2

A palpable, firm, subcutaneous cordlike vein
Surrounding area may be itchy, tender, reddened, and warm
Mild temperature elevation
Leukocytosis
Edema of the extremities

Question 3

symptoms of Lower Extremity Venous Thromboembolism

Answer 3

Unilateral leg edema, pain, tenderness, dilated superficial veins
Sense of fullness in the thigh or the calf
Paresthesia
Erythema and warm skin
Systemic temperature greater than 100.4° F (38° C)
If inferior vena cava is involved, both legs may be edematous and cyanotic.
If superior vena cava is involved, similar symptoms may occur in the arms, neck, back, and face.

Question 4

symptoms of Pulmonary Embolism

Answer 4

as sudden onset of dyspnea, tachypnea, and pleuritic chest pain.

Small emboli may go undetected or produce vague, transient symptoms.
Dyspnea is the most common presenting symptom.
Mild or moderate hypoxemia may occur.
Other clinical manifestations include tachypnea, cough, chest pain, hemoptysis, crackles, wheezing, fever, tachycardia, and syncope.
Massive emboli may cause sudden change in mental status, hypotension, and feelings of impending doom.

Question 5

diagnosis tests for venous thromboembolism

Answer 5

Activated clotting time (ACT)
D-Dimer
Duplex ultrasound:
CT/MRI,

Question 6

The following should be implemented for patients at risk for venous thromboembolism (VTE):

Answer 6

• Change position every two hours.
• Flex/extend feet, knees, and hips at least every two hours while awake.
• Sit in a chair for meals and ambulate at least four to six times per day.
• Wear correctly-fitted graduated compression stockings

Question 7

The goals for treatment of a confirmed VTE are as follows:

Answer 7

prevent new clot development
prevent spread of the clot
prevent embolization

Question 8

What kinds of drugs do you use for VTE?

Answer 8

Anticoagulants are used routinely for VTE prevention and treatment. The goal of prophylactic anticoagulant therapy for VTE is to prevent clot formation.

Major classes of anticoagulants:
• Vitamin K antagonists (Warfarin)
• Thrombin inhibitors: Indirect
• Synthetic Thrombin: Direct
• Factor Xa Inhibitors

Question 9

Nursing care for the patient with VTE should be focused on what goal?

Answer 9

prevention of embolus formation and reduction of inflammation.

Question 10

patient education for Warfarin:

Answer 10

• avoid vitamin K foods
• avoid any supplements containing vitamin K.
• drink water to avoid hypercoagulation

Vitamin K, found often in green leafy vegetables, decreases the effectiveness of warfarin. The patient should maintain their vitamin K intake at a constant level, not increase or decrease.