DVT & PE Overview Quiz

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Questions and Answers

Which population is at increased risk for thrombotic events?

Patients with a history of asthma

Patients with a history of migraines

Individuals with a sedentary lifestyle (correct)

Elderly patients (correct)

What is a key clinical manifestation of a massive DVT?

Insomnia

Increased appetite

Nausea and vomiting

Swelling and bluish color (correct)

Which of the following assesses DVT risk by evaluating pain in the calf?

Homan's sign (correct)

D-dimer Test

Capillary refill test

Ankle-brachial index

Which treatment is effective in preventing the development of DVT?

Subcutaneous low-molecular weight heparin Signup and view all the answers

What does a positive D-dimer test indicate?

Increased coagulation activity Signup and view all the answers

Which condition is NOT considered a risk factor for DVT?

Chronic bronchitis Signup and view all the answers

How can healthcare providers assess the symmetry of extremities when checking for DVT?

By measuring circumference of each leg Signup and view all the answers

Which of the following factors does NOT contribute to the risk of DVT?

Age under 25 Signup and view all the answers

Which of the following anticoagulants is associated with a lower risk of heparin-induced thrombocytopenia (HIT)?

Low Molecular Weight Heparin Signup and view all the answers

What is the purpose of monitoring INR in patients on warfarin therapy?

To measure coagulation status Signup and view all the answers

Which medication is used as an antidote for heparin?

Protamine sulfate Signup and view all the answers

What is a recommended nursing intervention for patients at risk of venous thromboembolism?

Encourage active and passive leg exercises Signup and view all the answers

Which of the following drugs can be administered in fixed doses without routine coagulation monitoring?

Oral direct factor Xa inhibitors Signup and view all the answers

What is the primary function of Low Molecular Weight Heparin (LMWH)?

To prevent thrombus extension and new thrombus formation Signup and view all the answers

What nursing action should be taken when a patient is on bed rest to promote circulation?

Periodically elevate feet and lower legs above heart level Signup and view all the answers

Which of the following would indicate the need for urgent oxygen administration?

Severe acidosis Signup and view all the answers

What is the primary function of red blood cells?

Carry oxygen from the lungs to tissues Signup and view all the answers

What vitamin is essential for the production of red blood cells?

Vitamin B-12 Signup and view all the answers

What condition is characterized by a lack of iron in the body?

Iron deficiency anemia Signup and view all the answers

What is a common symptom of anemia?

Fatigue and weakness Signup and view all the answers

What treatment is commonly prescribed for pernicious anemia?

Vitamin B-12 injections Signup and view all the answers

Which physiological response is associated with anemia?

Tachycardia Signup and view all the answers

What might indicate the onset of disseminated intravascular coagulation (DIC)?

Oozing from the IV site Signup and view all the answers

Which option describes the role of iron in the body?

Aid in red blood cell production Signup and view all the answers

What is the condition characterized by a platelet count of 150,000 or less?

Thrombocytopenia Signup and view all the answers

What should be administered to a patient with low platelets due to cancer or anemia?

Platelets Signup and view all the answers

Which of the following symptoms indicates a state of shock?

Cool, clammy skin Signup and view all the answers

What is the main purpose of Fresh Frozen Plasma (FFP) in patients?

To supply clotting factors Signup and view all the answers

What is indicated when hemoglobin (HgB) is below 7?

Severe anemia requiring transfusion Signup and view all the answers

What happens if platelets are given to a client with low clotting factors?

It has no impact on bleeding Signup and view all the answers

What is a critical platelet count level that is considered deadly?

50,000 Signup and view all the answers

Which of the following conditions can lead to low clotting factors requiring FFP treatment?

Liver disease Signup and view all the answers

What is the first priority intervention when high potassium (hyperkalemia) is identified?

Slow or stop the infusion Signup and view all the answers

What electrolyte level indicates hyperkalemia?

Above 5.0 mEq/L Signup and view all the answers

What should be assessed immediately if a reaction to blood transfusion is suspected?

Vital signs Signup and view all the answers

What is the recommended solution to use with new tubing when managing a blood transfusion?

0.9% sodium chloride Signup and view all the answers

What ECG change is associated with hyperkalemia?

Peaked T waves Signup and view all the answers

What is an expected nursing action when hemolyzed RBCs are reported in a urine specimen?

Notify the healthcare provider immediately Signup and view all the answers

Which symptom might indicate a serious reaction to a blood transfusion?

Fever and tachycardia Signup and view all the answers

Which of the following conditions can cause hemolysis in a blood sample?

