Deep Vein Thrombosis Leave a Comment / Medical Surgical Nursing (MSN) / By nurseinfo.in DEEP VEIN THROMBOSIS – Etiology, Risk Factors, Pathophysiology, Clinical Manifestation, Diagnostic Evaluation and Management (Surgical and Nursing) Deep vein thrombosis or deep venous thrombosis (DVT) is a blood clot in a deep vein. A clot inside a blood vessel is called thrombus. Deep vein thrombosis (DVT) is a condition in which a blood clot forms in one or more of the deep veins in the body, usually in a calf or thigh muscle of legs. ETIOLOGY Combination of venous stasis Hypercoagulability Physical damage or endothelial activation Genetic factors: deficiencies in antithrombin, protein C RISK FACTORS Acquired Older age Major surgery and orthopedic surgery Cancers especially pancreatic Immobilization, as in orthopedic casts the sitting position, and travel, particularly by air Pregnancy and the postpartum period Antiphospholipid syndrome (such as lupus anticoagulant) Trauma and minor leg injury Previous oral contraceptives Hormonal replacement therapy Central venous catheters Inflammatory diseases and some autoimmune diseases Nephritic syndrome Obesity Infection HIV Polycythemia vera Chemotherapy Inherited Antithrombin deficiency Protein C deficiency Protein S deficiency (type I) Factor V Leiden Prothrombin Dysfibrinogenemia Non-O-blood type Mixed Low free protein S Activated protein C resistance High factor VIII levels Hyperhomocysteinemia High fibrinogen levels High factor IX levels High factor XI levels PATHOPHYSIOLOGY When legs are inactivated —- ineffective blood pools by gravity in the veins —- thrombus develops in local process —- platelets adhere to endothelium —- adenosine diphosphate is released by dead tissue —- this leads to platelet plug form —- risk of embolization CLINCIAL MANIFESTATION Swelling in one or both legs Pain or tenderness in one or both legs, which may occur only while standing or walking Warmth in the skin of the affected leg Red or discolored skin in the affected leg Visible surface veins Leg fatigue DIAGNOSTIC EVALUATION Physical examination: swelling in the leg from fluid can result in ‘pitting’ after pressure is applied CT scan: an abdominal CT scan shows a common iliac vein thrombosis D-dimer test: a type of blood test that detects pieces of blood clots that have broken down and are loose in the bloodstream Duplex ultrasound: during this test, high-frequency sound waves bounce off the inside of body, producing images of blood vessels. An ultrasound image demonstrates a blood clot in the left common femoral vein MANAGEMENT Anticoagulation: anticoagulation, which prevents further coagulation but does not act on existing clots, is the standard treatment for DVT. Parenteral anticoagulant (such as fondaparinux, or heparin) for at least five days and a vitamin K antagonist an oral anticoagulant Graduated compression stockings and walking: in addition to anticoagulation treatment, the graduated compression stockings, which apply higher pressure (30 to 40 mm Hg) at the ankles and a lower pressure around the knees is suggested. Walking is also suggested over bed rest for those without severe pain or edema SURGICAL MANAGEMENT Inferior vena cava filters: inferior vena cava filters (IVC filters) are used on the presumption that they reduce PE. They are only recommended in some high-risk scenariosThrombolysis: thrombolysis, which acts to break up clots, can be systemic or catheter-directed, patients may choose thrombolysis, if it concerns over the complexity, bleeding risk, and cost of the procedure Mechanical thrombectomy: a mechanical thrombectomy device can remove a thrombosis Nursing Management Nursing Diagnosis: Risk for hemorrhage related to graft procedure Interventions Monitor pulse rate Monitor central venous pressure Provide sterile dressing on wound Give vitamin K as per doctor’s advice Nursing Diagnosis: Pain related to disease condition as evidenced by verbal communication. Interventions Assess for the presence of pain, the scale and intensity of pain Teach the client about pain management and relaxation with distraction Secure the chest tube to restrict movement and avoid irritation Assess pain-reduction measures Provide analgesics as indicated Nursing Diagnosis: risk for impaired gas exchange related to cough and pain from incision Interventions Airway management Open the airway with headtilt, chinlift, jaw thrust Set the position to maximize ventilation Use tools airway Perform chest physiotherapy Teach breathing deeply and coughing effectively Perform suction Auscultation of breath sounds Give bronchodilators Oxygenation therapy Provide humidification system of oxygen equipment Monitor the flow of oxygen and the amount given Monitor signs of oxygen toxicity DEEP VEIN THROMBOSIS – Etiology, Risk Factors, Pathophysiology, Clinical Manifestation, Diagnostic Evaluation and Management (Surgical and Nursing) Post navigation ← Previous PostNext Post → Leave a Comment Cancel Reply Your email address will not be published. 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