Week 4 - Extra content

Question 1

What is the primary goal of DVT/VTE management?

Answer 1

• Prevent emboli
• Inflammation control
• Education
• Mobility plan
• Monitor coagulation, bleeding, PE signs
• Daily limb comparisons

Management includes anticoagulants/thrombolytics and TEDs/IPC as per orders.

Question 2

List the key components of PAD management.

Answer 2

• Risk reduction (smoking, BP, lipids, glucose)
• Antiplatelets/cilostazol/pentoxifylline
• Analgesia
• Meticulous wound/foot care
• Nutrition
• Teach claudication walking programmes

Escalate to IR/surgery if refractory.

Question 3

What is the first-line treatment for CVI?

Answer 3

• Compression (bandaging → stockings)
• Generous wound care
• Infection vigilance
• Weight management
• Plan for vein procedures if indicated

Address adherence barriers as well.

Question 4

What are the management strategies for anaemia (IDA focus)?

Answer 4

• Support ADLs
• Oxygen if hypoxaemic
• Iron therapy with counselling
• Diet support
• Monitor Hb/iron indices
• Transfuse PRBCs for severe/acute drops

Follow protocol for transfusions.

Question 5

What are the immediate post-op considerations for AAA?

Answer 5

• Haemodynamics
• Abdominal girth
• Urine output
• Pain control
• Wound assessment
• Frequent neurovascular checks LE
• Early ambulation as ordered
• DVT prophylaxis

Monitor for red flags like hypotension or new severe pain.

Question 6

What are the key differences between Open repair vs EVAR?

Answer 6

• Open: durable, for complex anatomy, higher infection risk
• EVAR: minimally invasive, shorter stay, risk of endoleak

Open repair is suited for younger patients or selected ruptures.

Question 7

What diagnostics are used for PVD?

Answer 7

• ABI
• Duplex
• Venography
• CT/angio

RN explains purpose & steps, assists, and counsels results meaning.

Question 8

True or false: Warfarin is interchangeable between brands like Coumadin and Marevan.

Answer 8

FALSE

Warfarin is brand-specific and requires INR monitoring.

Question 9

What are the key safety pearls for UFH/LMWH?

Answer 9

• Never IM
• Rotate SC sites
• Don’t rub site
• APTT for IV UFH only
• LMWH no APTT

Important for preventing complications.

Question 10

What surgical options are available for PAD?

Answer 10

• Bypass (autogenous or synthetic)
• Endarterectomy
• IR balloon + stent
• Amputation

Amputation is considered for necrosis.

Question 11

What should be included in patient education for DVT prevention?

Answer 11

• Mobilise
• Hydration
• Stockings/IPC
• Prophylactic meds

Education is crucial upon admission.

Question 12

What are the characteristics of arterial ulcers?

Answer 12

• Location: toes/lateral malleolus
• Appearance: punched-out, dry/min exudate

Arterial ulcers are often associated with poor blood flow.

Question 13

What does Virchow’s triad consist of?

Answer 13

• Stasis
• Endothelial injury
• Hypercoagulability

These factors contribute to thrombosis.

Question 14

What is the threshold for treating an AAA?

Answer 14

≥5.5 cm

Also consider rapid growth or symptomatic cases.

Question 15

What are the monitoring requirements for heparin?

Answer 15

• APTT for IV
• LMWH does not require APTT
• Warfarin needs INR
• DOACs—no routine lab dosing

Check renal function for DOACs.

Question 16

What are the first nursing priorities for VTE?

Answer 16

• Start prescribed anticoagulant promptly
• Educate on immobilisation vs mobilisation plan
• Baseline limb measurements
• Bleeding risk checks
• PE symptom escalation

These priorities are crucial for effective management and prevention of complications in patients at risk for VTE.

Question 17

What is the purpose of daily limb comparison?

Answer 17

• Measure calf/ankle circumference at fixed landmarks
• Track oedema and treatment response
• Detect asymmetry suggesting DVT progression

Regular measurement helps in monitoring changes that may indicate complications.

Question 18

What are the roles of TEDs vs IPC?

Answer 18

• TEDs: Continuous graded compression for VTE PPx/venous return
• IPC: Intermittent cycles to mimic muscle pump when immobile

Both are used to prevent venous thromboembolism in patients at risk.

Question 19

What checks should be performed for IPC application?

Answer 19

• Correct sleeve size/placement
• Hose connections secure
• Inflation cycles running
• Skin intact
• Remove for skin/Neurovascular checks per policy

Proper checks ensure effective and safe use of IPC devices.

Question 20

What are the PE red flags that require escalation?

