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.
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