DVT & varicose veins

8/8/2019 DVT & varicose veins

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VENOUS DISORDERS

Margaret Xaira R. Mercado RN


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DEEP VEIN THROMBOSIS

Inflammation of the vessel wall with formation of

a blood clot (thrombus) which could affect

superficial or deep vein resulting to venous

insufficiency Frequently affects lower extremity veins

saphenous, femoral, and popliteal

Can result damage to the surrounding tissues,

ischemia and necrosis Complication: life threatening pulmonary

thromboembolism


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RISK FACTORS:

VIRCHOWS TRIAD Venous stasis

Surgery, obesity, pregnancy, CHF and immobility

Hypercoagulability

Malignant neoplasms, dehydration, blooddyscrasias and oral contraceptive use

Venous wall injury

Constriction due to restrictive matrial (i.e., garters,

straps) or trauma to lower extremities causing

injury to venous walls


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PATHOPHYSIOLOGYPlatelets release

chemicalsinitiating platelet

aggregation

Clot formation Clot grows in size

Blocks orobstruct vein

Prevention ofvenous drainagefrom area distal

to site

Clot maydislodge and

travel tocirculation

May lodge to thepulmonary artery

Pulmonaryembolism


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ASSESSMENT

CARDIOVASCULAR SYSTEM

Superficial vein: tenderness, redness, and

induration along the course of the vein

Deep vein: swelling, venous distention of limb,tenderness over involved vein, and cyanosis


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OTHER MANIFESTATIONS

Positive Homans sign-pain on calf muscles when clients leg is

dorsiflexed due to the stretching of inflammed

veins

-pathognomonic sign of DVT

Pain in the affected extremity

Low grade fever

Edema of the leg


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HOMANS SIGN


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DIAGNOSTIC TESTS

1. VENOGRAPHY: increased uptake ofradioactive material

2. DOPPLER ULTRASONOGRAPHY: impaired

blood flow ahead of thrombus

3. VENOUS PRESSURE MEASURE: high in

affected limb until circulation is formed

4. CBC: elevated WBC and ESR


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NURSING INTERVENTIONS

1. Monitor and improve clients circulatory state

- assess vital signs every 4 hours

- measure thighs, calves, ankles, and instep

every morning- monitor for chest pain or shortness of breath

(possible pulmonary embolism)

2. Provide bed rest, elevating lower extremity to

increase venous return and to decrease edema


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3. Apply continuous, warm, moist soaks to

decrease lymphatic congestion

4. Provide client teaching and discharge planning

- avoid standing, sitting for long periods, wearing

constrictive clothing, leg crossing, smoking, and

oral contraceptive use- adequate hydration to prevent

hypercoagulability

- use of elastic stockings if ambulatory

- importance of planned rest periods and

elevation of the feet


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-plan for exercise/ activity

feet dorsiflexion (sitting or lying down)

swim several times weekly

gradually increase walking distance

-weight reduction if obese


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5. Provide dependent and other collaborative

nursing interventionsSURGERY

vein ligation and stripping

venous thromboectomy removal of a clot in the

ileo-femoral region

Application of the vena cava filter insertion of

an umbrella-like prosthesis to the vena cavas

lumen to filter incoming clots


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*After Surgery

Encourage deep breathing exercises Early ambulation to promote vrnous return

Use of anti-embolic stockings

Elevate the foot of the bed to aid in venousreturn

ASSISST IN DRUG REGIMEN

Administer anticoagulants

Heparin

Warfarin


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HEPARIN

Blocks conversion of

prothrombin to

thrombin and reduces

formation orextension of thrombus


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SIDE EFFECTS

a. Spontaneous bleeding

b. Injection site reactions

c. Ecchymoses

d. Tissue irritation and sloughinge. Reversible transient alopecia

f. Cyanosis

g. Pain on arms and legs

h. Thrombocytopenia


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NURSING RESPONSIBILITIES

1. Monitor partial thromboplastin time (PTT);dosage is adjusted to maintain PTT between

1.5 to 2.5 times normal

2. Use of infursion pumps in IV heparin

administration

3. Ensure proper injection technique

- syringe: use gauge 26-27 syringe; inject to

subcutaneous area of abdomen- avoid injecting within 2 inches of the umbilicus


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- do noth withdraw plunger to assess blood

return- apply gentle pressure after removal of needle;

avoid massaging the injection site

4. Assess for increased bleeding tendencies and

report to the physician

- hematuria; hematemesis; bleeding gums;

petichiae of soft palate; ecchymoses; epistaxis;

bloody sputum; melena


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5. Instruct the client to avoid aspirin,

antihistamines, and cough preparationscontaining glyceryl, guaiacolate, and to obtain

physicians permission before using other over-

the-counter drugs

6. Always have protamine sulfate (antidote forheparin toxicity) available at hand


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WARFARIN (COUMADIN)

Blocks prothrombin synthesis by interferring withvitamin K synthesis

SIDE EFFECTS Gastrointestinal: anorexia, nausea and

vomitting, diarrhea, stomatitis

Hypersensitivity: dermatitis, urticaria, pruritus,

fever Others: transient hair loss, burning sensation of

feet, bleeding complications


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NURSING RESPONSIBILITIES

a. Monitor prothrombin time (PT) daily; dosage is

adjusted to maintain PT at 1.5-2.5 times normal

b. Obtain careful medication history

c. Advise client to withhold dose and to notify thephysician for signsof bleeding

d. Instruct to use soft toothbrush and to floss

gently


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e. Alert client to factors that may affect anti-coagulant response (high fat diet or sudden

increases in vitamin K-rich foods)

f. Always have vitamin K (antidote for warfarin

toxicity) available at hand.


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VARICOSE VEINS

Dilated veins that occur most often in the lowerextremities and trunk

Vessels dilate and valves become stretched and

incompetent with resultant venous

pooling/edema

Most common between ages 30-50


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RISK FACTORS

a. Congenital weakness of the veinsb. Thrombophlebitis

c. Pregnancy

d. Obesitye. Heart disease


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ASSESSMENT

SYSTEMIC

MANIFESTATIONS

Pain after prolonged

standing (relieved byelevation)

Swollen, dilated, tortous skin

veins

Leg heaviness and

dependent edema


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DIAGNOSTIC TESTS

BRODIE-TRENDELENBURG TEST Medical test to determine valvular incompetence

in superficial vein. A finger is placed over the

lower (distal) part of the vein being examined.

The upper (proximal) part of the vein is then

tapped (percussed). If the impulse is felt by the

finger placed at the lower end, it indicates

incompetence of valves in that vein

Varicose veins distend very quickly (less than 35

seconds)


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DOPPLER

ULTRASOUND Decreased or no

blood flow heard after

the calf or thigh

compression

DUPLEX SCAN


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NURSING INTERVENTIONS

1. Monitor and improve clients cardio-circulatorystate measure circumference of ankle and

calf daily

2. Provide adequate rest

3. Instruct to avoid prolonged standing and sitting

and to change position frequently

4. Elevate legs when tired

5. Provide client health teaching and dischargeplanning: same as in thrombophlebitis


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6. Provide dependent and other collaborative

nursing interventions:a. Apply anti-embolic stockings

b. Prepare client for vein ligation (ligation of the

saphenous vein where it joins the femoral vein

and stripping the saphenous vein system fromgroin to ankle)

- provide routine preoperative care

- keep affected extremity elevated above thelevel of the heart to prevent edema


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- Apply elastic bandages and stockings, which

should be removed every 8 hours for shortperiods and then reapplied

- Assist in getting out of bed within 24 hours

- Assess for increased bleeding, particularly the

groin area

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DVT & varicose veins