Answer 20

• Sudden pleuritic chest pain
• Dyspnoea
• Tachypnoea
• Hypoxia
• Haemoptysis
• Unexplained tachycardia/syncope

These symptoms indicate potential serious complications that need immediate attention.

Question 21

What is the purpose of the Wells score in DVT?

Answer 21

Clinical pre-test probability stratification to guide D-dimer vs ultrasound sequencing and reduce unnecessary imaging

The Wells score helps in assessing the likelihood of DVT in patients.

Question 22

When is D-dimer useful?

Answer 22

• Low/moderate Wells probability: negative D-dimer can rule out DVT/PE
• Not specific—avoid as sole test in high probability

D-dimer testing is part of a broader diagnostic strategy.

Question 23

What is the hallmark symptom of PAD?

Answer 23

Intermittent claudication: reproducible exertional muscle pain relieved by ≤10 minutes rest

This symptom is key in diagnosing peripheral artery disease.

Question 24

What does a claudication walking programme involve?

Answer 24

• Intervals of walking to moderate pain then rest
• Progress duration/distance over weeks to improve collateral flow and function

This program is designed to enhance mobility and circulation in patients with PAD.

Question 25

What are the **essentials of PAD foot care**?

Answer 25

* Daily inspection * Moisturise (not between toes) * Nail care/podiatry * Protective footwear * Avoid heat pads * Prompt ulcer review ## Footnote Proper foot care is crucial to prevent complications in patients with PAD.

Question 26

How do **arterial vs venous ulcers** differ in appearance?

Answer 26

* Arterial: punched-out, minimal exudate * Venous: irregular edge, moderate–large serous exudate with slough ## Footnote Understanding these differences aids in proper diagnosis and treatment.

Question 27

What are common **CVI adherence barriers**?

Answer 27

* Difficulty donning stockings * Heat/discomfort * Skin irritation * Arthritis ## Footnote Addressing these barriers is essential for effective management of chronic venous insufficiency.

Question 28

What are the **key contraindications for compression**?

Answer 28

* Severe PAD/critical limb ischaemia (very low ABI) * Acute cellulitis without control * Acute DVT without specialist advice ## Footnote These contraindications must be considered to avoid complications.

Question 29

What are the **ABI thresholds**?

Answer 29

* Normal: 1.0–1.3 * Borderline: 0.91–0.99 * PAD: ≤0.90 * Severe: <0.5 * Calcified arteries: >1.3—use toe pressures/Doppler waveforms ## Footnote ABI measurements are crucial for diagnosing PAD.

Question 30

What are the **absorption tips for IDA counselling**?

Answer 30

* Take iron away from tea/coffee/calcium * Vitamin C enhances absorption * Expect dark stools * Manage GI effects (dose timing, stool softener) ## Footnote These tips help improve iron absorption in patients with iron deficiency anemia.

Question 31

What is the recommended **duration of iron therapy**?

Answer 31

Continue 2–3 months after Hb normalises to replete stores (ferritin typically >100 µg/L target in IDA) ## Footnote This duration ensures adequate replenishment of iron stores.

Question 32

What must be done during a **PRBC transfusion**?

Answer 32

* Two-person ID check * Start slow * Stay 15 min * Obs per policy * Document lot/time/volume * Stop immediately if reaction suspected ## Footnote These steps are essential to ensure safe blood transfusion practices.

Question 33

Why is **urine output** monitored post-AAA surgery?

Answer 33

Renal perfusion marker; low output may indicate renal hypoperfusion/ischemia or bleeding—escalate promptly ## Footnote Monitoring urine output is vital for assessing kidney function after surgery.

Question 34

What specific **surveillance** is required after EVAR?

Answer 34

* Groin puncture site haematoma/pseudoaneurysm/AVF * Limb neurovascular checks * Endoleak suspicion (fullness/girth ↑, new pain) ## Footnote Close monitoring is necessary to detect complications early.

Question 35

What are the **classic features of AAA rupture**?

Answer 35

* Severe sudden back/abdominal pain * Hypotension/syncope * Pulsatile abdominal mass ## Footnote These features indicate a surgical emergency requiring immediate intervention.

Question 36

How do **open vs EVAR** recovery differ?

Answer 36

* Open: longer LOS/pain * EVAR: shorter LOS, quicker mobilisation ## Footnote Both procedures require long-term BP/lipid/smoking risk reduction.

Question 37

What monitoring is needed for **UFH vs LMWH**?

