Post-Operative Complications: Deep Vein Thrombosis
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Questions and Answers

What is the primary goal of DVT management?

  • To administer anticoagulation therapy indefinitely
  • To immediately remove the clot surgically
  • To dissolve the existing clot completely
  • To stop the clot from getting any bigger and preventing it from breaking loose (correct)

    • What is the usual duration of heparin therapy for DVT management?

  • 7 days
  • 3 days
  • 10 days
  • 5 days (correct)

    • What is the antidote for heparin?

  • Atropine
  • Protamine sulphate (correct)
  • Narcan
  • Vitamin K

    • What is the primary mechanism of action of thromboembolytic therapy?

    <p>Lysing the thrombus</p> Signup and view all the answers

    What is the primary advantage of using low-molecular-weight heparin (LMWH) over unfractionated heparin?

    <p>Lower risk of HIT</p> Signup and view all the answers

    What is the antidote for warfarin (Coumadin)?

    <p>Vitamin K</p> Signup and view all the answers

    What is the primary action of fondaparinux?

    <p>Inhibiting factor Xa</p> Signup and view all the answers

    What is the primary risk associated with heparin-induced thrombocytopenia (HIT)?

    <p>Risk of developing life-threatening blood clots</p> Signup and view all the answers

    What is the most serious complication of post-operative complications?

    <p>Deep Vein Thrombosis</p> Signup and view all the answers

    What is the main reason why venous thrombi form in veins?

    <p>Because of the valves in the veins causing venous stasis</p> Signup and view all the answers

    What is Virchow's Triad?

    <p>Stasis of blood, endothelial injury, and altered blood coagulability</p> Signup and view all the answers

    What is the primary purpose of graduated compression stockings?

    <p>To compress the veins and promote venous return</p> Signup and view all the answers

    What is the primary purpose of pneumatic compression devices?

    <p>To prevent blood clots in the lower extremities</p> Signup and view all the answers

    What is the primary purpose of anticoagulation therapy?

    <p>To prevent the formation of new blood clots</p> Signup and view all the answers

    What is the primary purpose of elevation of the affected limb in suspected DVT?

    <p>To reduce pain and swelling</p> Signup and view all the answers

    What is the primary purpose of Homan's Sign?

    <p>Contraindicated when DVT is suspected</p> Signup and view all the answers

    What is the primary purpose of Duplex Ultrasonography?

    <p>To diagnose deep vein thrombosis</p> Signup and view all the answers

    What is the primary purpose of D-dimer blood test?

    <p>To diagnose deep vein thrombosis</p> Signup and view all the answers

    What is the primary goal of thrombolytic therapy in the treatment of deep vein thrombosis?

    <p>To dissolve existing clots</p> Signup and view all the answers

    When is surgical management of deep vein thrombosis indicated?

    <p>In patients with permanent damage to an extremity</p> Signup and view all the answers

    What is the target therapeutic range for an INR when using warfarin?

    <p>1.5-2 times normal</p> Signup and view all the answers

    What is the primary complication of heparin therapy?

    <p>Bleeding</p> Signup and view all the answers

    What is the primary mechanism of action of thrombolytic therapy?

    <p>Dissolving existing clots</p> Signup and view all the answers

    Which vein is most likely to cause a pulmonary embolism?

    <p>Femoral vein</p> Signup and view all the answers

    What is a major risk factor for pulmonary embolism?

    <p>All of the above</p> Signup and view all the answers

    What is the primary purpose of anticoagulation therapy monitoring?

    <p>To prevent bleeding complications</p> Signup and view all the answers

    What is the target therapeutic range for aPTT when using heparin?

    <p>1.5-2.5 times normal</p> Signup and view all the answers

    What is the effect of a pulmonary embolism on the pulmonary vascular bed?

    <p>Decreased size of pulmonary vascular bed</p> Signup and view all the answers

    What is the effect of a pulmonary embolism on the right ventricle?

    <p>Increased workload</p> Signup and view all the answers

    What is the primary indication for catheter-directed thrombolysis?

    <p>Acute deep vein thrombosis</p> Signup and view all the answers

    What is the primary mechanism of action of warfarin?

