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NUR1 421 (1)

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McGill University
NUR1 421
Mark Shrimpton

Venous Thrombosis  Most common vein disorder  Classified as superficial or deep.  Superficial: o Inflammation of vein (occurs in 65% of pt’s on IV therapy) o Usually minor  Deep Venous Thrombosis: o Involves a thrombus in a deep vein o Most common in the iliac and femoral veins o Occurs in 5% of all surgical clients o More serious because it can result in thrombi in the lungs, PE (life threatening) Etiology  3 important factors (called Virchow’s Triad) o Venous stasis  Occurs when valves are dysfunctional or muscles of extremities are inactive  Occurs frequently in obese people, CHF, post-op inactive people o Damage to endothelium (inner lining of vein)  Can be caused by trauma or external pressure by venipuncture  Damaged endothelium has decreased fibronlytic properties predisposing it to thrombus formation  Giving medications VIA IV can cause damage o Hypercoaguability of blood  Occurs in blood disorders such as polycythemia, anemia and cancer Pathophysiology  RBCs, WBCs, platelets and fibrin adhere to form a thrombus  Frequent site of thrombus formation is in the valve cusps, where venous stasis allows accumulation  As the thrombus enlarges increased number of blood cells and fibrin collect behind it producing a larger clot and occluding the lumen of the vein  If it only partially occludes the vein it becomes covered by endothelial cells and the thrombotic process stops  If it doesn’t get detached then it undergoes lysis within 5-7days  Detached thrombi are called emboli  The embolus will flow and end up in the lungs generally  Major factor contributing to detachment is blood flow turbulence Superficial Thrombophlebitis Clinical Manifestations  Client may have a firm, palpable, subcutaneous cord-like vein  The area surrounding the vein may be tender to touch, red and warm.  Mild systemic temperature elevation and leukocytosis may be present  Can be edema in extremities  Most common cause in upper extremities is trauma caused by IV therapy  Most common cause in lower extremities is trauma to varicose veins  Can be diagnosed on physical examination alone  Treatment includes elevation, warm moist heat, stockings, NSAIDs Deep Vein Thrombosis  May have no symptoms or have unilateral edema, extremity pain, warm skin and erythema  If in calf, tenderness, pain of dorsiflexion (hormans sign)  If vena cavas are involved, cyanosis  Complications: PE, chronic venous insufficiency (valve destruction), and phlegmasia
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