88 Questions
What is the most serious complication of a blood clot in a deep vein?
Pulmonary embolism
What is the term for a blood clot that forms in a deep vein?
Thrombus
Which of the following is a predisposing factor for deep vein thrombosis?
Obesity
What is the purpose of graduated compression stockings in preventing deep vein thrombosis?
To promote venous return and decrease venous stasis
What is the term for the passage of a blood clot from a deep vein to the lungs?
Pulmonary embolism
Which of the following is a clinical manifestation of deep vein thrombosis?
Pain and tenderness in the affected limb
What is the purpose of intermittent pneumatic compression devices in preventing deep vein thrombosis?
To promote venous return and decrease venous stasis
Which of the following is a diagnostic test used to diagnose deep vein thrombosis?
Duplex ultrasonography
What is the term for a blood clot that forms in a superficial vein?
Phlebitis
What is the purpose of Homan's sign in diagnosing deep vein thrombosis?
Not recommended when DVT is suspected
What is the main purpose of thrombolysis therapy in deep vein thrombosis?
To dissolve the blood clot and prevent long-term damage to valves
Why is surgical management of deep vein thrombosis necessary in some cases?
Because of the risk of permanent damage to the extremity or pulmonary embolism
What is the target therapeutic range for aPTT in patients on heparin therapy?
1.5-2 times the control
What is the usual duration of warfarin therapy for deep vein thrombosis?
Usually 3 months or longer
What is the primary concern in patients taking warfarin therapy?
Narrow therapeutic window
What is the normal range for platelet count?
150-400 x 10^9/L
What is the primary sign of bleeding in patients on anticoagulation therapy?
All of the above
What is the term for a decrease in platelet count caused by heparin therapy?
Heparin-induced thrombocytopenia (HIT)
What is an important aspect of patient teaching for anticoagulation therapy?
All of the above
What is the primary mechanism of pulmonary embolism?
All of the above
What is the primary goal of DVT management?
To prevent the clot from getting any bigger and breaking loose
What is the purpose of anticoagulant therapy in DVT management?
To prevent or reduce blood clotting within the vascular system
What is the antidote for heparin?
Protamine sulphate
What is a serious complication of taking heparin?
Heparin Induced Thrombocytopenia (HIT)
What is the advantage of using Low-Molecular-Weight Heparin (LMWH) over unfractionated heparin?
All of the above
What is the antidote for warfarin (Coumadin)?
Vitamin K
What is the purpose of thrombolytic therapy in DVT management?
To dissolve the existing thrombus
What is the primary advantage of using fondaparinux over other anticoagulation agents?
Lower risk of HIT
What is the most common location of deep veins that are prone to pulmonary embolism?
Femoral or iliac veins
What is a major risk factor for pulmonary embolism?
History of varicose veins
What is the effect of pulmonary embolism on the pulmonary vascular bed?
Decreased size of the pulmonary vascular bed
What is the result when the workload of the right ventricle exceeds its capacity?
Right ventricular failure
What is the consequence of pulmonary embolism on gas exchange in the affected area?
Impaired gas exchange
What is the potential outcome of untreated pulmonary embolism?
Cardiogenic shock
What is the goal of pharmacological therapy for PE?
All of the above
What is the recommended dose of Heparin for PE?
5,000u IV bolus then continuous infusion
What is the purpose of LMWH in PE treatment?
To maintain therapeutic PTT while Warfarin is adjusted
What is the classification of hemorrhage based on the type of vessel involved?
Arterial, Venous, and Capillary
What is the goal of nursing interventions for hemorrhage?
Control bleeding and prevent shock
What is the purpose of thrombolytic therapy in PE treatment?
To dissolve clots and improve oxygenation
What is the recommendation for patients undergoing major elective surgery?
Low dose of Heparin SQ 2h preop + continued q8-12h until discharged
What is the classification of hemorrhage based on visibility?
Evident and Concealed
What is the purpose of ABG's in hemorrhage management?
To monitor oxygenation and prevent shock
What is the purpose of elevation and immobilization in hemorrhage management?
To reduce bleeding and promote clotting
What is the primary goal of pharmacological therapy in Deep Vein Thrombosis (DVT) management?
Prevent the clot from getting any bigger and breaking loose
What is the advantage of using Low-Molecular-Weight Heparin (LMWH) over unfractionated heparin?
