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NU318 Exam 5 > venous thromboembolism > Flashcards

venous thromboembolism Flashcards

1
Q

hemostasis

A

regulated process of preserving vascular integrity by balancing clotting formation and excessive bleeding

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2
Q

regular process of hemostasis

A

activated by injury to blood vessel

hemostatic system seals off injury through platelet plug and fibrin formation

allows injured endothelium to heal

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3
Q

hypercoagulability

A

more risk for clotting
multiple coagulation factors
extra blood clot forming - thrombus can obstruct blood vessels and interfere with blood flow

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4
Q

coagulation cascade

A

terminal steps (each step is dependent on one before)
activation of factor x
conversion of prothrombin to thrombin
conversion of fibrinogen to fibrin

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5
Q

intrinsic side

A

look at this to measure PTT

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6
Q

extrinsic side

A

look at this to measure PT

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7
Q

vasoconstriction

A

reduces blood loss

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8
Q

platelet plug

A

platelets form onto injury along with fibrin plug

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9
Q

clotting cascade

A

clotting factors are activated

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10
Q

virchow’s triad

A

endothelial damage, hypercoagulability, stasis

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11
Q

endothelial dysfunction can be caused by

A

smoking, HTN

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12
Q

endothelial damage can be caused by

A

surgery, catheter (PICC lines), trauma

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13
Q

hypercoagulability can be caused by

A

cancer, chemo, pregnancy, obesity, HIT, oral contraceptives, hormone replacement

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14
Q

stasis can be caused by

A

immobility, polycythemia (excess platelets)

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15
Q

DVT

A

impede venous return, create inflammatory response, risk for pulmonary embolism

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16
Q

acute DVT

A 
redness
unilateral swelling
uncomfortable
difficulty with walking
half of DVTs are asymptomatic
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17
Q

clinical manifestations of DVT depend on

A

location and size of thrombus

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18
Q

clinical manifestations of DVT

A 
edema
warmth
tenderness to pain
functional impairment
may be asymptomatic
signs and symptoms of inflammation (fever, malaise, increase in WBC)
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19
Q

D-dimer level

A

positive is greater than 500

serum blood test that shows breakdown of fibrin in the blood

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20
Q

compression ultrasonography

A

shows that a clot exists, pushing down on veins

shows restriction of blood flow

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21
Q

complications of DVT

A 
clot extension (more platelets joining clot)
pulmonary embolism
postphlebitic syndrome 
venous valve damage
recurrent DVT formation
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22
Q

goal of managing DVT

A

prevent further thrombosis and complications

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23
Q

strategies to manage DVT

A

anticoagulant therapy
patient education
endovascular management
symptom management

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24
Q

DVT nursing management

A 
anticoagulant therapy
monitor complications
provide comfort
graduated compression stockings
positioning and activity
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25
Q

graduated compression stockings

A 
decrease swelling 
prevent venous insufficiency 
wear them all day
remove at night
check pulses
pain will decrease
can apply warm, moist heat
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26
Q

positioning and activity

A

have legs up and do not want them to cross legs (avoid severe flexion)

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27
Q

initial anticoagulation (first 10 days)

A

subcutaneous low molecular weight heparin (enoxaparin)
Xa inhibitors
oral factor Xa inhibitors
unfractionated heparin

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28
Q

long term anticoagulation (10 days-3 months)

A

direct factor Xa inhibitors
thrombin inhibitors
vitamin K antagonists (warfarin)

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29
Q

nursing considerations for AC therapy

A 
safety
lab monitoring
close observation for bleeding
patient teaching
med safety
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30
Q

lab monitoring for heparin

A 
monitor PTT (1.5-2.5 x regular number)
has a short half-life
31
Q

lab monitoring for warfarin

A

monitor PT (64 secs) and INR (2-3)
above 3 - very high bleeding times
below 2 - slow and at risk for clot

32
Q

heparin antidote

A

protamine sulfate

33
Q

warfarin antidote

A

if INR is 7

vitamin K

34
Q

side effects of heparin

A

heparin-induced thrombocytopenia (HIT)
monitor platelets, baseline CBC before administration
if platelets are low, notify provider and stop infusion - start anticoagulant

35
Q

action of heparin/enoxaparin

A

inhibits thrombus and clot production by blocking the conversion of prothrombin to thrombin and fibrinogen t fibrin (inhibit formation of additional clots)

36
Q

adverse effects of heparin

A

loss of hair, bruising, chills, fever, osteoporosis, suppression of renal function (long term use), thrombocytopenia, hyperkalemia

37
Q

teaching points that are priority for a patient receiving AC therapy

A

brush teeth gently with soft bristle brush
wear or carry med alert notification
use an electric razor when shaving
obtain follow-up lab work regularly as ordered

