Venous thromboembolism( VTE ), Deep venous thrombosis( DVT ) -> Pulmonary Embolism (PE)

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Occurs when a blood clot (thrombus) becomes lodges in deep veins, frequently in the lower extremities

Diminished or blocked blood flow causes inflammation and edema at the site of blockage

Predisposed by Virchow triad

Altered blood flow (Stasis) + Endothelial damage + hypercoagulable state(pregnancy) = thrombosis

 

Risk factors

Age >65

Immobility

Obesity

Oral contraceptives

Pregnancy

surgery

Fractures

Malignancy

 

Clinical Features

Unilateral:

Edema

Pain

Redness

Warmth

 

Dignostics

d-dimer

venous doppler ultrasound

 

 

Nursing interventions

DVT prevention:

change positions and walk frequently

Perform leg exercises

Avoid crossing legs in bed or placing a pillow behind the knees

Use compression devices or anti-embolism stockings

Take anticoagulant as prescribed

 

DVT management:

Administer anticoagulant

observe for evidence of bleeding: gums or urine

comprehensive neurovascular assessment

monitor for signs of pulmonary embolism (PE)

Early ambulation after adequate anticoagulation

Explain the role of long-term anticoagulation and periodic blood testing

encourge adequate fluid intake -> proper cerculating volume.

 

+ Warm compresses help reduce edema and are safe with DVT.

- Massaging the site of thrombosis can cause the clot to become dislodged and result in life-threatening PE.

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Pulmonary embolism (PE)

 

Pathophysiology

-Occlusion of pulmonary arteries by either blood clot, fat, air, or amniotic fluid.

-blood clot: from deep veins in the leg or pelvis

-Fat: from fractured femur, hip

-Air: from injection of large air bolus through IV or arterial line

-Amniotic fluid: from around the time of delivery

 

Clinical features

-dyspnea (most common)

-pleuritic chest pain

-hypoxemia

-tachypnea

-cough

-hemoptysis

 

Massive pulmonary embolism

-feelings of impening doom

-sudden change in mental status

-hypotension

 

Complications

-Pulmonary infarction

-Pulmonary hypertension -> right heart failure

-obstructive shock

 

 

Diagnostic 

Monitor: Arterial blood gases: repiratory acidosis

d-dimer blood tests

CT pulmonary angiogram with IV contrast

Ventilation perfusion scan (VQ scan)

Duplex venous

 

Nursing interventions

Keep client in high-fowler position

administer-anticoagulants (IV heparin), anlgesics, supplemental oxygen

Anticipate fibrinolytics (clots busters) or embolectomy (Removal of the embolus) in clients with a vary large PE

Teach the client the need for long-term oral anticoagulation : Rivaroxaban, apixaban.

 

Management

Vena cava filter: placed to catch emboli in clients for whom anticoagulants are contraindicated