Deep Vein Thrombosis
What is the pathophysiology of a deep vein thrombosis?
-Resulting from thrombophlebitis deep within muscle
-Virchow's Triad (Vessel Wall Injury, Hypercoagability of blood, Stasis of Blood)
-The formed clot is called a venous thrombosis
What is the pathophysiology of a pulmonary embolism?
Obstruction of pulmonary vascular system by embolus
-Thromboembolus most frequent
-Other emboli: fat, pathogens, tumors, air, etc.
-Common occurrence with DVT
-Collectively called a venous thromboembolism
What blood thinner is contraindicated in pregnant women?
What is the antidote to warfarin (coumadin)?
Vitamin K+
A patient is giving themself an enoxaparin (lovenox) injection and the nurse sees them squirting the air bubble out of the syringe. Is this ok? (Why or why not)
No the air bubble is meant to keep the medication within the subcutaneous tissue and not leak out through the injection site.
What are the signs and symptoms of a deep vein thrombosis?
Sometimes asymptomatic
-Aching pain
-Tight Calf
-Tender
-Warm
-Edema
-Erythenatous
What are the signs and symptoms of a pulmonary embolism?
(List 5)
•Anxiety or Sense of “impending doom”
•Dyspnea
•Chest pain
•Cough/hemoptysis
•Syncope
•Cyanosis
•Petechiae
•Tachycardia & Tachypnea
•Low-grade fever & diaphoretic
•Pleural friction rub
What type of medication is referred to as a clot buster or disolver?
fibrinolytics.
What is the antidote to heparin?
Protamine Sulfate
A patient asks why they are being prescribed both heparin and warfarin simultaneously. Explain the rationale for this.
Effects of warfarin can take up to 3-5 days to be achieved.
Bridging the patient with heparin allows for the patient to be therapeutically treated while initiating warfarin therapy
How do we diagnose a deep vein thrombosis?
(Name 3)
•Duplex Venous Ultrasonography
•Plethysmography
•MRI
•Ascending Contrast Venography
•D-dimer blood test.
How do we diagnose a pulmonary embolism?
(Name 3)
Plasma D-dimer
Lung Scans
•Chest x-ray
•Chest CT with contrast
•CT pulmonary angiography
Less common/helps further confirm
•Arterial Blood Gases
•End-tidal carbon dioxide
•Coagulation studies
Where are the most common signs of bleeding?
Gums, nose bleed, ecchymosis, urine, stool, etc.
What are the lab values used to monitor a patient who is on warfarin?
PT & INR
What type of fracture puts a patient at risk for a fat embolism?
A long bone fracture (ex. femur)
How do we treat a deep vein thrombosis?
(Name 2)
Anticoagulants
Inferior Vena Cava Placement
Venous Thrombectomy
How do we treat a pulmonary embolism?
(Name 3)
Anticoagulant Therapy
Fibrinolytics
Filter Placement
Embolectomy
Abdomen only!
What lab value is used to monitor a patient who is on heparin?
PTT
A patient who is on warfarin decides that they want to start a new fad diet where they eat a kale or spinach salad for every meal to lose weight. What should we teach them?
A diet that is high in vitamin K+, which is found in dark leafy greens is contraindicated for a patient on warfarin.
What should we teach a patient about their deep vein thrombosis?
(Name 3)
Bedrest
Elevation
Avoid Heat
Avoid Compression
Avoid Massaging calves
Teaching about side effects of blood thinners and diets while on certain blood thinners.
When to seek medical treatment (chest pain, etc.)
Teach about risk factors.
What should we teach a patient about their a pulmonary embolism?
(Name 3)
Teaching about side effects of blood thinners and diets while on certain blood thinners.
When to seek medical treatment (chest pain, etc.)
Teach about risk factors and prevention.
What is the therapeutic range for a patient on warfarin?
INR of 2-3+ (depends on the physicians order)
What is the function of the D-Dimer test?
-D dimer is a type of protein produced by blood clots. Almost all people with severe DVT have increased blood levels of D dimer.
What are the risk factors for a person developing a DVT or PE?
(Name 5)
-Prolonged Immobility
-Trauma/Surgery
-MI/Heart Failure
-Race
-Advanced age
-Pregnancy
-Oral contraceptive/estrogen use
-Smoking
-Obesity
-Arrhythmias (A-fib & A-Flutter)
-Hypercoagulability
-Central venous catheters
-Sickle Cell disease
-Cancer
-Septicemia