Deep Vein Thrombosis
The patient has a confirmed DVT, the physician will order medications (Warfarin), name the med, how its given, and anything else you should know about it.
Warfarin: coumadin, PO daily, long term anticoagulation/started with heparin/labs PT/INR/risk of bleeding/diet and safety teaching
CVI is a disorder of inadequate venous return, most commonly cause by DVT. What are other some other causes of CVI?
Varicose veins, leg trauma
can occur without an identifiable cause
What is an UNNA boot and whats its purpose?
Its a medicated gauze dressing providing support and topical medication for venous ulcers without the presence of infection or necrosis.
Gauze is covered in zinc oxide, calamine lotion, and glycerin, keeps skin moist, enhances healing, and relieves itching.
Protects and provides even pressure to veins, patient remains ambulatory, gressing changed at least once a week
Complications caused by varicose veins
venous insufficiency, stasis ulcers, chronic stasis dermatitis, superficial venous thrombosis may also develop in patients (during and after pregnancy, following surgery, patients on estrogen therapy - oral contraceptives or hormonal replacement therapy)
What is lymphedema and whats the difference between primary and secondary?
results from inflammation, obstruction and/or removal of lymphatic vessels
primary lymphedema: uncommon, often associated with genetic disorder
secondary lymphedema: acquired either from tumors or surgical/radiation treatments
The patient has a confirmed DVT, the physician will order medications (Factor Xa Inhibitor), name the med, how its given, and anything else you should know about it.
Factor Xa Inhibitor: Fondaparinux (prophylactic - given SQ)/Rivaroxaban or Apixaban (treatment - PO), increased risk of bleeding
With CVI, veins are distended and valves are damaged, leading to venous stasis and increased venous pressure. This increased pressure results in edema, which has a cascade of other effects. Name a few complications that can develop due to this edema.
impaired arterial circulation, poor nutrient and O2 delivery, build up of waste causing dermatitis, venous ulcer formation
What education should you provide your patient on wearing an UNNA boot?
Do NOT get wet - do NOT scratch under dressing - bandage changes at least weekly - watch out for danger signs and report any - preventing recurrence of ulcers (elevate legs, walk, don't stand, don't cross legs, lose weight, don't smoke)
What treatment measures can be taken to correct varicose veins (conservative measure)?
compression stockings, daily walking, avoid prolonged sitting or standing, elevating legs frequently during the day
How does lymphedema progress and develop?
obstruction of lymph vessel/node
increase proteins draw more fluid into tissue
edema begins distally, moves up limb
initially edema is soft and pitting
over time, subcutaneous tissue becomes fibrotic
The patient has a confirmed DVT, the physician will order medications (direct thrombin inhibitor), name the med, how its given, and anything else you should know about it.
Direct thrombin inhibitor: Dabigatran, PO BID (wasn't on the PP), increased risk of bleeding
Clinical manifestations of CVI are...
lower leg edema (worsens with standing), itchy fragile skin w/ normal temp, discomfort of affected extremity w/ prolonged standing, cyanosis and brown pigmentation of lower leg and foot, may have weeping dermatitis, thick fibrous subcutaneous tissue, recurrent stasis ulcers (over medial and anterior ankle)
Ulcers appear as superficial, minimal pain, pink, uneven edges
What are varicose veins and whats the common cause?
Irregular, tortuous veins with incompetent valves, usually in the lower legs.
Caused by increased venous pressure due to prolonged standing
What treatment measures can be taken to correct varicose veins (invasive measure)?
compression sclerotherapy, vein ablation, surgery (litigation and stripping - removal of damaged veins)
after surgery, patient wears pressure bandages for up to 6 weeks
What diagnostic studies are done to confirm lymphedema and pinpoint the obstruction?
ultrasound - ct scan - mri - lymphangiography (uses dye) - lymphoscintigraphy (inject radioactive dye, pt moves, see where substance goes)
The patient has a confirmed DVT, the physician will order medications (thrombolytics), name the med, how its given, and anything else you should know about it.
Thrombolytics: Streptokinase/Urokinase/tPA (alteplase), IV injection, known as the "clot-buster"/high risk of bleeding and hemorrhage/will be given under strict supervision of nurse
What nursing interventions would you perform when caring for CVI patients?
relieve symptoms (reduce edema, discourage prolonged standing), promote adequate circulation (TED hoses, elevate legs and feet several times a day and at night), healing (medicated compresses, semi-rigid boot - UNNA boot, nutrition), prevent tissue damage
How will varicose veins manifest in a patient?
may be asymptomatic, aching leg pain with fatigue and heaviness, ankle edema, itching of the affected leg (stasis dermatitis), feeling of warmth in the leg, visible dilated veins, thin discolored skin above ankles, may have stasis ulcers
Lymphadenopathy is the inflammation of the lymph node, it can be localized or generalized, what are the causes of both?
localized is usually due to inflammatory process
generalized is usually associated with disease or malignancy
What are nursing diagnoses for lymphedema?
excess fluid volume (venous congestion)
disturbed body image (looks gross)
What surgical interventions might a physician order to remove a thrombus, prevent a PE, and restore flow after a clot has dissolved? (one each)
percutaneous mechanical thrombectomy (remove)
inferior vena cava interuption (prevent)
balloon angioplasty (after)
What is the treatment for venous ulcers?
compression and medication:
-increase venous return and decrease edema
-topical application in bandage - UNNA boot
How would you determine if a patient has varicose veins?
H&P, color duplex doppler ultrasound
Lymphangitis is inflammation of the lymph vessels, how might with look on a patient?
red streak along the inflamed vessel, pain, heat, swelling
What medical nursing interventions will you perform while caring of a patient with lymphedema?
skin care - exercise - elevation of extremity - TED hose - SCDs - antibiotics (infections like cellulitis) - diuretics - manual drainage (wrapping) - possible surgery