Week 4 - DVT Flashcards
1
Q
what is DVT
A
- disorder involving a thrombus in a deep veing
2
Q
what 2 veins does DVT typically effect
A
- femoral
- iliac
3
Q
what are the 3 main factors in the cause of venous thrombosis
A
- venous stasis
- endothelial damage
- hyerpcoaguable blood
4
Q
what are risk factors for venous stasis (7)
A
- obesity
- pregnancy
- HF
- afib
- long trips w/o regular exercise
- prolonged surgical procedure
- immobolity for long periods
5
Q
what are causes of endothelial damage (7)
A
- surgery
- imtravascular catheterization
- trauma
- burns
- chemo
- DM
- sepsis
6
Q
what can cause hypercoaguability of blood (4)
A
- sepsis
- oral contra
- smoking
- hematological disorders
7
Q
what are symptoms of DVT (8)
A
- unilateral leg edema
- extremitity pain
- sense of fullness in thigh/calf
- paresthesias
- warm skin
- erythema
- fever
- positive Homen’s
8
Q
what is a positive homen’s sign
A
- pain on forced dorsiflexion of the foot when the leg is raise
9
Q
what are complications of DVT (4)
A
- PE (life threatening)
- chronic venous insufficiency
- phlegmasia cerula dolens
- venous leg ulcers
10
Q
what are S&S of chronic venous insufficiency (5)
A
- persistent edema
- increased pigmentation
- secondary varicosities
- ulceration
- cyanosis of limb
when limb is placed in dependent position
11
Q
what types of care are done for DVT (3)
A
- prevention and prophylaxis
- drug therapy
- surgical therapy
12
Q
what are ways to prevent DVT in pts who are at risk (4)
A
- mobilization = easiest and most cost-effective method
- compression stocking
- sequential compression devices
- preventative anticoag
13
Q
what are some ways to mobilize to prevent DVT (3)
A
- if on bed rest, turn q2h
- flex & extend feet, knees, hip q2-4 h
- ambulate 4-6 x/day as tolerates
14
Q
what are sequential compression devices
A
- inflatable garments wrapped around the legs that apply intermittent external pressure
15
Q
what meds are used routinely for prevention and treatment of DVT
A
- anticoags
16
Q
what is the goal of anticoag therapy (4)
A
- prevent clot formation
- prevent propagation of clot
- prevent development of new thrombi
- prevent embolization
17
Q
what are 4 major classes of anticoag therapy
A
- vitamin K antagonist
- direct thrombin inhibitor
- indirect thrombin inhibitor
- factor Xa inhibitor
18
Q
anticoagulant therapy does not…
A
- dissolve the clot
19
Q
what type of med is not recommended for DVT thromboprophylaxis
A
- aspirin
20
Q
what is a type of vitamin K antag
A
- warfarin
21
Q
how long does it take for warfarin to be effective
A
- 48-72 hr to affect PT time
- several days for maximum effort
22
Q
due to the time it takes for warfarin to be effective, what is required
A
- overlap of a parental anticoag (ex. unfractioned heparin, low molecular weight heparin) for at least 5 days
- once warfarin at therapeutic lvl, d/c heparin
23
Q
what blood coag test should be monitored w warfarin
A
INR
24
Q
a diet that frequently varies in _____, makes it difficult to achieve and maintain therapeutic INR w warfarin
A
- vitamin K
25
what is the normal INR time? therapeutic?
- normal = .81-1.2
| - therapeutic = 2-3
26
what are 2 classes of indirect thrombin inhibitors
- unfractioned heparin
| - low molecular weight heparin
27
what blood coagulation test should be monitored w heparin
- aPTT (PTT)
28
what is a serious s/e of heparin
- heparin induced thrombocytopenia
29
what is the benefit of LMWH (4)
- more predictable dose response
- lower incidence of bleeding complications
- less likely to cause HIT and osteoporosis
- do not require anticoag monitoring and dose adjustment
30
what is a type of direct thrombin inhibitor
- hirudin
31
what meds are used for DVT prophylaxis (4)
low dose
- UH
- LMWH
- warfarin
- fondaparinux
32
what anticoag meds are used for DVT treatment (4)
- LMWH
- UH
- fondaparinux
- warfarin
for at least 5 days or until INR is 2 or higher
33
what thrombolytic therapy is used for DVT (5)
- catheter directed admin of a thrombolytic drug
- tPa/alteplase
- angioplasty
- stents
- mechanical thrombectomy
34
what is the normal aPTT time? therapeutic?