    <p>Inhibiting vitamin K-dependent clotting factors</p> Signup and view all the answers

    What is the effect of a pulmonary embolism on gas exchange?

    <p>Impaired gas exchange</p> Signup and view all the answers

    What can occur when the workload of the right ventricle exceeds its capacity?

    <p>Cardiogenic shock</p> Signup and view all the answers

    What is the primary purpose of patient education for anticoagulation therapy?

    <p>To reduce the risk of bleeding complications</p> Signup and view all the answers

    What is the primary goal of pharmacological therapy in the management of pulmonary embolism?

    <p>To prevent further embolization and reduce the risk of recurrence</p> Signup and view all the answers

    Which of the following is NOT a contraindication for thrombolytic therapy?

    <p>Hypertension</p> Signup and view all the answers

    What is the primary advantage of using low-molecular-weight heparin (LMWH) over unfractionated heparin in the prevention of DVT?

    <p>LMWH has a more predictable dose response</p> Signup and view all the answers

    Which of the following is a complication of hemorrhage?

    <p>Cardiogenic shock</p> Signup and view all the answers

    What is the primary goal of nursing interventions in the management of hemorrhage?

    <p>To assess the cause of bleeding</p> Signup and view all the answers

    Which of the following is a sign of hemorrhage?

    <p>Delayed capillary refill</p> Signup and view all the answers

    What is the primary goal of thrombolytic therapy in the management of pulmonary embolism?

    <p>To dissolve the embolus</p> Signup and view all the answers

    Which of the following is a classification of hemorrhage?

    <p>All of the above</p> Signup and view all the answers

    What is the primary advantage of using heparin in the prevention of DVT?

    <p>It can be administered subcutaneously</p> Signup and view all the answers

    Which of the following is a WHO grading of hemorrhage?

    <p>All of the above</p> Signup and view all the answers

    Study Notes

    Post-Operative Complications: Hemorrhage and Deep Vein Thrombosis

    Deep Vein Thrombosis (DVT)

    • Blood clot in a deep vein, most serious complication
    • Clot can dislodge and travel to the lungs, a medical emergency
    • Range in size from 1 mm in diameter to a mass that can completely obstruct the vein
    • Deep veins are thin walled and run parallel to arteries with unidirectional flow back to the heart

    Venous Thrombus (Clot)

    • Composed of RBC, WBC, Platelets, Fibrin, and a tail-like appendage
    • Tail grows or propagates in the direction of blood flow
    • Likes valves of veins where venous stasis occurs
    • Can occlude lumen

    Contributing Factors (Virchow's Triad)

    • Stasis of the blood/alterations in blood flow
    • Endothelial injury/vessel wall injury
    • Altered blood coagulability

    Predisposing Factors for DVT

    • Venous Stasis:
      • Bedrest, bedridden, immobilization
      • Obesity
      • History of varicosities
      • Heart failure/shock
      • Veins dilated with certain medications
      • Spinal cord injury (SCI)
      • Age
      • Surgery (past 3 months)
      • Anesthesia
      • Cast
      • Driving/flying
    • Vessel Wall Injury:
      • Fractures and dislocations
      • Diseases of veins
      • Trauma
      • Chemical irritation
      • Central venous catheters
      • Repetitive motion injury
    • Altered Blood Coagulability:
      • Blood dyscrasia
      • Oral contraceptives (OCP)
      • Hormone replacement therapy (HRT)
      • Polycythemias
      • Deficient blood volume
      • Stress response
    • Others:
      • Pregnancy
      • Cancer
      • Smoking
      • Height
      • Family history
      • History of DVT + PE

    Upper Extremity Venous Thrombosis

    • Less common than lower extremity
    • Reasons: IV catheters, disease states, trauma, dialysis catheters, central lines, and effort thrombosis

    Prophylaxis (Prevention)

    • Doctor's orders
    • Anticoagulation:
      • Unfractionated Heparin (UFH) or Low Molecular Weight Heparin (LMWH)
      • Can decrease risk of DVT by up to 50%
    • Mechanical:
      • Intermittent pneumatic compression device
      • Graduated compression stockings

