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Thrombophlebitis (DVT) 842

Thrombophlebitis (DVT) 842. Pathophysiology: Clot found either in deep large veins of the leg. Venous thrombosis or phlebothrombosis refers just to the clot itself. The additional inflammation in the vein that accompanies the clot makes it thrombophlebitis

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Thrombophlebitis (DVT) 842

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  1. Thrombophlebitis (DVT) 842 • Pathophysiology: Clot found either in deep large veins of the leg. Venous thrombosis or phlebothrombosis refers just to the clot itself. The additional inflammation in the vein that accompanies the clot makes it thrombophlebitis • Risk factors: prolonged BR, sitting, inactivity, incompetent valves, presence of catheters or wires, pregnancy, BCP, lupus, dehydration, and clotting disorders. Virchow’s triad refers to the combination of venous stasis, hypercoagulation, and damage.

  2. Assessment of DVT • 50% are asymptomatic unless the clot is in the ileofemoral vein. • Symptomatic patients and those with ileofemoral clot have redness, pain, edema, warmth, decreased movement, +Homan’s sign (20% reliable). • Dx Tests: venogram, venous US

  3. Preventative: TEDs Venodynes AEEs SQLMWH (Lovenox) Early ambulation fluids Acute: BR or BRP Thrombolytics-may use up to 3d after dx to dissolve clot and reduce damage Heparin-bolus followed by infusion with pump Warfarin, analgesics, heat PTT, PT, INR qam-heparin and warfarin doses depend on results Monitor for complications (Pulm. embolism-50%,) Surgery-thrombectomy, vena cava filter Management of DVT

  4. Nursing Management of DVT • Preventative measures for pts at risk • Acute cases: • Monitor VS and NV status • Reinforce BR or BRP • Encourage fluids • Monitor IV and labs • Analgesics and heat • Restrict Vit K in diet • Monitor for complications-PE and hemorrhage • TEDs-family needs to know how to apply • Pt education-anticoag tx (845), activity, diet, complications

  5. Varicose Veins (849) • Pathophysiology: congenital absence of valves or acquired valve incompetence from heredity, DVT, trauma, inflammation, obesity, pregnancy, prolonged sitting or standing. Usually occurs in legs and lower trunk in saphenous veins. Superficial spider veins are called primary varicosities; deep varicosities are called secondary. • S/S: aching, heaviness, itching, swelling, unsightly appearance

  6. Management of Varicose Veins • Prevention: support hose, exercise, elevation • Sclerotherapy with sclerosing agent, followed by elastic bandages and walking • SDS: Vein stripping by tying off great saphenous vein at saphenofemoral junction, making incisions along leg, introducing nylon wire, and pulling vein out.

  7. Nursing Management of Varicose Veins • Teach prevention techniques • Postop nursing care: • Maintain firm elastic pressure over whole limb • Regular movement and exercise of legs • FOB up 6-9” above heart level • Monitor for complications: hemorrhage, infection, nerve damage, DVT • Analgesics • Pt education: meds, activity, MD will remove elastic bandages, watch for bleeding

  8. Leg Ulcers (846) • Pathophysiology: 75% are venous from venous insufficiency or severe varicosities. Poor O2 supply causes necrosis and an open necrotic lesion. Bacterial infection is a common complication. Diabetics are especially vulnerable.

  9. Venous stasis ulcers Irregular borders with serous exudate Mild pain Ankle or medial or lateral malleolus Arterial ulcers Definite border, usually circular Painful Dorsal foot or toes (usually medial hallux or 5th toe) May be necrotic Assessment of Leg Ulcers

  10. Management of Leg Ulcers • Goals are to promote skin integrity, increase mobility, and provide good nutrition • Promoting skin integrity includes good foot care, avoiding trauma, avoiding pressure and standing for long periods. It also includes proper tx of existing ulcers. • Increase mobility as allowed and tolerated. • Good nutrition includes protein, Vits A & C, Fe, Zn, and weight control.

  11. Wound Care Management of Leg Ulcers • Goal # 1: Keep wound moist to promote healing-Tegaderm, hydrocolloids except for deep or infected wounds • Goal # 2: Keep wound clean-saline irrigation is preferred. Necrotic tissue may be debrided with wet to dry dsgs, enzyme ointments, Debrisan beads, Ca++alginate, or surgery. • Goal # 3: Prevent infection-clean or sterile technique depending on depth of wound. Wound cultures prn with antibiotic tx if needed.

  12. Wound Care Management (cont’d) • Compression with Unna boots or TEDs and elevation of the leg is needed for a venous ulcer in order to decrease edema. • New treatments: • Apligraft, made from human skin, stimulates production of growth factors • Hyperbaric O2 increases O2 tension, which increases production of fibroblasts and stimulates collagen growth.