Answer 37

* IV UFH needs APTT titration * LMWH generally no APTT—consider anti-Xa levels in special populations (pregnancy, obesity, renal failure) ## Footnote Monitoring protocols differ based on the type of anticoagulant used.

Question 38

What are the **essentials of warfarin education**?

Answer 38

* Consistent vitamin K intake * Frequent INR at initiation * Interactions (antibiotics, herbals) * Bleeding precautions * Teratogenic—avoid in pregnancy ## Footnote Patient education is critical for safe warfarin management.

Question 39

Why is a **renal check** necessary for DOACs?

Answer 39

Renal clearance determines dosing/eligibility; impaired function increases bleeding; check eGFR regularly (esp. elderly/frail) ## Footnote Regular renal function assessment is essential for safe DOAC use.

Question 40

What are the **nursing rules for thrombolysis**?

Answer 40

* High-risk med: 1:1 * Strict neuro/obs * No IM injections/arterial lines if avoidable * Minimise venepuncture * Prepare for bleed management ## Footnote These rules ensure patient safety during thrombolytic therapy.

Question 41

What is the approach to **post-DVT mobilisation**?

Answer 41

* Early, guided by pain/oedema and anticoagulation status * Elevation when resting * Compression if prescribed to reduce PTS risk ## Footnote Proper mobilisation strategies are essential to prevent post-thrombotic syndrome.

Question 42

What are the signs of **post-thrombotic syndrome**?

Answer 42

* Chronic leg pain * Oedema * Heaviness * Skin changes * Venous ulceration after DVT ## Footnote Recognizing these signs is important for timely intervention.

Question 43

What is included in the **VTE prophylaxis bundle on admit**?

Answer 43

* Risk assess * Prescribe PPx (LMWH or mechanical) * Ensure TEDs/IPC * Early mobilisation * Hydration * Patient education ## Footnote This bundle is crucial for preventing VTE in hospitalized patients.

Question 44

What is the advice for **antiplatelet blister** usage?

Answer 44

Remove tablets from blister just before use; some combos have special packaging—don’t decant into weekly packs without checking ## Footnote Proper handling ensures medication efficacy and safety.

Question 45

What are the myths regarding **aspirin's EC coating**?

Answer 45

Enteric coating doesn’t prevent GI bleeding; consider gastroprotection in high-risk patients per medical plan ## Footnote Understanding these myths helps in better patient education.

Question 46

What should be monitored for **ulcer infection (CVI)**?

Answer 46

* Increased pain * Erythema * Warmth * Malodour * Purulent exudate * Systemic signs ## Footnote Vigilance is essential for early detection and treatment of infections.

Question 47

What is the approach to **arterial ulcer wounds**?

Answer 47

* Keep dry eschar intact if no infection/ischemia surgery planned * Protect surrounding skin * Avoid compression unless vascular cleared ## Footnote Proper wound management is critical to prevent complications.

Question 48

What is the approach to **venous ulcer wounds**?

Answer 48

* Moist wound healing with absorbent dressings * Regular debridement as tolerated * Compression therapy is cornerstone ## Footnote This approach is essential for effective treatment of venous ulcers.

Question 49

What should be included in **AAA discharge teaching**?

Answer 49

* Wound care * Activity progression * Avoid heavy lifting early * When to seek help (bleeding, fever, distension, new/worsening pain) * Keep imaging follow-ups ## Footnote Comprehensive discharge teaching is vital for recovery.

Question 50

What **medication interactions** should be flagged?

Answer 50

* Warfarin with antibiotics/antifungals * NSAIDs with anticoagulants/antiplatelets ↑ bleed risk * Herbal (St John’s wort, ginkgo) interactions—refer pharmacist ## Footnote Awareness of interactions is crucial for safe medication management.

Question 51

What are the components of **neurovascular checks (LE)**?

Answer 51

* Colour * Warmth * Cap refill * Pulses (DP/PT) ± Doppler * Motor * Sensation * Pain ## Footnote Regular checks help in monitoring limb perfusion and function.

Question 52

When should **transfusion** be considered for severe anaemia?

Answer 52

Consider PRBCs per protocol when Hb <70 g/L or symptomatic/ongoing bleed; individualise with comorbidities and signs of hypoxia ## Footnote Transfusion decisions should be based on clinical guidelines and patient condition.

Question 53

What are the **high-yield “one-liners”** recap?

Answer 53

* Virchow triad * ABI ≤0.90 = PAD * AAA ≥5.5 cm treat * IV heparin needs APTT * LMWH no APTT * Warfarin needs INR * DOACs: check renal * Iron 2–3 months after Hb normal ## Footnote These key points summarize essential concepts in vascular and hematological care.