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Complex Care > VTE/PE > Flashcards

VTE/PE Flashcards

1
Q

Usual location of SVT

A

superficial arm veins or leg veins

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2
Q

Usual location of VTE

A

deep veins of arm (axilla, subclavian)

legs (femoral)

pelvis (iliac/inferior vena cava)

pulmonary system

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3
Q

Clinical findings of SVT

A

tenderness, redness, warmth, pain, inflammatin, palpable cord

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4
Q

Clinical findings of VTE

A

tenderness to pressure over involved vein

venous distention

edema

mild pain

deep brown color

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5
Q

Complications of SVT

A

usually benign but can become VTE if spreads to deep veins

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6
Q

Complications of VTE

A

PE, potential death

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7
Q

What 3 things cause VTEs?

A
  1. venous stasis
  2. endothelial damage
  3. blood hypercoaguability
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8
Q

What 3 things cause venous stasis?

A

dysfunctional valves, change in blood flow, or inactive muscle

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9
Q

What individuals are at risk for venous stasis?

A
  1. obese/pregnant
  2. heart failure
  3. atrial fibrillation
  4. long trips
  5. prolonged immobilization
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10
Q

Why are obese/pregnant clients at risk for venous stasis?

A

1 mile of capillaries for every pound of weight

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11
Q

Why are patients in heart failure at risk for venous stasis?

A

heart pump slower - blood doesn’t move through the system as fast

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12
Q

Why are patients with atrial fibrillation at risk for venous stasis?

A
  • blood pools and can become clots in the atria
  • upper chambers of the heart (atria) beat irregularly and too fast, causing inefficient blood flow.
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13
Q

What are the two types of endothelial damage and examples of both?

A

Direct: surgery, trauma, burns (damage from outside)

Indirect: chemo, diabetes, sepsis (something from inside)

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14
Q

How does endothelial damage increase VTE risk?

A

Damage/vasoconstriction stimulate platelets and release of clotting factors

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15
Q

What is blood hypercoaguability

A

Imbalance in clotting mechanisms (fibrin production) leading to increasing coagulation

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16
Q

Who is at risk for endothelial damage?

A
  • Surgical repair - pelvic, abdomen, ortho
  • Trauma
  • Burns
  • Chemotherapy
  • Diabetes
  • Sepsis
  • Individuals with prior VTE are at risk for another
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17
Q

What individuals are at risk for blood hypercoagulability?

A
  • Women on BCP/ERT especially over 35
  • Person with sepsis
  • Malignancies
  • Clotting disorders (genetic)
  • Dehydration
  • Malnourished
  • Severe anemia
  • Sepsis
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18
Q

Half of VTE patients are:

A

Asymptomatic

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18
Q

3 effects of smoking for VTE risk

A
  1. nicotine causes vasoconstriction
  2. increases plasminogen activates intrinsic coagulation pathway
  3. increase homocysteine levels causing vascular inflammation
19
Q

Symptoms of VTE:

A
  1. tenderness with palpation
  2. low grade fever
  3. chills/lethargy
  4. unilateral leg pain
  5. altered symmetry, size, color, temperature
  6. venous insufficiency
20
Q

Symptoms of venous insufficiency

A
  1. swelling/heaviness related to pooling of blood
  2. decreased cap refill
  3. edema
  4. more pronounced varicose veins
21
Q

Describe the pain associated with a VTE

A

dull, aching, fulllness, ‘pulled muscle’

22
Q

What does ultrasound imaging show you r/t VTE

A
  • color flow techniques to identify areas of insufficiency
  • bilateral comparison of blood flow
  • dependent on area of clot
23
Q

What is a CT scan imaging show r/t VTE

A

for soft tissues only (wouldn’t be ordered if concern is just with calves)

For concern with PE

24
Q

What does d-dimer bloodwork show

A

D-dimer is a product of the breakdown of blood clots. Elevated levels of D-dimer can indicate the presence of abnormal blood clot formation in the body

25
Q

What does CT angiography show?

