Cardiovascular - CVD : Venous

What venous disorders should you know?

Chronic Venous Insufficiency (CVI), Deep Vein Thrombosis (DVT), and Pulmonary Embolism (PE).

What causes chronic venous insufficiency (CVI)?

Venous valve failure causing venous pooling and edema.

How does CVI develop?

Valve failure → venous pooling → edema → decreased venous return → decreased cardiac output.

What are the hallmark signs of chronic venous insufficiency?

Edema, brown pigmentation (stasis dermatitis), venous ulcers, and pulses remain present.

Why do pulses remain present in venous disease?

The arterial blood supply is intact.

Where are venous ulcers located?

Medial malleolus (inside ankle).

What do venous ulcers look like?

Beefy red, moist, superficial, irregular borders.

Where are arterial ulcers located?

Toes, heels, or pressure points.

What do arterial ulcers look like?

Deep, pale/black, dry, and painful.

What treatment promotes healing of venous ulcers?

Moist wound dressings.

Are topical antibiotics routinely used for venous ulcers?

No.

Why are compression stockings used in venous disease?

To increase venous return.

Should compression stockings be used in PAD?

No.

What exercises improve venous return?

Walking and calf muscle activity.

What should patients with venous disease avoid?

Standing, sitting for long periods, crossing legs, and constrictive clothing.

What diet promotes healing in venous disease?

High-protein diet.

How should legs be positioned with venous insufficiency?

Elevated above the heart.

How should legs be elevated for venous disease?

Elevate the foot of the bed or use a wedge.

Why should pillows under the knees be avoided?

They impair venous return.

What is the highest-yield positioning difference?

PAD = legs DOWN; Venous disease = legs UP.

What are the three components of Virchow's Triad?

Venous stasis, vessel injury, and hypercoagulability.

What causes venous stasis?

Bedrest, immobility, sedentary lifestyle.

What causes vessel injury?

Trauma or surgery.

What causes hypercoagulability?

Cancer, estrogen, smoking, dehydration, clotting disorders.

What is a thrombus?

A clot that remains where it formed.

What is an embolus?

A clot that travels and lodges elsewhere.

Where do emboli commonly originate?

From thrombi.

What serious complication can a DVT cause?

Pulmonary embolism.

What are the major risk factors for DVT?

Surgery, trauma, hip/knee surgery, stroke, atrial fibrillation, dehydration, immobility, smoking, cancer, estrogen, clotting disorders.

What are the hallmark signs of DVT?

Unilateral pain, warmth, redness, swelling, and heaviness.

Is Homan's sign reliable?

No.

How is DVT diagnosed?

Doppler ultrasound, venography, and D-dimer.

What is D-dimer?

A fibrin degradation product indicating thrombosis.

What are the best methods to prevent DVT?

Early ambulation, leg exercises, hydration, compression stockings, SCDs, foot pumps, and anticoagulants.

What is the first-line treatment for DVT?

Anticoagulation.

Which anticoagulants are preferred for most adults with DVT?

DOACs.

How long is anticoagulation typically continued after a DVT?

At least 3 months.

When are thrombolytics or thrombectomy used?

For extensive or limb-threatening DVT.

When is an IVC filter indicated?

When anticoagulation is contraindicated.

How should a patient with DVT position the affected leg?

Elevated 6–8 inches above the heart.

Should patients remain on bedrest after anticoagulation begins?

No. Encourage early ambulation.

Should heat be applied after DVT is diagnosed?

No.

What should the nurse do if bleeding occurs during fibrinolytic therapy?

Stop the infusion and notify the provider immediately.

How is heparin administered?

IV or subcutaneous.

Which coagulation pathway does heparin affect?

Intrinsic pathway.

Which laboratory test monitors heparin?

aPTT.

What is the therapeutic aPTT?

1.5–2.5 times normal.

What is the antidote for heparin?

Protamine sulfate.

What is the half-life of heparin?

About 1.5 hours.

How is warfarin administered?

Orally.

Which coagulation pathway does warfarin affect?

Extrinsic pathway.

Which laboratory test monitors warfarin?

PT/INR.

What is the therapeutic INR for warfarin?

2–3.

What is the antidote for warfarin?

Vitamin K.

What is the half-life of warfarin?

About 5 days.

Why is heparin overlapped with warfarin?

Warfarin has a delayed onset, so heparin provides immediate anticoagulation until INR is therapeutic.

What dietary teaching is important for warfarin?

Maintain a consistent intake of vitamin K.

How is blood pressure calculated?

BP = Cardiac Output × Systemic Vascular Resistance.

What percentage of hypertension is primary?

90–95%.

What percentage of hypertension is secondary?

5–10%.

What causes primary hypertension?

Unknown.

What causes secondary hypertension?

An identifiable underlying condition.

What is the first step in treating hypertension?

Lifestyle modification.

When are medications started for Stage 1 hypertension?

If the 10-year cardiovascular risk is greater than 10% or the patient has CVD, diabetes, or CKD.

How is Stage 2 hypertension treated?

Lifestyle modification plus two antihypertensive medications from different classes.

What medication classes should you know for hypertension?

Diuretics, ACE inhibitors, ARBs, beta blockers, calcium channel blockers, and vasodilators.

Which antihypertensive class is first-line?

Diuretics.

What does DASH stand for?

Dietary Approaches to Stop Hypertension.

What foods are emphasized on the DASH diet?

Fruits, vegetables, whole grains, lean protein, low-fat dairy, calcium, potassium, and fiber.

How much sodium is recommended on the DASH diet?

Less than 1500 mg/day.

Which foods should be limited on the DASH diet?

Canned foods, processed foods, fast food, deli meats, MSG, soy sauce, ketchup, mustard, and excess alcohol.

What potassium intake is recommended on the DASH diet?

3500–5000 mg/day.

Besides diet, what lifestyle modifications reduce blood pressure?

Weight loss and regular exercise.

What is the highest-yield difference between PAD and venous disease?

PAD = legs DOWN; Venous disease = legs UP.

What is the highest-yield ulcer comparison?

Arterial ulcers = toes/heels, deep, painful; Venous ulcers = medial malleolus, superficial, moist.

What is the highest-yield pulse comparison?

PAD = absent pulses; Venous disease = pulses present.

What is the highest-yield temperature comparison?

PAD = cool extremity; Venous disease = warm extremity.

What are the highest-yield anticoagulant facts?

Heparin = aPTT + Protamine; Warfarin = INR + Vitamin K.

What are the highest-yield DVT prevention measures?

Early ambulation and anticoagulation.

What is the highest-yield HTN lifestyle intervention?

DASH diet.