Deep Vein Thrombosis and Pulmonary Embolism Flashcards

Flashcards covering predisposing risk factors, clinical manifestations, prevention, diagnostic studies, and nursing management of VTE and PE.

Why is venous thromboembolism (VTE) the preferred term over deep vein thrombosis (DVT)?

Venous thromboembolism (VTE) is the preferred term because it represents the full spectrum from DVT to pulmonary embolism (PE).

What three factors comprise Virchow's triad?

1. Venous stasis
2. Damage to the endothelium
3. Hypercoagulability of the blood

What are the clinical manifestations of venous thromboembolism (VTE)?

Unilateral leg pain, edema, tenderness, dilated superficial veins, sense of fullness in leg/thigh, warm skin, and erythema.

Which laboratory studies are used in the diagnostic evaluation of VTE?

aPTT, INR, bleeding time, Hgb/Hct, platelet count, D-Dimer, and fibrin monomer complex.

Which non-invasive venous studies are used to diagnose VTE?

Duplex ultrasound and venous compression ultrasound.

Which invasive venous studies are used to diagnose VTE?

Computed tomography venography (CTV), magnetic resonance venography, and contrast venography (phlebogram).

What are the three recommended ways to prevent VTE in a hospital setting?

1. Early and aggressive mobilization
2. Graduated compression stockings (TED hose)
3. Intermittent pneumatic compression devices (SCDs)

Which classes and specific medications are used for anticoagulant therapy in VTE?

Vitamin K antagonists (warfarin), low-molecular weight heparin (enoxaparin), unfractionated heparin (heparin sodium), Factor Xa inhibitors (apixaban), Hirudin derivatives (angiomax), and synthetic thrombin inhibitors (argatoban).

What objective data should the nurse assess in a patient with VTE?

Vital signs (including pain assessment), skin assessment of affected extremity, edema and cyanosis of affected extremity, and diagnostic findings.

What nursing management steps are recommended to prevent bleeding in patients receiving anticoagulants?

Monitor urine/stool for signs of blood, evaluate lab results, evaluate for bruising (especially with compression devices), assess frequently for bleeding or clotting, reduce venipunctures, hold pressure for at least $10\,\text{minutes}$ after blood draws, use electric razors (not straight razors), use a soft toothbrush, and perform fall risk and skin breakdown assessments.

What key teachings should be provided to a patient and caregiver regarding anticoagulant therapy?

Explain the need for medication, side effects, and length of therapy; take medication at the same time every day; potential for lab tests; adverse effects and when to call HCP or $911$; avoid trauma; avoid medications with ASA and NSAIDS; avoid foods high in vitamin K if taking warfarin; and inform all providers (including dentists) of anticoagulant therapy.

What is the definition of a pulmonary embolism (PE)?

The blockage of $1$ or more pulmonary arteries by a thrombus, fat or air embolus, or tumor tissue.

What is the primary cause of most pulmonary embolisms?

Venous thromboembolism (VTE) originating from the deep veins of the legs.

What is the most common symptom of a pulmonary embolism (PE)?

Dyspnea.

What are the clinical manifestations associated with a pulmonary embolism (PE)?

Dyspnea, tachypnea, cough, chest pain, hemoptysis, crackles/wheezing, fever, tachycardia, and syncope.

Which laboratory studies are used in the diagnostic evaluation of PE?

D-dimer, ABGs, troponin level, and b-natriuretic peptide level.

What is the most common test used to diagnose a pulmonary embolism (PE)?

CT angiography.

What is the recommended anticoagulant treatment for patients with acute PE?

Low-molecular weight heparin (LMWH), such as enoxaparin.

When is surgical intervention indicated for a patient with a pulmonary embolism?

When the patient is hemodynamically unstable.

What bedrest position and specific lab monitoring are indicated for nursing management of PE?

Bedrest in a semi-Fowler's position; monitor aPTT for IV heparin and INR for warfarin.