Class Notes (1,100,000)
US (440,000)
ISU (1,000)
NUR (50)
NUR 229 (20)
Lecture 13

NUR 229 Lecture Notes - Lecture 13: Deep Vein Thrombosis, Collard Greens, Bed Rest


Department
Mennonite College of Nursing
Course Code
NUR 229
Professor
Blanca Miller
Lecture
13

This preview shows pages 1-3. to view the full 12 pages of the document.
Nursing 229: Venous/Arterial Disease/ DVT/PE
In Class Notes
DVT: Deep Vein Thrombosis
1. Risk Factors: Sitting for long periods of time, trauma, surgery prolonged bedrest,
obesity, oral contraceptives, history of DVT
a. Virchows Triad: Three things that occur that cause a DVT
i. 1) Trauma to veins 2) causes venous stasis (slow blood flow/congestion of
blood) 3) blood will clot easier (hypercoaguability)
2. Clinical Manifestations: Calf pain, increased circumference of calf, edema, TTT, warm,
erythema
3. Medical Management: Goal is to keep DVT from growing, getting bigger, and
fragmenting and going into the bloodstream to lungs/heart
a. Anticoagulants
i. Prevention:
1. Heparin Sub Cutaneous (SC)
2. LMWH (Low Molecular Weight Heparin/Lovenox)
ii. Treatment:
1. Heparin gtt. (drip) cant send pt. home on this so you give them Coumadin
when they go home, BODY DISSOLVES CLOT, NOT HEPARIN, goal is to keep
the blood thin to prevent from any further DVTs to develop any further
2. Coumadin Patient is on this for a long period of time & they will take this
PO when they get home
4. Nursing Management
a. Comfort: Elevate legs decrease in edema & increase blood circulation, give pt.
pain medication,
i. Prevention: ROM & ambulation of patient, compression stockings/TED hose
b. Education: The patient is at risk for bleeding make sure to tell them to use an
electric razor, avoid physical sports, wear Medic Alert bracelet
***Heparin: Antidote is Protamine Sulfate
- Partial Thromboplastin Time (PTT) normal blood clot is 35-45 seconds; if youre put
on heparin then your clotting time will be prolonged; (draw a baseline before giving
heparin to know what therapeutic normal is) 1.5-2x the therapeutic normal, if
its higher then reduce the amount of heparin given
***Coumadin: Antidote is Vitamin K Pt. must be on the same brand of Coumadin and
they go on the same lab center each time they get their lab work done, wear Medic Alert
bracelet, make sure you dont put yourself in any danger/dont fall and, tell pt. not to eat
too many leafy greens (spinach, kale, collard greens); look at Chart 23.10
find more resources at oneclass.com
find more resources at oneclass.com

Only pages 1-3 are available for preview. Some parts have been intentionally blurred.

