Post-Operative Complications: Hemorrhage and DVT
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Questions and Answers

What is the most serious complication of a blood clot in a deep vein?

  • Heart failure
  • Infection
  • Vein rupture
  • Pulmonary embolism (correct)

    • What is the term for a blood clot that forms in a deep vein?

  • Thrombus (correct)
  • Emboli
  • Varicosity
  • Hemorrhage

    • Which of the following is a predisposing factor for deep vein thrombosis?

  • Diabetes
  • Hyperlipidemia
  • Hypertension
  • Obesity (correct)

    • What is the purpose of graduated compression stockings in preventing deep vein thrombosis?

    <p>To promote venous return and decrease venous stasis</p> Signup and view all the answers

    What is the term for the passage of a blood clot from a deep vein to the lungs?

    <p>Pulmonary embolism</p> Signup and view all the answers

    Which of the following is a clinical manifestation of deep vein thrombosis?

    <p>Pain and tenderness in the affected limb</p> Signup and view all the answers

    What is the purpose of intermittent pneumatic compression devices in preventing deep vein thrombosis?

    <p>To promote venous return and decrease venous stasis</p> Signup and view all the answers

    Which of the following is a diagnostic test used to diagnose deep vein thrombosis?

    <p>Duplex ultrasonography</p> Signup and view all the answers

    What is the term for a blood clot that forms in a superficial vein?

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

    What is the purpose of Homan's sign in diagnosing deep vein thrombosis?

    <p>Not recommended when DVT is suspected</p> Signup and view all the answers

    What is the main purpose of thrombolysis therapy in deep vein thrombosis?

    <p>To dissolve the blood clot and prevent long-term damage to valves</p> Signup and view all the answers

    Why is surgical management of deep vein thrombosis necessary in some cases?

    <p>Because of the risk of permanent damage to the extremity or pulmonary embolism</p> Signup and view all the answers

    What is the target therapeutic range for aPTT in patients on heparin therapy?

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

    What is the usual duration of warfarin therapy for deep vein thrombosis?

    <p>Usually 3 months or longer</p> Signup and view all the answers

    What is the primary concern in patients taking warfarin therapy?

    <p>Narrow therapeutic window</p> Signup and view all the answers

    What is the normal range for platelet count?

    <p>150-400 x 10^9/L</p> Signup and view all the answers

    What is the primary sign of bleeding in patients on anticoagulation therapy?

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

    What is the term for a decrease in platelet count caused by heparin therapy?

    <p>Heparin-induced thrombocytopenia (HIT)</p> Signup and view all the answers

    What is an important aspect of patient teaching for anticoagulation therapy?

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

    What is the primary mechanism of pulmonary embolism?

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

    What is the primary goal of DVT management?

    <p>To prevent the clot from getting any bigger and breaking loose</p> Signup and view all the answers

    What is the purpose of anticoagulant therapy in DVT management?

    <p>To prevent or reduce blood clotting within the vascular system</p> Signup and view all the answers

    What is the antidote for heparin?

    <p>Protamine sulphate</p> Signup and view all the answers

    What is a serious complication of taking heparin?

    <p>Heparin Induced Thrombocytopenia (HIT)</p> Signup and view all the answers

    What is the advantage of using Low-Molecular-Weight Heparin (LMWH) over unfractionated heparin?

    <p>All of the above</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 purpose of thrombolytic therapy in DVT management?

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

    What is the primary advantage of using fondaparinux over other anticoagulation agents?

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

    What is the most common location of deep veins that are prone to pulmonary embolism?

    <p>Femoral or iliac veins</p> Signup and view all the answers

    What is a major risk factor for pulmonary embolism?

    <p>History of varicose veins</p> Signup and view all the answers

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

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

    What is the result when the workload of the right ventricle exceeds its capacity?

    <p>Right ventricular failure</p> Signup and view all the answers

    What is the consequence of pulmonary embolism on gas exchange in the affected area?

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

    What is the potential outcome of untreated pulmonary embolism?

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

    What is the goal of pharmacological therapy for PE?

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

    What is the recommended dose of Heparin for PE?

    <p>5,000u IV bolus then continuous infusion</p> Signup and view all the answers

    What is the purpose of LMWH in PE treatment?

    <p>To maintain therapeutic PTT while Warfarin is adjusted</p> Signup and view all the answers

    What is the classification of hemorrhage based on the type of vessel involved?

    <p>Arterial, Venous, and Capillary</p> Signup and view all the answers

    What is the goal of nursing interventions for hemorrhage?

    <p>Control bleeding and prevent shock</p> Signup and view all the answers

    What is the purpose of thrombolytic therapy in PE treatment?

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

    What is the recommendation for patients undergoing major elective surgery?

    <p>Low dose of Heparin SQ 2h preop + continued q8-12h until discharged</p> Signup and view all the answers

    What is the classification of hemorrhage based on visibility?

    <p>Evident and Concealed</p> Signup and view all the answers

    What is the purpose of ABG's in hemorrhage management?

    <p>To monitor oxygenation and prevent shock</p> Signup and view all the answers

    What is the purpose of elevation and immobilization in hemorrhage management?

    <p>To reduce bleeding and promote clotting</p> Signup and view all the answers

    What is the primary goal of pharmacological therapy in Deep Vein Thrombosis (DVT) management?