Improper storage of the sample Signup and view all the answers

Study Notes

DVT & PE

Medications to prevent thrombosis include anticoagulants, such as subcutaneous or low-molecular weight heparin
Patients with a history of varicose veins, hypercoagulation, neoplastic disease, cardiovascular disease, or recent major surgery or injury are at high risk of DVT
Other patients at high risk include those who are obese, immobile, or elderly, as well as women taking oral contraceptives
Signs and symptoms of DVT are non-specific unless it's massive
Massive DVT will have swelling, tension, pain, bluish color, and loss of distal pulses
DVT will have manifestations for a pulmonary embolism before a DVT
Low grade fever, tenderness, and asymmetry of extremities are common DVT symptoms
Assessment
- Carefully compare extremities to see if they are symmetrical
- Measure circumference of each leg
- Assess for tenderness by gently touching on the legs
- Assess for Homans sign - positive if the patient feels pain after the foot is sharply dorsiflexed
- D-Dimer Blood Assay is a marker of coagulation activity
Risk Factors
- Varicose veins
- Hypercoagulation
- Neoplastic disease, like cancer
- Cardiovascular disease
- Recent major injury or disease
Medical Management
- Heparin therapy is effective as a prophylactic, subcutaneous to prevent development of DVT
- Heparin IV to prevent the extension of a thrombus and the development of new thrombi
- Monitor PTT and platelets in patients with renal insufficiency
- Low Molecular Weight Heparin has a longer half-life than unfractionated heparin, so doses can be given in one or two subcutaneous injections each day. Doses are adjusted according to patient weight
- Warfarin Antidote is Vitamin K
- For extended treatment, warfarin (coumadin) is frequently used. Monitor INR
- Oral direct factor Xa inhibitors include rivaroxaban, apixaban, and edoxaban. They are as effective and safe as warfarin, and the ability to be administered in fixed doses without routine coagulation monitoring has led to an increase in their use.
- Thrombectomy is done if anticoagulant or thrombolytic therapy is contraindicated
  - Filter placement or balloon angioplasty and a stent placement
Nurse Management
- Monitor PTT and PT/INR
- Assess for unusual or spontaneous bleeding
- Use SCDs (Sequential Compression Device)
- Walk if possible
- Don't sit for long periods of time
- Flex and point toes to activate calf muscles
- Elevate affected extremities/legs
- Wear compression socks when necessary
- Take analgesics to help with circulation and comfort
- Put warm, moist packs on
- When the patient is on bed rest, the feet and lower legs should be elevated periodically above the level of the heart
- Deep breathing exercises
- Active and passive leg exercises

Blood Transfusion Reactions

Causes
- Respiratory acidosis
Treatment
- Administer O2 IMMEDIATELY
- Administer any additional medications and tests ordered:
  - Diuresis, DIC, blood screening, antihistamines, anaphylactic medications
Symptoms
- Chills, flushing, tachycardia
- Signs of DIC like oozing from IV site
- Hypotension
- Urine turning red or brown

Red Blood Cell Disorders

Function
- RBCs carry oxygen from the lungs to the rest of the body and tissues
- RBCs return to the lungs to expel carbon dioxide
- Hemoglobin (Hgb) is a protein in RBCs that carry oxygen
- Iron is a component of Hgb and aids in red blood cell production
- Vitamin B-12 aids in red blood cell production
- RBCs are formed in bone marrow with WBCs and platelets
Common Symptoms
- Fatigue, SOB, trouble concentrating (lack of O2 reaching the brain)
- Muscle weakness
- Tachycardia (body is working hard to distribute healthy RBCs)

Anemia

Iron Deficiency Anemia
- Cause: Lack of mineral iron in the body!
- Tx: Give iron supplementation
Pernicious Anemia
- Cause: The body is unable to absorb enough Vitamin B-12, resulting in decreased RBC production
- Tx: Give Vitamin B-12 shots!

Hemoglobin levels

< 7 HgB = Heaven

Shock

Top Shock Symptoms
- Pale skin: pallor, dusky skin signs
- Cool, clammy skin
- Fatigue, weakness

Platelets

Function
- Proteins that help the blood clot
- Help form scabs to stop bleeding
- Given to clients with low platelets
Low Platelets
- Typically results from cancers, and certain types of anemia
- 150,000 or LESS
Deadly Low Platelets
- 50,000 or LESS

Fresh Frozen Plasma (FFP)

Function
- Clotting factors that act like glue, helping to stick all the platelets together in order to form a clot and stop bleeding
Given to Clients With Low Clotting Factors:
- Hemophilia
- Liver disease (Cirrhosis and Hepatitis) since the liver helps make clotting factors.

Important Note

It is important to know the difference between low platelets vs. low clotting factors, since giving a bunch of platelets to a client with hemophilia (low clotting factors) is not going to do anything if they lack the glue that holds it all together.

Hyperkalemia

Priority Interventions
- Slow or STOP the infusion
- Use new tubing 0.9% sodium chloride (normal saline)
- Report to HCP immediately
- Assess:
  - Vital signs
Symptoms
- Hemolyzed RBCs
- High Potassium (Hyperkalemia, above 5.0)
- Potassium Priority Pumps heart
  - Peaked T waves on ECG
- Urine specimen: “check for hemolyzed RBC”
ATI Ordered Response
- "Reaction to blood transfusion"
  - STOP transfusion
  - Assess vital signs

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Description

Test your knowledge on Deep Vein Thrombosis (DVT) and Pulmonary Embolism (PE). This quiz covers risk factors, symptoms, and assessment strategies for DVT, including the identification of high-risk patients. Enhance your understanding of the medications used for prevention and the critical signs to watch out for.