A

fluoroscopy under x-ray with contrast to visualize blood vessels to evaluate blockages, aneurysms, and vascular abnormalities

26
Q

Prevention of VTE

A
  1. early mobilization
  2. leg exercises
  3. anti-embolic stockings
  4. fluids for good circulating volume
  5. preventative anticoagulation (heparin)
27
Q

What subjective information would you want to assess for a VTE patient?

A
  1. lifestyle (smoking, sedentary, high BMI)
  2. prolonged immibility (sedentary, recent hospitalization)
  3. medications (birth control, steroids, chemo)
28
Q

Symptoms of bleed

A

tarry stools, bleeding in gums, bruising

29
Q

What are your priority assessments for a patient with a VTE

A
  1. peripheral vascular and skin (redness and warmth BILATERALLY)
  2. peripheral pulses
  3. pain
  4. cardio and resp for changes
  5. bleeding with anticoagulation therapy
30
Q

What are the key things to monitor for a patient on anticoagulant therapy?

A
  1. cardiopulmonary
  2. peripheral vascular assessment
  3. CBC and coagulation panel
31
Q

What vitamin k antagonist is used for anticoagulant therapy and what are its considerations?

A

warfarin

PO

long term use

intrinsic pathway

frequent lab work and titration

32
Q

Advantages of heparin:

A
  • less likely to cause allergic reaction
  • better bioavailability
  • decreased risk of bleeding
  • prevents conversion of fibrin
  • antidote is protamine
  • Patients can go home on it
33
Q

What indirect thrombin inhibitors are used in anticoagulant therapy?

A

heparin (unfractionated and LMWH) IV and SC

34
Q

Who are direct thrombin inhibitors (Hirudin derivatives - Angiomax, Refludan
Synthetic - Argatroban (no antidote) IV) used for?

A

Those with heparin induced thrombocytopenia (HIT); similar to allergic reaction

35
Q

Considerations of Factor Xa inhibitors

A

no bloodwork monitoring

not for use in patients with renal failure

36
Q

What surgical therapies are available for VTE?

A

Open venous thrombectomy: Physical removal when ineligible for thrombolytic therapy or really large occlusion

Inferior vena cava interruption: filter placed percutaneously via femoral

37
Q

Describe pleuritic chest pain

A

Stabby pain that changes with movement

37
Q

Symptoms of PE

A
  1. dyspnea
  2. tachypnea
  3. Pleuritic pain
  4. cough
  5. wheezing
  6. unilateral leg pain/swelling
  7. crackles r/t atelectasis
  8. tachycardia
  9. anxiety
38
Q

What are the priority assessment for a patient with PE?

A
  1. pulmonary
  2. cardiac
  3. peripheral
39
Q

Prevention of PE

A
  1. mobility and ROM
  2. pneumatic compression
  3. anticoagulation
  4. avoidance of restrictive clothing and importance of mobility
40
Q

Treatment of PE

A
  1. ABCs
  2. Oxygen therapy
  3. anticoagulation
  4. thrombolytics
  5. labs (PTT/INR/d-dimer/factor xa)
41
Q

What are important patient teaching for a VTE/PE?

A
  1. having one predisposes you to lifelong risk
  2. frequent mobility
  3. refrain from restrictive clothing
  4. no crossing legs
  5. encourage smoking cessation
  6. adequate hydration
  7. change birth control
42
Q

A high INR means

A

It takes your blood a longer time to clot - extrinsic/tissue pathway

High = Risk for bleed
Low = Risk for clots

Normal 0.8-1.2

Someone on anticoagulants 2-3

42
Q

How soon can you mobilize someone with a DVT?

A

As soon as they have had their first dose of SC heparin

43
Q

If someone is at risk for a clot they should have a _______ INR

A

higher - so it takes them a longer time to clot decreasing risk

44
Q

What does aPTT assess

A

How long it takes to clot - intrinsic/contact pathway of coagulation

Complex Care (9 decks)

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