    <p>Prevent the clot from getting any bigger and breaking loose</p> Signup and view all the answers

    What is the advantage of using Low-Molecular-Weight Heparin (LMWH) over unfractionated heparin?

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

    What is the primary mechanism of action of thrombolytic therapy in DVT management?

    <p>Lysing and dissolving existing thrombi</p> Signup and view all the answers

    What is the primary concern in patients taking warfarin therapy?

    <p>Risk of bleeding complications</p> Signup and view all the answers

    What is the purpose of intermittent pneumatic compression devices in DVT management?

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

    What is the target therapeutic range for aPTT in patients on heparin therapy?

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

    What is the primary advantage of using fondaparinux over other anticoagulation agents?

    <p>No risk of heparin-induced thrombocytopenia</p> Signup and view all the answers

    What is the usual duration of warfarin therapy for DVT?

    <p>6-12 months</p> Signup and view all the answers

    What is the target therapeutic range for aPTT in patients on heparin therapy?

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

    What is the mechanism of action of thrombolytic therapy?

    <p>Dissolve blood clots</p> Signup and view all the answers

    What is the most common complication of pulmonary embolism?

    <p>Right ventricular failure</p> Signup and view all the answers

    What is the primary concern in patients taking warfarin therapy?

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

    What is the purpose of IVC filter?

    <p>To prevent pulmonary embolism</p> Signup and view all the answers

    What is the term for a decrease in platelet count caused by heparin therapy?

    <p>Heparin-induced thrombocytopenia</p> Signup and view all the answers

    What is the primary goal of DVT management?

    <p>To prevent pulmonary embolism</p> Signup and view all the answers

    What is the usual duration of warfarin therapy for deep vein thrombosis?

    <p>3 months</p> Signup and view all the answers

    What is the purpose of thrombectomy?

    <p>To remove the blood clot</p> Signup and view all the answers

    What is the primary mechanism of pulmonary embolism?

    <p>The passage of a blood clot from a deep vein to the lungs</p> Signup and view all the answers

    What is the primary mechanism by which deep vein thrombi form in the lower extremities?

    <p>Stasis of blood flow and endothelial injury</p> Signup and view all the answers

    A patient with a history of deep vein thrombosis is at increased risk for which of the following complications?

    <p>Pulmonary embolism</p> Signup and view all the answers

    Which of the following is a contraindication for the use of Homan's sign in diagnosing deep vein thrombosis?

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

    What is the primary advantage of using low-molecular-weight heparin over unfractionated heparin in the prevention of deep vein thrombosis?

    <p>Simplified dosing regimen</p> Signup and view all the answers

    Which of the following is a predisposing factor for upper extremity deep vein thrombosis?

    <p>Central venous catheterization</p> Signup and view all the answers

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

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

    Which of the following is a common complication of deep vein thrombosis in the lower extremities?

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

    What is the primary purpose of graduated compression stockings in the prevention of deep vein thrombosis?

    <p>Reducing venous stasis</p> Signup and view all the answers

    Which of the following deep veins is most likely to cause a fatal pulmonary embolism?

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

    Which of the following is a potential consequence of untreated pulmonary embolism?

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

    What is the primary mechanism of action of unfractionated heparin in the prevention of deep vein thrombosis?

    <p>Activating antithrombin III</p> Signup and view all the answers

    Which of the following is a risk factor for pulmonary embolism?

    <p>History of varicose veins</p> Signup and view all the answers

    What is the effect of pulmonary embolism on pulmonary vascular resistance?

    <p>It increases pulmonary vascular resistance</p> Signup and view all the answers

    What is the consequence of pulmonary embolism on gas exchange in the affected area?

    <p>Gas exchange is impaired or absent</p> Signup and view all the answers

    What is the result when the workload of the right ventricle exceeds its capacity?

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

    What is the primary mechanism of pulmonary embolism?

    <p>A blood clot forms in a deep vein and travels to the lungs</p> Signup and view all the answers

    Which of the following is NOT a goal of pharmacological therapy for pulmonary embolism?

    <p>Promote platelet aggregation</p> Signup and view all the answers

    What is the primary mechanism of action of thrombolytic therapy in pulmonary embolism?

    <p>Dissolving the blood clot</p> Signup and view all the answers

    What is the classification of hemorrhage based on the WHO grading system?

    <p>Petechial bleeding, mild blood loss, gross blood loss, debilitating blood loss</p> Signup and view all the answers

    What is the purpose of anticoagulant therapy in deep vein thrombosis management?

    <p>To prevent clot propagation and formation</p> Signup and view all the answers

    What is the primary concern in patients taking warfarin therapy?

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

    What is the recommended dose of Heparin for pulmonary embolism?

    <p>5000u IV bolus followed by continuous infusion</p> Signup and view all the answers

    What is the purpose of LMWH in pulmonary embolism treatment?

    <p>To prevent clot propagation and formation</p> Signup and view all the answers

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

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

    What is the classification of hemorrhage based on the type of vessel involved?

    <p>Capillary, venous, arterial, mixed</p> Signup and view all the answers

    What is the goal of nursing interventions for hemorrhage?

    <p>To control bleeding and prevent shock</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

    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 post-operative complications, specifically deep vein thrombosis (DVT) and venous thrombus, their causes, symptoms, and treatment.

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