- normal = 30-40 sec
| - therapeutic = 46-70 sec
35
what is discharge teaching for anticoag therapy (9)
- contact EMS for bleeding that doesn't stop (10-15 min)
- take med at same time everyday
- frequent follow ups for bloodwork
- avoid contact sports (d/t risk for trauma)
- use soft bristled toothbrush
- limit alcohol (1oz/day)
- wear medic alert bracelet
- inform all HCP of anticoag therapy (including dentist)
- avoid changes in eating habits (espec vit K)
36
what should a pt on anticoag therapy report (6)
- tarry stools
- severe headache
- stomach pain
- confusion
- dizziness
- bruising
that is more than normal
37
what should pts on anticoag therapy not take (3)
- NSAIDs
- ASA
- many herbal drugs
38
what is a type of surgical therapy for DVT (2)
- open thrombectomy
| - inferior vena cava interruption
39
describe teaching for a pt with DVT (10)
- modification of risk factors
- use of compression stockings
- avoid constrictive clothing
- avoid standing or sitting in motionless, lep-dependent position
- frequent knee flexion, ankle rotation and active walking during long periods of sitting or standing
- wear compression stocking or take 1 dose of LMWH before long flight
- S&S of PE
- med education
- apply pressure for 10-15 min if bleeding occurs
- proper hydration to avoid hypercoagulability of blood
40
what is chronic venous insufficiency
- a condition in which the valves in the veins are damaged causing retrograde blood flow, swelling & pooling of blood in legs
41
what can CVI lead to
- venous leg ulcers
42
what impact does CVI have on hydrostatic P and wat does this cause
= increased hydrostatic pressure
| = serious fluid & RBCs leak from capillaries into tissue resulting in edema & skin irritation
43
what are symptoms of CVI (5)
- edema
- itching
- stasis dermatitis (eczema)
- skin hyperpigmentation (brown, leathery)
- venous ulcers
44
where are venous ulcers often located
- medial mallelous
45
describe manifestations of venous ulcers (3)
- painful (may be worse when in dependent position)
- irregular borders
- lots of drainage
46
describe collaborative care for venous ulcers (9)
- compression bandages
- moist enviro dressings
- balanced diet
- maintain normal BG if has DM
- prevent and assess for S&S of infection
- proper skin care & non scented moisturizers
- daily walking program
- avoid standing or sitting for too long
- elevate legs to reduce swelling
47
what are compression bandages imp for? (3)
- treatment of CVI
- venous ulcer healing
- prevention of ulcer recurrence
48
how do compression bandages help w treatment of venous ulcers and CVI (2)
- constrict the veins
| - improves fnxn of venous valves
49
describe the diet for someone w venous ulcers (6)
- adequate protein
- cal
- vitamin A
- vitamin C
- zinc
- weight loss diet
*all imp for healing)
50
what foods are high in vitamin A
- green leafy veggies
51
what foods are high in vitamin C (3)
- citrus fruits
- tomatoes
- canteloupe
52
what food are high in zinc (2)
- meat
| - seafood
53
what are signs of infection in a venous ulcer (8)
- change in quanitity, color, or odour of drainage
- presence of pus
- erythema of wound edges
- increased local pain and/or edema
- dark colored granulation tissue
- induration around wound
- delayed healing
- cellulitis
54
if signs of infection are present in a venous ulcer, what should you do
- get wound culture before instituting ab
55
what is the usual treatment for infection in a venous ulcer (3)
- debridement
- wound excision
- systemic antibiotics
56
what should you teach a pt with venous leg ulcers and CVI (9)
- avoid trauma to limbs
- teach proper skin care
- teach how to use compression stockings
- proper foot and leg care
- w each dressing change, assess the wound for signs of infection
- avoid standing or sitting for long periods of time
- elevate legs to reduce edema
- daily walking program once ulcer heals
- prescription graduated compression stocking worn daily and replaced every 4-6 mo.
57
describe what to teach a pt r/t proper foot and leg care w CVI and venous leg ulcer (2)
- daily moisturizing to decrease itching and prevent cracking
- avoid scented moisturizers
58
can compression bandages be used for both arterial and venous issues?
no never use for arterial
