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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