Week 6 - Venous Conditions Flashcards
What does the Padua scale assess?
Need for anticoagulation
When is Wells used?
ONLY if DVT is suspected
- Mobilize <2
- Hold PT > or equal to 2
Arteries
Thick walls that are muscular and elastic - can handle higher pressure and absorb pressure while moving the blood along down stream
Have pulse
Veins
Thinner walls and lower BP
Reside at the end of the system furthest from the pump and the heart
No pulse
Need assistance pumping the blood against gravity and back to the heart
What prevents backflow?
One way valves
Counteract gravitational forces
Smooth muscle contraction in veins
Directs blood flow where needed
How much blood do veins hole at rest?
65%
Skeletal muscle pumping in veins
Prevents pooling and edema
Directs blood back towards the heart
Venous conditions
Venous insufficiency = varicose veins, phlebitis
VTE (venous thrombosis embolism) —> DVT/PE
Varicose veins
One way valves become defective —> blood pools
Visible in surface veins
Most frequently in legs
Phlebitis
Varicose veins w inflammation
Signs and symptoms of venous insufficiency
Swelling
Varicose veins
Pain and heaviness
Restless leg syndrome
Leg cramps
Itchy skin
Darkened, hard, leathery skin
Risk factors for venous insufficiency
Age
Genetics
Obesity
Prolonged standing
Sedentary lifestyle
Smoking
Female hormones
Factors that increase hydrostatic pressure in veins
Considerations for PT with venous insufficiency
Obtain history of risk factors
Signs and symptoms
Interventions for venous insufficiency
Interventions for venous insufficiency
Exercise
Elevation of affected extremity
Avoiding long periods of standing or sitting
Compression garments
Wound management
Venous thromboembolism (VTE
Formation of blood clot (thrombus) in a vein
Deep vein thrombosis
Embolism: pulmonary, CVA or MI
Block blood flow —> tissue damage
DVT locations
Calf
Thigh - popliteal area
Pelvis - femoral
Upper extremities
Pulmonary embolism
Life-threatening, acute complication of DVT
- DVT clot dislodges, travels through venous system - through the R side of the heart - blockage in the pulmonary circulation
Classification of severity of PE
- Based on clinical symptoms and degree of effect on R ventricle
Massive, submissive and non massive
High, intermediate (low and high) and low risk
Why do DVTs form?
Coagulation cascade is activated when injury to blood vessels occurs
When do DVTs occur?
When there is the result in a state of Hypercoagulability for at least 5-6 weeks
- Surgeries
- Other trauma — MVA, falls
- Active cancer
What do anticoagulants do?
Help lower the risk of future clots and cal stop the growth of the present thrombus
What is used in emergency’s with PE ?
Thrombolytics
What is the Padua prediction score?
It assesses VTE risk
Score > or equal to 4 is high risk
Used to justify use of anticoagulants
Used to identify presence of VTE
Signs and symptoms of PE
Dyspnea
Chest pain
Presyncope or syncope
Hemoptysis
HR elevated > 95 at rest
Increased risk for PE
Elevated Padua score
Signs of DVT - unilateral LE swelling or pain
Signs and symptoms of VTE/DVT
Entire leg swollen
Tenderness, redness and heat in area
Unilateral calf swelling
Unilateral pitting edema
What happens if Wells Criteria is > or equal to 2?
Wells is gold standard for screening for DVT assessment
Greater than or equal 2 probably DVT
If likely - referred for d-dimer lab test
If d-dimer positive, sent for follow up diagnostic tests
When patient has positive DVT: prior to mobilization
Check for anticoagulation medications
Heparin
“Early” ambulation safe as soon as level of effective anticoagulation has been reached
Pts can assess most current aPTT levels and mobilize patients when they achieve a therapeutic level
Monitor/observe signs of increased bleeding or bruising in pts who are taking anticoagulants
When established LE DVT below the knee is NOT anticoagulated and has NO IVD filter, consult w the medical team prior to mobilization
Therapeutic range aPTT
1.5 to 2.5 times the control value (in seconds)
When is it sage to mobilize with no DVT diagnosed?
Safe to begin/return to normal if no signs of DVT or PE, wells is < 2, already anticoagulated
When is it sage to mobilize if DVT found?
After initiation of coagulation - check aPTT time (1.5-2.5(
NO MOB < 3 hours
> 5 hours safe to mobilize
Check with physician if 3 to 5 hours
Post thrombotic syndrome - venous insufficiency
Residual problem that persists after a patient is diagnosed with a DVT
Associated with high morbidity and lower quality of life
Signs and symptoms of post thrombotic syndrome
Edema and swelling, chronic arm or leg pain
Skin changes, heaviness of affected limb
WITH signs and symptoms of post thrombotic syndrome
Recommend mechanical compression or graduated compression stockings
Additional education (VTE): maintain adequate hydration, use of mechanical compression, importance of mobility
True or false: it’s better to mobilize early even with fall risk
True - helps minimize DVT progression/severity and maximizes outcomes