- Prothrombin Time (PT): Normal blood clotting time is 10-12 seconds, want it to be
1.5-2x of your normal time
- International Normalized Ratio (INR): Ratio calculated in the lab that looks at PT
and it will draw up the right dose of Coumadin; normal range is 1; if someone just
had a valve replacement then itll be higher (2-3)
Pulmonary Embolism: VERY EMERGET PT. CAN DIE VERY QUICKLY
5. What is it? A person gets a DVT and ends up getting a PE; a clot in the lung that travels
to the pulmonary artery or one of its branches; obstruction in pulmonary artery due to
a clot inflammatory process that happens where there is diminished blood flow to
the lung and you end up with lung necrosis
6. Clinical Manifestations: Tachycardia happens because the heart is trying to work harder
and it eventually gives out cardiac arrest; chest pain, anxiety because you cant
breathe, hymoptosis (coughing up blood) due to pulmonary necrosis, make sure you get
a CAT scan right away so they can locate the clot
7. Nursing Management: Pt. will need oxygen, will be started on an anticoagulant
(heparin) and send home on Coumadin; monitor vital signs, may need pain medication
due to chest pain but watch respiratory status; help decrease patients anxiety
a. When sending pt. home on Coumadin tell them to wear a bracelet, use soft
brushes to brush teeth, avoid Vitamin K, use electric shaver, keep an eye out for
internal bleeding (echomosis diffuse bruises), blood stools, etc.
PAD: Peripheral Arterial Disease caused by lack of oxygen/blood to legs, caused by
plaque and arterial sclerosis (hardening of arteries)
8. Clinical Manifestations: Intermittent claudication (pain when they walk/activity), rest
pain (pain all of the time, even when sitting) advanced PAD, ulcers that are
small/circular may appear are found on the toes that become dry gangrene and it leads
to amputation; when you touch the pt.s feet will have no hair & will be cold to the
touch, skin will be taught/shiny from lack of blood flow, thick toenails, extremities will
be pale/cyanotic, when we put the pt. in the dependent position (feet dangle)
9. Medical Management: Have pt. join an exercise/walking program to develop collateral
circulation (blood flow is going to feet) if not, amputation will occur, start pt. on
medications
a. Intermittent Clauditcation: vasoactive, helps improve blood flow to distal portion
i. Trental
ii. Pletal
b. Antiplatelets: thins the blood just a little bit
i. Plavix
ii. Aspirin
10. Nursing Management: Walking program to develop circulation, stop smoking (nicotine
constricts blood vessels), ulcers will be shallow and superficial, irregularly shaped,
edema of foot/leg, pt. will complain of heaviness/achiness because there is venous
insufficiency (blood flow thru veins that is impaired), leg will feel warm
Care of Client with Leg Ulcers
find more resources at oneclass.com
find more resources at oneclass.com

Only pages 1-3 are available for preview. Some parts have been intentionally blurred.

11. Assessment: Look at skin, temperature, pain level (arterial more pain; venous
aching pain), check pulse & palpate if possible; immobility issues?
12. Nursing Diagnoses: Impaired skin integrity, impaired physical mobility
13. Nursing Planning/Implementation:
a. Interventions:
i. Dependent Edema: Happens with someone with venous disease; elevate the legs
to decrease swelling/increase blood to heart
ii. Avoid trauma to the legs/feet:
1. Venous disease ulcers on the ankles; Teach pt. to wear long pants, wear
TED hose because decrease in edema/increase circulation; wear closed toe
shoes & socks
2. Arterial disease dont put TED hose because it will impair more blood flow;
wear closed toe shoes & socks; decrease in sensation avoid hot/cold
temperatures because it will cause burns or frostbite on the legs; make sure
paths are clear so they dont bump into things
iii. Walking Program: if the pt. has an ulcer we dont want them to walk on it
1. Arterial Disease: helps with circulation
2. Venous Disease: helps with venous return to heart & decrease in edema
iv. Nutrition: Eat a lot of protein & vitamins (& iron) to help with healing,
14. Evaluation: Is mobility better? Are they progressively increasing the amount they walk?
Decrease in pain/no pain? Are they eating a nutritious diet (low fat/low cholesterol
foods)? Are their ulcers healing/decreasing?
Learning Objectives
1. Use the nursing process as a framework of care for patients with arterial and venous
insufficiency of the extremities, leg ulcers, DVT and PE
2. Compare the various diseases of the veins/arteries and their causes, pathophysiologic
changes, clinical manifestations, management, and prevention.
3. Compare strategies to prevent venous insufficiency, leg ulcers, DVT, and PE.
Terms to Know
15. Arteriosclerosis
16. Atherosclerosis
17. Pulmonary edema
18. Pulmonary embolism
19. Intermittent claudication: Pain, discomfort, or fatigue caused by the inability of the
arterial system to provide adequate blood flow to the tissues in the face of increased
demands for nutrients and oxygen during exercise
20. Ischemia
21. Rest pain
22. Rubor
23. Stenosis
Assessment of the vascular system Page 845-847
find more resources at oneclass.com
find more resources at oneclass.com
You're Reading a Preview

Unlock to view full version