VTE, FES

What is a venous thromboembolism?

Blood clot that may dislodge and travel through the bloodstream, eventually blocking off a blood vessel

What are the RF for VTE?

• venous stasis from muscle inactivity

  • Hip fracture

  • THR, TKR

• limited mobility

what are the clinical manifestations of DVT?

• unilateral swelling

• localized pain that worsens with activity

• erythema, venous distenion

• Homan’s sign

What are the clinical manifestations of PE?

• Pleuritic chest pain

• tachycardia

• hemoptysis, dyspnea

• syncope

What are the nursing considerations for VTE?

• Assess for s/s of DVT or PE

• Teach and use preventative measures

• administer anticoagulants

• reposition pt every 2-4hrs, assist with walking

What are preventative measures for VTE?

• prophylactic drugs

• antiembolism stockings

• Intermittent pneumatic compression devices

• Exercises

  • dorsiflexion, plantarflexion

What is fat embolism syndrome?

disorder where systemic fat globules enter the circulatory system

what are the causes of FES?

• Fractures

  • 2 theories:

    • mechanical theory - fat released from marrow enters circulation, where it can obstruct, leading to local ischemia and inflammation

    • biochemical theory - hormonal changes caused by trauma or sepsis stimulate release of fatty acids, which form fat emboli

• Joint replacement, bone marrow transplantation

• Burns, crush injuries

• Pancreatitis

• Liposuction

What are the clinical manifestations of FES?

• s/s occur 24-48hrs after injury

• s/s of ARDs

• Petechiae on neck, chest wall, axilla, buccal membrane, or conjunctiva

• Quick clinical course

  • pallor to cyanosis, then comatose

• CXR may show bilateral pulmonary infiltrates

what are the s/s of ARDs?

• Chest pain

• tachypnea, dyspnea

• cyanosis

• apprehension, change in mental status

What are lab changes in FES?

• Fat cells in blood/urine/sputum

• PaO2 <60

• Decreased PLT, HCT

• Increased ESR

What are the EKG changes of FES?

• ST-segment and T-wave changes

what is the tx of FES?

• hemodynamic support

  • dobutamine, nitrous oxide

  • fluid and blood administration

• Respiratory support

  • O2 (intubation or IPPV), ECMO, Mechanical ventialtion

  • monitor for pulmonary edema and ARDs

What are preventative measures of FES?

• careful immobilization and handling of long bone fractures

  • reposition as little as possible