NURS 311: Lab 6 - Venous Thromboembolism and Pulmonary Embolism

What is a venous thromboembolism (VTE)?

A blood clot in the vein.

What are the 2 main types of VTE?

Deep vein thrombosis and pulmonary embolism.

What are the 3 main parts of Virchow's Triad?

Blood flow stasis, endothelial injury, and hypercoagulability.

What is a thrombophlebitis?

A thrombus that is associated

with inflammation.

What is deep vein thrombosis (DVT)?

A blood clot in the deep veins.

What are significant risk factors for developing DVT?

1. Advanced age

2. Stasis of blood flow

3. Post-op

4. Long drives/flights

5. Varicose veins

6. Obesity

7. Pregnancy

8. COVID-19

9. Heart failure

10. Atrial fibrillation

11. May-Thurner Syndrome

What diagnostic test is considered the gold standard for diagnosing pulmonary embolism?

Computed tomography pulmonary angiography (CTPA).

What are the common locations for DVT in the body?

Lower extremities, including iliac, femoral, and popliteal veins.

What are the s/s of DVT?

1. Calf or groin tenderness and pain

2. Sudden unilateral swelling of the leg

What is the significance of Homan's sign in DVT assessment?

It may indicate DVT but is unreliable due to false positives.

What are the imaging assessments used to diagnose DVT?

1. Venous duplex ultrasonography

2. Doppler flow studies

3. MRI

4. D-dimer test

What is the preferred imaging assessment used for DVT?

Venous duplex ultrasonography.

What is a relevant laboratory test for diagnosing DVT?

D-dimer.

Doppler flow studies are more useful in diagnosing proximal DVT. (True/False)

True

What are some preventative strategies for DVT?

1. Patient education

2. Leg exercises

3. Ambulation

4. Hydration

5. Compression stockings

6. Compression devices

7. Foot pumps

8. Anticoagulants

What are some non-surgical management strategies for DVT?

1. Bed rest

2. Elevation

3. Gradual mobilization

4. Warm compress

Massaging the site of a DVT is recommended as it will help alleviate the patient's pain. (True/False)

False

What are the main types of drug therapy for DVT?

1. Direct oral anticoagulants (DOACs)

2. Low molecular weight heparin (LMWH)

3. Warfarin

What should you do if bleeding occurs during anticoagulant therapy?

Stop the anticoagulant therapy and call the healthcare provider

What is an unfractionated heparin therapy (UFH)?

A form of anticoagulation treatment that uses standard heparin

Which lab values are required before a UFH?

1. Baseline PT

2. APTT/aPTT

3. NR

4. CBC

5. Urinalysis

6. stool sample for occult blood

7. Creatinine

Which lab values are monitored during a UFH?

aPTT and Anti-factor Xa.

What is heparin-induced thrombocytopenia (HIT)?

When heparin causes platelets to be less than 150,000.

What is the antidote to heparin?

Promatine sulfate.

What is the antidote to warfarin?

Vitamin K.

What is low-molecular-weight heparin (LMWH)?

A modified heparin that has a longer half-life and a more predictable response due to less binding.

It is not recommended to start a patient on warfarin when they are already on heparin since both drugs are anticoagulants and work the same. (True/False)

False

Which lab values are inaccurate for direct oral anticoagulants?

PT and INR.

What is the antidote for dabigatran?

Idarucizumab.

What is the antidote for edoxaban, rivaroxaban, and apixaban?

Andexanet alfa.

What are some surgical managements for DVT?

Thrombectomy and IVC filtration.

Thrombectomy is only used for DVT when there is a massive occlusion or when pharmacotherapy doesn't work. (True/False)

True

What is a common complication of DVT?

Pulmonary embolism (PE).

What is a pulmonary embolism (PE)?

A blood clot in the lungs.

A pulmonary embolism can be a solid, liquid, or air. (True/False)

True

1 multiple choice option

In which area of the lungs are blood clots usually found in PE?

Lower lobes

What are s/s of PE?

Sudden dyspnea, chest pain, restlessness, impending doom feeling, light-headedness, cough, hemoptysis, diaphoresis, tachypnea, crackles, pleural friction rub, tachycardia, s3 and s4, fever, petechiae, and hypoxemia.

Which laboratory tests are used for PE?

ABGs, pulse oximetry, BNP, troponin, and D-dimer.

Which imaging assessments are used for PE?

Computed tomography pulmonary angiography, V/Q scan, magnetic resonance arteriography, chest x-ray, Doppler ultrasound, and transthoracic echocardiography.

Which imaging assessment is used when computed tomography pulmonary angiography is contraindicated for a PE?

V/Q scan or magnetic resonance arteriography.

V/Q scans and transthoracic echocardiography are the best imaging tools to diagnose a PE. (True/False)

False

1 multiple choice option

Which imaging assessment is the standard for diagnosing a PE?

Computed tomography pulmonary angiography.

What are the main interventions for hypoxemia with PE?

Implement oxygen therapy, administer anticoagulation, assess the patient's response, and provide psychosocial support

What is the recommended position for a patient experiencing a pulmonary embolism?

High-Fowler's position.

What are the main interventions for hypotension with PE?

IV fluid therapy and drug therapy.

What are the main interventions for the risk of bleeding with PE?

Have antidotes be readily accessible and check labs daily.