38
Q

if a patient is on a heparin infusion and exhibits bleeding, nursing interventions include

A

stop the heparin infusion (first)
obtain coagulation labs
monitor BP hourly

39
Q

meds that can affect the action of anticoagulants

A 
vitamins
cold meds
antibiotics
aspirin
mineral oil
anti-inflammatory agents
40
Q

report symptoms to health provider

A 
faintness
dizziness
increased weakness
severe headaches
abdominal pain
reddish/brownish urine
any bleeding
bruises/nosebleeds
red or black bowel movements 
rash
41
Q

thrombectomy

A

getting rid of thrombus by inserting catheter

42
Q

vena cava filter

A

done for patients at high risk for clotting but not appropriate for AC therapy
seen in orthopedic surgeries
threaded through femoral vein into vena cava

43
Q

DVT prevention

A 
prophylactic meds (heparin)
graduated compression stockings
pneumatic compression devices
positioning - avoid flexion
hydration
activity and passive limb exercises
ambulation
avoid sitting/standing for long time
44
Q

pulmonary embolism

A

thrombus that originated in venous system and turns into emboli, breaks off, and gets into the right side of the heart

45
Q

pathophysiology of PE

A

thrombus obstructing pulmonary artery

increase in alveolar dead space

increase in pulmonary vascular resistance and pulmonary artery pressure

may lead to ischemic necrosis

46
Q

perfusion without ventilation

A

obstruction within airway
normal blood flow
blood is going to be not oxygenated

47
Q

ventilation without perfusion

A

blocking flow of blood

air is going to lungs but blood is not getting to alveoli

48
Q

clinical manifestations of PE

A 
dyspnea and tachypnea
chest pain (pleuritic pain) 
anxiety and apprehension (impending sense of doom)
fever
tachycardia
hemopytsis
cough
49
Q

symptoms will depend on ____ of PE and _____ of obstruction

A

size; location

50
Q

complications of PE

A

hemodynamic instability (syncope, weak rapid breath)
shock
death

51
Q

vitals for PE

A

tachypnea, tachycardia, low BP

52
Q

ABGs for PE

A

can start off with respiratory acidosis and progress to alkalosis

53
Q

EKG for PE

A

inverted T-waves

no presence of ST elevation

54
Q

chest XR for PE

A

infiltrates present

55
Q

V/Q scan for PE

A

mismatch between perfusion and ventilation

56
Q

pulmonary angiography for PE

A

gold standard

direct visualization of obstructed artery

57
Q

diagnostic tests that are related to PE

A

d-dimer assay
V/Q scan
spiral CT
pulmonary angiography

58
Q

objectives of managing PE

A

restore pulmonary perfusion
prevent further DVT/PE
protect lungs from thromboemboli

59
Q

management strategies for PE

A 
AC therapy
symptom management
surgical management
Pt education 
thrombolytic therapy
60
Q

AC vs. thrombolytic therapy

A

AC therapy used for non-massive PE

thrombolytic therapy used for massive PE

61
Q

general management for PE

A 
O2 therapy
managing pain
relieving anxiety
monitor complications
AC or thrombolytic therapy
patients should have IV access (meds and fluids)
62
Q

action of urokinase

A

activating plasminogen to plasmin which breaks down fibrin threads in a clot to dissolve a formed clot

63
Q

indications of urokinase

A

acute MI, massive pulmonary emboli, ischemic stroke

64
Q

pharmacokinetics of urokinase

A

drug must be injected and are cleared from the body after liver metabolism
pregnancy and lactation

65
Q

prior to administration of urokinase

A

monitor coagulation status (CBC)

66
Q

after administration of urokinase

A

monitor bleeding and LOC

67
Q

contraindications of urokinase

A

allergy and bleeding disorders

68
Q

adverse effects of urokinase

A

bleeding (do invasive procedures beforehand)
cardiac dysrhythmias
hypotension
hypersensitivity (rash, flushing, bronchospasm, anaphylactic reaction)

69
Q

embolectomy

A

catheter through vena cava to pull out clot; not common because PE can happen too quickly

70
Q

administration of enoxaparin (LMWH)

A

IV and subcutaneous (can take it home)

71
Q

administration of heparin

A

IV and subcutaneous

72
Q

signs of enoxaparin overdose

A

hemorrhagic complications

73
Q

signs of heparin overdose

A

bleeding, nosebleeds, hematuria, tarry stools, bruising, petechial formations

74
Q

signs of warfarin overdose

A

blood in stools/urine, excessive bruising, persistent oozing from superficial injuries, excessive menstrual bleeding, melena, petechiae

NU318 Exam 5 (4 decks)

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