Terms
Ischemic muscle pain caused by exercise but resolves 10 minutes or less with rest.
What is intermittent claudication?
Formation of a blood clot with inflammation of the vein.
What is Venous thrombosis?
Obesity, sedentary lifestyle
What are some risk factors for venous statis?
The 6 P's that are suggestive of arterial ischemia.
What are pain, pallor, pulselessness, paresthesia, paralysis, and poikilothermia (adaptation of the limb to the environmental temperature, most often cool). If you detect these signs, immediately notify the HCP.
This med is often given prophylactically to prevent a DVT?
Low-Molecular-Weight Heparin (LMWH)
dalteparin (Fragmin) enoxaparin (Lovenox) Subcutaneous
Routine coagulation tests typically not needed.
Monitor CBC count at regular intervals.
Do not expel air bubble from prefilled syringe. If giving subcutaneously, inject deep into subcutaneous tissue (preferably into the abdominal fatty tissue or above the iliac crest), inserting the entire length of the needle. Hold skinfold during injection but release before removing needle. Do not aspirate. Do not inject IM. Do not rub site after injection. Rotate sites.
Reduced dosage needed in patients with renal problems. Use extreme caution in patients with a history of HIT.
Antidote: Protamine reverses the effects of LMWH.
An inflammatory thrombus that blocks the vessel. Over time, the thrombus becomes more organized and the inflammation in the vessel wall subsides. During the chronic phase, thrombosis and fibrosis in the vessel cause tissue ischemia. Smoking and marijuana makes this worse and more common in men.
What is Thromboangiitis obliterans (Buerger’s disease)
A thrombus (blood clot) in a deep vein, often in the femoral vein.
What is a deep vein thrombosis (DVT)?
What is hardening of arteries?
arteriolosclerosis
What is numbness and tingling?
Paresthesia (numbness or tingling) in the toes or feet may result from nerve tissue ischemia.
This med is given IV for a positive blood clot?
Heparin sodium
Therapeutic effects measured at regular intervals by the aPTT or ACT.
Monitor CBC counts at regular intervals and titrate according to parameters.
IV given as an adjunct for existing blood clots.
Antidote: Protamine reverses the effect of UH.
Vasospasm-induced color changes (white, blue, and red) of fingers, toes, ears, and nose? Triggers, such as cold.
What is Raynaud's disease?
Dilated (3 mm or larger in diameter), tortuous superficial veins.
What are varicose veins or varicosities?
What causes pain to worsen in a dependent position?
Venous ulcers
They classically occur above the medial malleolus. The ulcer is often quite painful, particularly when edema or infection is present. Pain may be worse when the leg is in a dependent position. If the venous ulcer is untreated, the wound becomes wider and deeper, increasing the risk for infection.
What is shooting or burning pain common in extremeties?
neuropathy
It is given sub-cu for prevention of blood clots that is not Lovenox?
SQ given prophylactically to prevent the development of clots.
Antidote: Protamine reverses the effect of UH.
Thickening of the artery walls?
PAD
A palpable, firm, subcutaneous cordlike vein. The area surrounding the vein may be itchy, painful to the touch, reddened, and warm.
What is superficial vein thrombosis?
Sitting and traveling for long periods are a risk factor for this?
VTE (venous thromboembolism)
What occurs in PAD when lower extremities are elevated?
Pallor (blanching of the foot) develops when the leg is elevated (elevation pallor).
This is given orally and used for
VTE prevention and treatment?
Routine coagulation tests not needed. Monitor CBC and creatinine at regular intervals.
May cause thrombocytopenia.
apixaban (Eliquis) PO
rivaroxaban (Xarelto) PO
Acute inflammation of the walls of small, cannulated veins?
What is phlebitis?
An acute inflammation of the walls of small, cannulated veins.
What is phlebitis?
Three key factors that increase chances of a venous thrombosis- 1) venous stasis, (2) damage of the endothelium (inner lining of the vein), and (3) hypercoagulability.
What is Virchow triad?
What occurs when lower extremity is dependent?
Reactive hyperemia (redness of the foot) develops when the limb is in a dependent position (dependent rubor).
Med requires monitoring lab of PT/INR.
INR used to monitor therapeutic levels.
Give at the same time each day.
Antidote: Vitamin K. For VKA-related bleeding, treatment with prothrombin complex concentrate (human) (Kcentra), IV vitamin K and/or fresh frozen plasma is recommended.
ACT, Activated clotting time; HIT, heparin-induced thrombocytopenia.
What is warfarin (Coumadin)?