Week 4 - DVT Flashcards
what is DVT
- disorder involving a thrombus in a deep veing
what 2 veins does DVT typically effect
- femoral
- iliac
what are the 3 main factors in the cause of venous thrombosis
- venous stasis
- endothelial damage
- hyerpcoaguable blood
what are risk factors for venous stasis (7)
- obesity
- pregnancy
- HF
- afib
- long trips w/o regular exercise
- prolonged surgical procedure
- immobolity for long periods
what are causes of endothelial damage (7)
- surgery
- imtravascular catheterization
- trauma
- burns
- chemo
- DM
- sepsis
what can cause hypercoaguability of blood (4)
- sepsis
- oral contra
- smoking
- hematological disorders
what are symptoms of DVT (8)
- unilateral leg edema
- extremitity pain
- sense of fullness in thigh/calf
- paresthesias
- warm skin
- erythema
- fever
- positive Homen’s
what is a positive homen’s sign
- pain on forced dorsiflexion of the foot when the leg is raise
what are complications of DVT (4)
- PE (life threatening)
- chronic venous insufficiency
- phlegmasia cerula dolens
- venous leg ulcers
what are S&S of chronic venous insufficiency (5)
- persistent edema
- increased pigmentation
- secondary varicosities
- ulceration
- cyanosis of limb
when limb is placed in dependent position
what types of care are done for DVT (3)
- prevention and prophylaxis
- drug therapy
- surgical therapy
what are ways to prevent DVT in pts who are at risk (4)
- mobilization = easiest and most cost-effective method
- compression stocking
- sequential compression devices
- preventative anticoag
what are some ways to mobilize to prevent DVT (3)
- if on bed rest, turn q2h
- flex & extend feet, knees, hip q2-4 h
- ambulate 4-6 x/day as tolerates
what are sequential compression devices
- inflatable garments wrapped around the legs that apply intermittent external pressure
what meds are used routinely for prevention and treatment of DVT
- anticoags
what is the goal of anticoag therapy (4)
- prevent clot formation
- prevent propagation of clot
- prevent development of new thrombi
- prevent embolization
what are 4 major classes of anticoag therapy
- vitamin K antagonist
- direct thrombin inhibitor
- indirect thrombin inhibitor
- factor Xa inhibitor
anticoagulant therapy does not…
- dissolve the clot
what type of med is not recommended for DVT thromboprophylaxis
- aspirin
what is a type of vitamin K antag
- warfarin
how long does it take for warfarin to be effective
- 48-72 hr to affect PT time
- several days for maximum effort
due to the time it takes for warfarin to be effective, what is required
- 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
what blood coag test should be monitored w warfarin
INR
a diet that frequently varies in _____, makes it difficult to achieve and maintain therapeutic INR w warfarin
- vitamin K
what is the normal INR time? therapeutic?
- normal = .81-1.2
- therapeutic = 2-3
what are 2 classes of indirect thrombin inhibitors
- unfractioned heparin
- low molecular weight heparin
what blood coagulation test should be monitored w heparin
- aPTT (PTT)
what is a serious s/e of heparin
- heparin induced thrombocytopenia
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
what is a type of direct thrombin inhibitor
- hirudin
what meds are used for DVT prophylaxis (4)
low dose
- UH
- LMWH
- warfarin
- fondaparinux
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
what thrombolytic therapy is used for DVT (5)
- catheter directed admin of a thrombolytic drug
- tPa/alteplase
- angioplasty
- stents
- mechanical thrombectomy
what is the normal aPTT time? therapeutic?
- normal = 30-40 sec
- therapeutic = 46-70 sec
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)
what should a pt on anticoag therapy report (6)
- tarry stools
- severe headache
- stomach pain
- confusion
- dizziness
- bruising
that is more than normal
what should pts on anticoag therapy not take (3)
- NSAIDs
- ASA
- many herbal drugs
what is a type of surgical therapy for DVT (2)
- open thrombectomy
- inferior vena cava interruption
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
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
what can CVI lead to
- venous leg ulcers
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
what are symptoms of CVI (5)
- edema
- itching
- stasis dermatitis (eczema)
- skin hyperpigmentation (brown, leathery)
- venous ulcers
where are venous ulcers often located
- medial mallelous
describe manifestations of venous ulcers (3)
- painful (may be worse when in dependent position)
- irregular borders
- lots of drainage
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
what are compression bandages imp for? (3)
- treatment of CVI
- venous ulcer healing
- prevention of ulcer recurrence
how do compression bandages help w treatment of venous ulcers and CVI (2)
- constrict the veins
- improves fnxn of venous valves
describe the diet for someone w venous ulcers (6)
- adequate protein
- cal
- vitamin A
- vitamin C
- zinc
- weight loss diet
*all imp for healing)
what foods are high in vitamin A
- green leafy veggies
what foods are high in vitamin C (3)
- citrus fruits
- tomatoes
- canteloupe
what food are high in zinc (2)
- meat
- seafood
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
if signs of infection are present in a venous ulcer, what should you do
- get wound culture before instituting ab
what is the usual treatment for infection in a venous ulcer (3)
- debridement
- wound excision
- systemic antibiotics
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.
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
can compression bandages be used for both arterial and venous issues?
no never use for arterial
