NURS 3512 - Class 1-6 > Week 4 - DVT > Flashcards

Week 4 - DVT Flashcards

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1
Q

what is DVT

A
  • disorder involving a thrombus in a deep veing
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2
Q

what 2 veins does DVT typically effect

A
  • femoral

- iliac

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3
Q

what are the 3 main factors in the cause of venous thrombosis

A
  • venous stasis
  • endothelial damage
  • hyerpcoaguable blood
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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
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5
Q

what are causes of endothelial damage (7)

A
  • surgery
  • imtravascular catheterization
  • trauma
  • burns
  • chemo
  • DM
  • sepsis
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6
Q

what can cause hypercoaguability of blood (4)

A
  • sepsis
  • oral contra
  • smoking
  • hematological disorders
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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
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8
Q

what is a positive homen’s sign

A
  • pain on forced dorsiflexion of the foot when the leg is raise
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9
Q

what are complications of DVT (4)

A
  • PE (life threatening)
  • chronic venous insufficiency
  • phlegmasia cerula dolens
  • venous leg ulcers
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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

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11
Q

what types of care are done for DVT (3)

A
  • prevention and prophylaxis
  • drug therapy
  • surgical therapy
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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
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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
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14
Q

what are sequential compression devices

A
  • inflatable garments wrapped around the legs that apply intermittent external pressure
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15
Q

what meds are used routinely for prevention and treatment of DVT

A
  • anticoags
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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
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17
Q

what are 4 major classes of anticoag therapy

A
  • vitamin K antagonist
  • direct thrombin inhibitor
  • indirect thrombin inhibitor
  • factor Xa inhibitor
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18
Q

anticoagulant therapy does not…

A
  • dissolve the clot
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19
Q

what type of med is not recommended for DVT thromboprophylaxis

A
  • aspirin
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20
Q

what is a type of vitamin K antag

A
  • warfarin
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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

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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
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23
Q

what blood coag test should be monitored w warfarin

A

INR

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24
Q

a diet that frequently varies in _____, makes it difficult to achieve and maintain therapeutic INR w warfarin

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
NURS 3512 - Class 1-6
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