Flashcards in DVT and PE Deck (49)
clot formed in a vessel
a thrombus that moves through the blood stream
- inflammation associated with a clot
thrombus in a deep vein with inflammation
What is virchow's triad?
Alteration of blood flow-
What is a vascular injury?
What occurs when there are alterations in blood flow?
How does hypercoagulability occur?
◦ Sudden withdrawal anticoagulant meds
◦ Oral contraceptive use
◦ Clotting factor abnormalities-genetic
What signs and symptoms should you look for when assessing for DVT?
◦ Dull ache
◦ Measure affected extremity daily
What are the diagnostic test done for DVT?
What are the nursing interventions?
Activity-rest, elevate, walk after anticoagulated
Leg exercises – elevate extremity
◦ Avoid prolonged sitting or standing
Sequential Compression Devices (SCD)
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
What are the complications of DVT?
Pulmonary Embolus (PE)
Cerebrovascular Accident (CVA)
Venous stasis ulcers
What are the priority nursing diagnosis for DVT?
Ineffective tissue perfusion
Risk for embolism
Obstruction of the pulmonary artery or one of its branches by a thrombus
Thrombus usually originates elsewhere in the venous system
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
What part of the lungs are more frequently affected?
Lower lobes are most frequently affected because they have a higher blood flow
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
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
Less common causes of pulmonary emboli besides blood clots include:
Tumors emboli – break off of tumor tissue
What are the risk factors for pulmonary embolism?
Trauma or surgery
◦ Right side heart pathology
Atrial fibrillation (irregular heart rhythm)
Over age 50
Long term use of oral contraceptives
What are the signs & symptoms of pulmonary embolism?
Sudden onset of unexplained dyspnea
Chest pain – sudden, sharp & pleuritic
Cough - may be dry
Secretions - clear or blood tinged
Accentuation of pulmonic heart sound
Change in mental status
◦ Secondary to hypoxemia
Apprehension – feeling of impending doom
What are the signs & symptoms of massive emboli?
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
May go undetected
Produce vague transient symptoms
May cause cardiac compromise
small pulmonary emboli
What are the complications of a pulmonary embolism?
occurs death of lung tissue occurs with medium or large sized pulmonary vessels are occluded
occurs when there is insufficient collateral blood flow as well as pre-existing lung disease is present
Occurs when more than 50% of area of normal pulmonary bed compromised
occurs when there is dilation & hypertrophy of the right
ventricle from multiple Pulmonary Emboli
What are the diagnostic test for pulmonary emboli?
*Spiral CT (also called helical)
*Ventilation/Perfusion lung scan