Fewer bleeding complications
What is the primary mechanism of action of thrombolytic therapy in DVT management?
Lysing and dissolving existing thrombi
What is the primary concern in patients taking warfarin therapy?
Risk of bleeding complications
What is the purpose of intermittent pneumatic compression devices in DVT management?
To prevent the formation of new thrombi
What is the target therapeutic range for aPTT in patients on heparin therapy?
1.5-2 times the control
What is the primary advantage of using fondaparinux over other anticoagulation agents?
No risk of heparin-induced thrombocytopenia
What is the usual duration of warfarin therapy for DVT?
6-12 months
What is the target therapeutic range for aPTT in patients on heparin therapy?
1.5-2 times the control
What is the mechanism of action of thrombolytic therapy?
Dissolve blood clots
What is the most common complication of pulmonary embolism?
Right ventricular failure
What is the primary concern in patients taking warfarin therapy?
Bleeding
What is the purpose of IVC filter?
To prevent pulmonary embolism
What is the term for a decrease in platelet count caused by heparin therapy?
Heparin-induced thrombocytopenia
What is the primary goal of DVT management?
To prevent pulmonary embolism
What is the usual duration of warfarin therapy for deep vein thrombosis?
3 months
What is the purpose of thrombectomy?
To remove the blood clot
What is the primary mechanism of pulmonary embolism?
The passage of a blood clot from a deep vein to the lungs
What is the primary mechanism by which deep vein thrombi form in the lower extremities?
Stasis of blood flow and endothelial injury
A patient with a history of deep vein thrombosis is at increased risk for which of the following complications?
Pulmonary embolism
Which of the following is a contraindication for the use of Homan's sign in diagnosing deep vein thrombosis?
Suspected deep vein thrombosis
What is the primary advantage of using low-molecular-weight heparin over unfractionated heparin in the prevention of deep vein thrombosis?
Simplified dosing regimen
Which of the following is a predisposing factor for upper extremity deep vein thrombosis?
Central venous catheterization
What is the primary goal of thrombolytic therapy in the management of deep vein thrombosis?
Lysing the thrombus
Which of the following is a common complication of deep vein thrombosis in the lower extremities?
All of the above
What is the primary purpose of graduated compression stockings in the prevention of deep vein thrombosis?
Reducing venous stasis
Which of the following deep veins is most likely to cause a fatal pulmonary embolism?
Iliac vein
Which of the following is a potential consequence of untreated pulmonary embolism?
All of the above
What is the primary mechanism of action of unfractionated heparin in the prevention of deep vein thrombosis?
Activating antithrombin III
Which of the following is a risk factor for pulmonary embolism?
History of varicose veins
What is the effect of pulmonary embolism on pulmonary vascular resistance?
It increases pulmonary vascular resistance
What is the consequence of pulmonary embolism on gas exchange in the affected area?
Gas exchange is impaired or absent
What is the result when the workload of the right ventricle exceeds its capacity?
Cardiogenic shock
What is the primary mechanism of pulmonary embolism?
A blood clot forms in a deep vein and travels to the lungs
Which of the following is NOT a goal of pharmacological therapy for pulmonary embolism?
Promote platelet aggregation
What is the primary mechanism of action of thrombolytic therapy in pulmonary embolism?
Dissolving the blood clot
What is the classification of hemorrhage based on the WHO grading system?
Petechial bleeding, mild blood loss, gross blood loss, debilitating blood loss
What is the purpose of anticoagulant therapy in deep vein thrombosis management?
To prevent clot propagation and formation
What is the primary concern in patients taking warfarin therapy?
Bleeding risk
What is the recommended dose of Heparin for pulmonary embolism?
5000u IV bolus followed by continuous infusion
What is the purpose of LMWH in pulmonary embolism treatment?
To prevent clot propagation and formation
What is the primary goal of thrombolytic therapy in pulmonary embolism treatment?
To dissolve existing blood clots
What is the classification of hemorrhage based on the type of vessel involved?
Capillary, venous, arterial, mixed
What is the goal of nursing interventions for hemorrhage?
To control bleeding and prevent shock
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
This quiz covers post-operative complications, specifically deep vein thrombosis (DVT) and venous thrombus, their causes, symptoms, and treatment.
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