    Clinical Manifestations

    • Superficial Veins:
      • Pain/tenderness
      • Redness
      • Warmth
      • Most dissolve spontaneously
    • Deep Vein Thrombosis (DVT):
      • No symptoms to nonspecific
      • Tenderness affected limb
      • Pain
      • Edema/Swelling
      • Discoloration or redness
      • Increased skin temperature
      • Superficial veins prominent

    Suspected DVT

    • Report immediately
    • Nurse can elevate leg but avoid pressure on suspected thrombus area
    • No massage area
    • Homan's Sign on calf pain or dorsiflexion contraindicated when DVT suspected

    Diagnostics

    • Duplex Ultrasonography
    • D-dimer Blood Test
    • Contrast Venography
    • MRI/CT

    Goal of DVT Management

    • Stop the clot from getting any bigger
    • Prevent the clot from breaking loose and causing a pulmonary embolism (PE)
    • Reduce the chance of deep vein thrombosis again
    • Prevent Post-Thrombotic Syndrome (PTS)

    Treatment Options

    • Pharmacological Therapy:
      • Anticoagulant Therapy
      • Thromboembolytic Therapy
    • Surgical Management:
      • Thrombectomy
      • Catheter-Directed Thrombolysis
      • IVC filter
      • Ligation, clips

    Anticoagulation Agents

    • Unfractionated Heparin (UFH)
      • Prevent extension or development of new thrombi
      • Intermittent or continuous IV infusion for 5 days
    • Low Molecular Weight Heparin (LMWH)
      • Used for some DVTs, prevents extension or new thrombi
      • Longer half-life, given SQ, decreased risk of HIT
    • Fondaparinux (Arixtra)
      • Synthetic inhibitor of factor Xa
      • Treats and prevents DVT and PE
      • No reversal agent, never causes HIT

    Anticoagulation Therapy Monitoring

    • Bleeding
    • Thrombocytopenia
    • Heparin induced thrombocytopenia (HIT)
    • Regular monitoring of blood levels, counts, and INR

    Teaching

    • Self-injections – site and technique
    • Avoid injury
    • Signs and symptoms to report
    • Medications interactions
    • Diet
    • Routine monitoring required
    • Communicate anticoagulation to all other HCP

    Client Comfort and Healing

    • Adjuncts to therapy: activity, elevation, warm moist packs, analgesics
    • Walking preferred over sitting/standing
    • Bed exercises
    • Hydration

    Pulmonary Embolism (PE)

    • Collection of particulate matter (solids, liquid, gaseous) enters systemic venous circulation and lodges in pulmonary vessels
    • Obstructs pulmonary circulation causing impaired gas exchange, constriction of regional blood vessels, and bronchioles
    • Decreases oxygenation
    • Can be fatal
    • Caused by blood clot, foreign body, tumor, fat emboli, amniotic fluid, pus

    PE Risk Factors

    • Immobilization/paralyzed
    • Surgery
    • Trauma
    • Increased blood coagulation
    • History of varicose vein(s)
    • Obesity, smoking, pregnancy, OCP, CHF, stroke
    • History
    • Age
    • Septic
    • Cancer + therapy

    PE Pathway

    • Deep veins of the legs
    • Most lethal from femoral or iliac veins
    • Right side of heart and upper extremities
    • Pelvic veins

    Signs and Symptoms (PE)

    • Dyspnea
    • Tachypnea
    • Tachycardia
    • Chest pain/chest wall tenderness
    • Syncope
    • Diaphoresis
    • Anxiety/apprehension
    • Cough/hemoptysis
    • Hemoptysis

    Diagnostic Tests and Assessment

    • Computed tomographic pulmonary angiography
    • Ventilation-perfusion scan (V/Q)
    • Pulmonary angiography
    • MRI
    • CXR
    • ECG
    • Peripheral vascular studies
    • ABG's

    Interventions

    • Goals: increase alveolar gas exchange, improve tissue perfusion, get rid of embolism, prevent complications
    • Pharmacological Therapy:
      • Anticoagulation
      • Thrombolytics
    • Surgical Management:
      • Embolectomy
      • Clips
      • Filter

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    Description

    This quiz covers the concept of Deep Vein Thrombosis, a serious post-operative complication that occurs when a blood clot forms in a deep vein, and can lead to a medical emergency. It also delves into the characteristics of deep veins and venous thrombi.

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