  13. Nursing Management of Leg Ulcers • Assess location, size, color, odor, and drainage • Follow order as to cleaning and dressing of wound. Use appropriate technique and materials. • Request wound cultures if needed • Administer antibiotics and analgesics as ordered • Teach and reinforce good skin and foot care, proper diet, appropriate activity, avoidance of trauma, S/S infection. May need to teach patient and family dressing changes.

  14. Medications for Peripheral Vascular Diseases and Anemias • Peripheral Arterial Occlusive Disease-Trental* • Acute Arterial Occlusion-anticoagulants (heparin), thrombolytics (streptokinase) • Raynaud’s-Ca++channel blocker-(nifedipine*) • HTN-diuretics-HCTZ*, Ablocker-phentolamine*, ACEI-Vasotec*, ARB-Cozaar*, Ca++channel blocker-(diltiazem), BBlocker(atenolol) • DVT- (heparin), (warfarin) • Fe Deficiency Anemia-ferrous sulfate* • Pernicious Anemia-cyanocobalamin* • Herbal supplement-ginkgo biloba*

  15. Trental (pentoxifylline) • Action: Decreases blood viscosity, increases blood flow by increasing flexibility of RBCs • Indication: Intermittent claudication • Forms: po, po XR • Side effects: HA, tremors, dizziness, indigestion, NV, leukopenia • Nursing Considerations: Watch BP if pt is on antihypertensives. Assess for improvement in activity with continued use.

  16. HCTZ (hydrochlorothiazide) • Action: Increases excretion of water, sodium, chloride, and potassium in the distal tubule and ascending limb of loop of Henle. • Indications: Edema, HTN, diuresis, CHF • Form: po • Side effects: Dizziness, weakness, fatigue, hypokalemia, NV, anorexia, hepatitis, aplastic anemia, pancytopenia, glucosuria, allergic reaction (sulfa) • Nursing Considerations: Assess daily wts, I&O, postural BPs, lytes, blood sugar

  17. Regitine (phentolamine) • Action: Binds to alpha adrenergic receptors, dilating peripheral blood vessels, lowering peripheral resistance. and lowering BP • Indication:HTN secondary to pheochromocytoma • Forms: IV, IM • Side effects: Dizziness, hypotension, tachycardia, angina, dysrhythmias, dry mouth, NVD, cerebrovascular spasm • Nursing Considerations: Postural BPs before tx and q4h, daily wts, I&O

  18. Vasotec (enalapril) • Action: Suppresses renin-angiotensin-aldosterone system; prevents conversion of angiotensin I to angiotension II. Dilates arterial and venous vessels. • Indications: HTN, CHF • Forms: po, IV • Side effects: Insomnia, dizziness, hypotension, dysrhythmias, proteinuria, renal failure, agranulocytosis, neutropenia, dry cough • Nursing Considerations: Monitor CBC, BP, P. If pt is on diuretic tx, monitor for syncope

  19. Cozaar (losartan) • Action: Blocks the vasoconstrictor and aldosterone-secreting effects of angiotensin II • Indication: HTN, nephropathy in Type 2 DM • Forms: po • Side effects: Dizziness, insomnia, CVA, MI, dysrhythmias, cough, diarrhea, indigestion, renal failure, angioedema • Nursing Considerations: BP, P. Monitor for edema, lytes, hepatic and renal function before tx begins

  20. Feosol (ferrous sulfate) • Action: Replaces iron stores needed for RBC development, energy, and O2 transport • Indications: Iron deficiency anemia • Forms: po • Side effects: Nausea, epigastric pain, constipation, black stools • Nursing considerations: Assess CBC qmo.

  21. Vitamin B-12 (cyanocobalamin) • Action: Needed for adequate nerve functioning, protein and carbohydrate metabolism, normal growth, RBC development, cell reproduction • Indication: Pernicious anemia • Forms: po, sq, IM • Side effects: CHF, pulmonary edema, diarrhea, anaphylaxis • Nursing considerations: Check K+ levels q6mo, folic acid and B-12 levels after 1 wk, reticulocyte counts

  22. Ginkgo (ginkgo biloba) • Action: Relaxes blood vessels, inhibits platelet aggregation, decreases ischemia and edema • Indications: Peripheral artery disease, intermittent claudication, to enhance circulation • Form: po • Side effects: HA, anxiety, restlessness, NV, anorexia, diarrhea, rash • Nursing considerations: Interacts with anticoagulants, antiplatelets, and some antidepressants (MAOIs). Don’t use during pregnancy and lactation.

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