Deep Vein Thrombosis and Pulmonary Embolism Flashcards

Venous Thromboembolism (VTE) is the preferred comprehensive medical term because it represents the entire spectrum of disease from Deep Vein Thrombosis (DVT) to Pulmonary Embolism (PE).
Deep Vein Thrombosis specifically involves the formation of a thrombus (blood clot) inside a deep vein.
Core objectives for clinical management include:
- Evaluating risk factors predisposing patients to VTE development.
- Identifying the clinical characteristics associated with VTE.
- Outlining interprofessional care and comprehensive nursing management.
- Prioritizing critical aspects of care for patients undergoing anticoagulant therapy.
- Managing the pathophysiology, clinical manifestations, and interprofessional care of pulmonary embolism.

Virchow's triad defines the three primary pathological factors that cause venous embolism:
- Venous stasis: Stagnation or slowdown of blood flow within the venous system.
- Endothelial damage: Direct or indirect damage to the inner endothelial lining of blood vessels.
- Hypercoagulability of the blood: Alterations in blood factors that increase the tendency of blood to clot.

Laboratory Studies:
- Activated partial thromboplastin time (aPTT).
- International normalized ratio (INR).
- Bleeding time.
- Hemoglobin and Hematocrit (Hgb/Hct).
- Platelet count.
- D-Dimer.
- Fibrin monomer complex.
Non-Invasive Venous Studies:
- Duplex ultrasound.
- Venous compression ultrasound.
Invasive Venous Studies:
- Computed tomography venography (CTV).
- Magnetic resonance venography.
- Contrast venography (phlebogram).

Three key evidence-based methods recommended for preventing VTE in the hospital setting:
- Early and aggressive mobilization of the patient.
- Application of graduated compression stockings (TED hose).
- Use of intermittent pneumatic compression devices (Sequential Compression Devices / SCDs).

Subjective Data Assessment:
- Past health history.
- Current medications, herbal supplements, and recreational drug use.
- Past surgical history.
Objective Data Assessment:
- Vital signs, explicitly including comprehensive pain assessment.
- Detailed skin assessment of the affected extremity.
- Presence and extent of edema and cyanosis in the affected extremity.
- Monitoring and evaluation of diagnostic findings.

Routinely monitor urine and stool for hidden or overt signs of blood.
Systematically evaluate laboratory testing results.
Inspect the skin for bruising, particularly at application sites when compression devices are used.
Assess frequently for clinical signs of systemic bleeding or recurring clotting.
Minimize venipunctures; hold firm pressure on venipuncture sites for at least $10\,\text{minutes}$ following blood collection.
Instruct patients to use electric razors exclusively instead of straight razors.
Instruct patients to use a soft toothbrush to prevent oral mucosal trauma.
Perform routine assessments for fall risk and skin breakdown.

Clearly explain the clinical necessity for the medication, potential side effects, and expected total duration of therapy.
Emphasize the vital importance of taking the medication at the exact same time every day.
Explain the necessity and potential schedule of ongoing laboratory tests.
Outline adverse effects and clearly define parameters for when to contact a Healthcare Provider (HCP) or call 911.
Advise avoiding activities that carry a risk of physical trauma.
Instruct patients to strictly avoid medications containing aspirin (ASA) and nonsteroidal anti-inflammatory drugs (NSAIDs).
Instruct patients receiving warfarin to avoid foods high in vitamin K.
Advise patients to inform all healthcare professionals, including dentists, that they are undergoing anticoagulant therapy.

Pathophysiology:
- Pulmonary embolism (PE) is the blockage of one or more pulmonary arteries by a thrombus, fat embolus, air embolus, or tumor tissue.
- Most pulmonary emboli originate from venous thromboembolism arising in the deep veins of the lower extremities.
Clinical Manifestations:
- Signs and symptoms are frequently varied and non-specific.
- Dyspnea: Identified as the most common symptom of PE.
- Tachypnea.
- Cough.
- Chest pain.
- Hemoptysis.
- Adventitious breath sounds, specifically crackles or wheezing.
- Fever.
- Tachycardia.
- Syncope.

Diagnostic Laboratory Studies:
- D-dimer test.
- Arterial Blood Gases (ABGs).
- Troponin level.
- b-natriuretic peptide level.
Diagnostic Imaging and Procedures:
- Computed Tomography (CT) Angiography: Represents the most common diagnostic test used to diagnose PE.
- Perfusion scanning.
- Ventilation scanning.
- Chest X-ray.
- Electrocardiogram (ECG).

Prevention:
- Direct prevention of PE relies on the prevention of DVT/VTE through early/aggressive mobilization, graduated compression stockings, and intermittent pneumatic compression devices.
Pharmacotherapy:
- Treatment must be initiated immediately upon suspicion of PE.
- Low-molecular-weight heparin (LMWH, such as Enoxaparin) is the recommended standard treatment for acute PE.
- Intravenous unfractionated heparin.
- Warfarin.
- Fibrinolytic agents, such as tissue plasminogen activator (tPA).
Surgical Management:
- Emergency surgical intervention is indicated if the patient becomes hemodynamically unstable.

Place the patient on bedrest in a semi-Fowler's position.
Monitor vital signs continuously, specifically including pulse oximetry.
Auscultate and assess lung sounds regularly.
Assess relevant laboratory values:
- ABGs.
- INR (for patients receiving warfarin).
- aPTT (for patients receiving intravenous unfractionated heparin).
Observe carefully for potential bleeding complications.
Conduct fall risk and skin breakdown assessments based on the patient's individual activity level.
Provide emotional support to manage patient anxiety.
Educate the patient regarding long-term compliance with medication regimens.