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Flashcards in DVT and PE Deck (49)
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1

clot formed in a vessel

thrombus

2

a thrombus that moves through the blood stream

Embolus

3

- inflammation associated with a clot

Thrombophlebitis

4

thrombus in a deep vein with inflammation

DVT

5

What is virchow's triad?

 Vascular injury-
 Alteration of blood flow-
 Hypercoagulability

6

What is a vascular injury?

Endothelial damage

7

What occurs when there are alterations in blood flow?

venous stasis

8

How does hypercoagulability occur?

◦ Sudden withdrawal anticoagulant meds
◦ Oral contraceptive use
◦ Clotting factor abnormalities-genetic
◦ Pregnancy

9

What signs and symptoms should you look for when assessing for DVT?

◦ Dull ache
◦ Tenderness
◦ Pain
◦ Cramping
◦ Erythema
◦ Warmth
◦ Edema
◦ Measure affected extremity daily

10

What are the diagnostic test done for DVT?

 D Dimer
 ESR
 Venous Duplex
 Venogram

11

What are the nursing interventions?

 Activity-rest, elevate, walk after anticoagulated
 Leg exercises – elevate extremity
◦ Avoid prolonged sitting or standing
 Anti-embolism stockings
 Sequential Compression Devices (SCD)
 IV fluids
 Medications – anti coagulants
◦ Monitor: Heparin – PTT = 1.5-2.5x control
 Usually PTT=over 60-under100 per protocol
◦ Coumadin – PT/INR = 2-2.5x control
 Usually between INR 2.0-3.0
◦ Analgesics – pain relief

12

What are the complications of DVT?

 Pulmonary Embolus (PE)
 Cerebrovascular Accident (CVA)
 Re-occuring DVT
 Venous stasis ulcers

13

What are the priority nursing diagnosis for DVT?

 Pain
 Impaired mobility
 Ineffective tissue perfusion
Risk for embolism

14

 Obstruction of the pulmonary artery or one of its branches by a thrombus
 Thrombus usually originates elsewhere in the venous system

Pulmonary Embolism

15

What is the ideal location for pulmonary emboli? Why?

Lungs are ideal location for emboli to lodge because of extensive capillary network & arterial blood flow

16

What part of the lungs are more frequently affected?

Lower lobes are most frequently affected because they have a higher blood flow

17

What is the etiology (causes) of pulmonary embolism?

 Thrombi in the deep veins can dislodge spontaneously
 Mechanical events (ie injury, sudden standing) can break off a clot & send it into cardiovascular network
 Clot partially or completely obstructs the pulmonary artery or its branches

18

What is the physiologic presentation of pulmonary embolism?

 Pulmonary alveolar space that is near the occluded vessel gets little or no O2
 Substances released from the clot cause surrounding blood vessels & bronchioles to constrict
 Gas exchange is impaired or absent
◦ Due to little or no blood flow to area

19

Less common causes of pulmonary emboli besides blood clots include:

 Fat emboli
 Air emboli
 Amniotic fluid
 Tumors emboli – break off of tumor tissue

20

What are the risk factors for pulmonary embolism?

 Trauma or surgery
 Heart failure
◦ Right side heart pathology
 Atrial fibrillation (irregular heart rhythm)
 Hyper-coagulable states=DVT
 Prolonged immobility
 Over age 50
 Long term use of oral contraceptives

21

What are the signs & symptoms of pulmonary embolism?

 Sudden onset of unexplained dyspnea
 Tachypnea
 Tachycardia
 Chest pain – sudden, sharp & pleuritic
 Cough - may be dry
 Secretions - clear or blood tinged
 Crackles
 Fever
 Accentuation of pulmonic heart sound
 Change in mental status
◦ Secondary to hypoxemia
 Anxiety
 Apprehension – feeling of impending doom

22

What are the signs & symptoms of massive emboli?

 Sudden collapse
 Shock
 Massive emboli patients may not have chest pain
 EKG indicates right ventricular strain with acute cor pulmonale
◦ Right ventricle can no longer pump blood into the lungs
 Death occurs in > 60% of patients

23

 May go undetected
 Produce vague transient symptoms
 May cause cardiac compromise

small pulmonary emboli

24

What are the complications of a pulmonary embolism?

*Pulmonary infarction
*Pulmonary hypertension

25

occurs death of lung tissue occurs with medium or large sized pulmonary vessels are occluded

pulmonary infarction

26

occurs when there is insufficient collateral blood flow as well as pre-existing lung disease is present

pulmonary infarction

27

Occurs when more than 50% of area of normal pulmonary bed compromised

pulmonary hypertension

28

occurs when there is dilation & hypertrophy of the right
ventricle from multiple Pulmonary Emboli

pulmonary hypertension

29

What are the diagnostic test for pulmonary emboli?

*Spiral CT (also called helical)
*Ventilation/Perfusion lung scan
*Coagulation studies
*Platelets
*Venous doppler
*Duplex scanning
*Venogram
*Pulmonary angiogram
*EKG
*CBC
*ABGs

30

 Supplies definitive diagnosis
 Most recently developed
 Most accurate method
 beam remains on continuously & rotates around patient
 More efficient technique
◦ Reduces scanning time of entire chest to 20- 30 seconds
 3 dimensional images

spiral CT