DEEP VEIN THROMBOSIS EXAM M 16.4 QUESTIONS AND ANSWERS

DEEP VEIN THROMBOSIS EXAM M 16.4 QUESTIONS AND ANSWERS thrombus - answer- a blood clot embolus - answer- a clot that breaks lose and travels through the bloodstream DVT (deep vein thrombosis) - answer- a blood clot (thrombus) forms in one or more of the deep veins, usually in your legs PE (pulmonary embolism) - answer- is blockage in one or more arteries in the lungs caused by blood clots most commonly from the legs TED hose (compression stockings) - answer- long, tight fitting stockings that place mild static pressure on the legs to prevent blood from clotting SCDs (sequential compression devices) - answer- ROM - answer- What is a major risk factor for DVT? - answer- Immobility; Immobility related to casts, splints, braces Additional risk factors? - answer- -Recent surgery (esp. abd., pelvic, long-bone) -Varicosities, venous stasis -Dehydration -Atrial fibrillation, Congestive heart failure, Chronic obstructive pulmonary disease, Recent myocardial infarction -Pregnancy or recent childbirth; hemorrhage -Family history of coagulopathy, DVT, PE, Previous DVT or PE -Obesity -Trauma, Fractures of pelvis, femur, knee -Smoking -Cancer therapy (hormonal, chemotherapy, or radiotherapy) -Increasing age What can lead to a PE? - answer- -A thrombus is still attached/not traveling. An embolus is a thrombus that has broken free and is traveling through the vascular system until it gets to a vessel small enough that it cannot pass through. DVT is the most common precursor to PE. Clot breaks free from deep vein in leg (often the popliteal), travels to vena cava and right side of heart, then to pulmonary arterial system from right side of heart (blood behind the clot can't get oxygenated by lung if pulmonary artery obstructed—body will have less oxygenated blood). Small PE's may go un-notice but large or accumulating PE's could result in death. -(Emboli can also be caused by air, fat, lymph, amniotic fluid, bacterial vegetations, tumor debri, foreign bodies) Symptoms of DVT - answer- -Pain & Tenderness -Swelling -Discoloration or redness of the affected area -Skin that is warm to the touch How can nurse prevent DVT's. - answer- -Anti-coagulant therapy: Heparin, Lovenox -SCDs / IPC ---Sequential compression devices ---Intermittent pneumatic compression -Anti-embolism stockings (Elastic stockings, TEDs, graded compression stockings) -Positioning -Ambulation - Often and early after surgery -ROM exercises -Hydration Considerations for use of SCD's - answer- 1. Use as soon as possible 2. Keep on pt until fully ambulatory 3. Measurement for correct size is essential 4. Correct application 5. Inflation pressure average: 40 mmHg 6. Inflation cycle: 10-15 seconds on.... 45-60 seconds off 7. Assess for wounds/conditions that would worsen if ICP is used 8. Q8Hrs: remove sleeves and assess skin integrity & circulation 9. Frequently assess equipment for proper functioning 10. Frequently assess that the pressure setting is correct 11. Do not use with active DVT or in peripheral artery disease How to determine the correct anti-embolism stocking size for your patient - answer- -Calf Circumference: ---Measure at widest portion of calf -Length: ---Knee High measure heel to fold of knee ---Thigh High measure heel to gluteal fold Why do passive ROM for your patient - answer- 1. Baseline movement for evaluation of progress 2. Reduce the hazards of immobility i.e.: ---Contractures ---Muscle atrophy 3. Determine the type of ROM exercise: ---Active = The client moves the joints ---Passive = The nurse moves each joint How to do passive ROM - answer- -Passive ROM should be done for the patient if the patient can't do the exercises themselves. ---nurse moves each joint -Safety consideration: