DVT & varicose veins

Embed Size (px)

Text of DVT & varicose veins

  • 8/8/2019 DVT & varicose veins

    1/30

    VENOUS DISORDERS

    Margaret Xaira R. Mercado RN

  • 8/8/2019 DVT & varicose veins

    2/30

    DEEP VEIN THROMBOSIS

    Inflammation of the vessel wall with formation of

    a blood clot (thrombus) which could affect

    superficial or deep vein resulting to venous

    insufficiency Frequently affects lower extremity veins

    saphenous, femoral, and popliteal

    Can result damage to the surrounding tissues,

    ischemia and necrosis Complication: life threatening pulmonary

    thromboembolism

  • 8/8/2019 DVT & varicose veins

    3/30

    RISK FACTORS:

    VIRCHOWS TRIAD Venous stasis

    Surgery, obesity, pregnancy, CHF and immobility

    Hypercoagulability

    Malignant neoplasms, dehydration, blooddyscrasias and oral contraceptive use

    Venous wall injury

    Constriction due to restrictive matrial (i.e., garters,

    straps) or trauma to lower extremities causing

    injury to venous walls

  • 8/8/2019 DVT & varicose veins

    4/30

    PATHOPHYSIOLOGYPlatelets release

    chemicalsinitiating platelet

    aggregation

    Clot formation Clot grows in size

    Blocks orobstruct vein

    Prevention ofvenous drainagefrom area distal

    to site

    Clot maydislodge and

    travel tocirculation

    May lodge to thepulmonary artery

    Pulmonaryembolism

  • 8/8/2019 DVT & varicose veins

    5/30

    ASSESSMENT

    CARDIOVASCULAR SYSTEM

    Superficial vein: tenderness, redness, and

    induration along the course of the vein

    Deep vein: swelling, venous distention of limb,tenderness over involved vein, and cyanosis

  • 8/8/2019 DVT & varicose veins

    6/30

    OTHER MANIFESTATIONS

    Positive Homans sign-pain on calf muscles when clients leg is

    dorsiflexed due to the stretching of inflammed

    veins

    -pathognomonic sign of DVT

    Pain in the affected extremity

    Low grade fever

    Edema of the leg

  • 8/8/2019 DVT & varicose veins

    7/30

    HOMANS SIGN

  • 8/8/2019 DVT & varicose veins

    8/30

    DIAGNOSTIC TESTS

    1. VENOGRAPHY: increased uptake ofradioactive material

    2. DOPPLER ULTRASONOGRAPHY: impaired

    blood flow ahead of thrombus

    3. VENOUS PRESSURE MEASURE: high in

    affected limb until circulation is formed

    4. CBC: elevated WBC and ESR

  • 8/8/2019 DVT & varicose veins

    9/30

  • 8/8/2019 DVT & varicose veins

    10/30

    NURSING INTERVENTIONS

    1. Monitor and improve clients circulatory state

    - assess vital signs every 4 hours

    - measure thighs, calves, ankles, and instep

    every morning- monitor for chest pain or shortness of breath

    (possible pulmonary embolism)

    2. Provide bed rest, elevating lower extremity to

    increase venous return and to decrease edema

  • 8/8/2019 DVT & varicose veins

    11/30

    3. Apply continuous, warm, moist soaks to

    decrease lymphatic congestion

    4. Provide client teaching and discharge planning

    - avoid standing, sitting for long periods, wearing

    constrictive clothing, leg crossing, smoking, and

    oral contraceptive use- adequate hydration to prevent

    hypercoagulability

    - use of elastic stockings if ambulatory

    - importance of planned rest periods and

    elevation of the feet

  • 8/8/2019 DVT & varicose veins

    12/30

    -plan for exercise/ activity

    feet dorsiflexion (sitting or lying down)

    swim several times weekly

    gradually increase walking distance

    -weight reduction if obese

  • 8/8/2019 DVT & varicose veins

    13/30

    5. Provide dependent and other collaborative

    nursing interventionsSURGERY

    vein ligation and stripping

    venous thromboectomy removal of a clot in the

    ileo-femoral region

    Application of the vena cava filter insertion of

    an umbrella-like prosthesis to the vena cavas

    lumen to filter incoming clots

  • 8/8/2019 DVT & varicose veins

    14/30

    *After Surgery

    Encourage deep breathing exercises Early ambulation to promote vrnous return

    Use of anti-embolic stockings

    Elevate the foot of the bed to aid in venousreturn

    ASSISST IN DRUG REGIMEN

    Administer anticoagulants

    Heparin

    Warfarin

  • 8/8/2019 DVT & varicose veins

    15/30

    HEPARIN

    Blocks conversion of

    prothrombin to

    thrombin and reduces

    formation orextension of thrombus

  • 8/8/2019 DVT & varicose veins

    16/30

    SIDE EFFECTS

    a. Spontaneous bleeding

    b. Injection site reactions

    c. Ecchymoses

    d. Tissue irritation and sloughinge. Reversible transient alopecia

    f. Cyanosis

    g. Pain on arms and legs

    h. Thrombocytopenia

  • 8/8/2019 DVT & varicose veins

    17/30

    NURSING RESPONSIBILITIES

    1. Monitor partial thromboplastin time (PTT);dosage is adjusted to maintain PTT between

    1.5 to 2.5 times normal

    2. Use of infursion pumps in IV heparin

    administration

    3. Ensure proper injection technique

    - syringe: use gauge 26-27 syringe; inject to

    subcutaneous area of abdomen- avoid injecting within 2 inches of the umbilicus

  • 8/8/2019 DVT & varicose veins

    18/30

    - do noth withdraw plunger to assess blood

    return- apply gentle pressure after removal of needle;

    avoid massaging the injection site

    4. Assess for increased bleeding tendencies and

    report to the physician

    - hematuria; hematemesis; bleeding gums;

    petichiae of soft palate; ecchymoses; epistaxis;

    bloody sputum; melena

  • 8/8/2019 DVT & varicose veins

    19/30

    5. Instruct the client to avoid aspirin,

    antihistamines, and cough preparationscontaining glyceryl, guaiacolate, and to obtain

    physicians permission before using other over-

    the-counter drugs

    6. Always have protamine sulfate (antidote forheparin toxicity) available at hand

  • 8/8/2019 DVT & varicose veins

    20/30

    WARFARIN (COUMADIN)

    Blocks prothrombin synthesis by interferring withvitamin K synthesis

    SIDE EFFECTS Gastrointestinal: anorexia, nausea and

    vomitting, diarrhea, stomatitis

    Hypersensitivity: dermatitis, urticaria, pruritus,

    fever Others: transient hair loss, burning sensation of

    feet, bleeding complications

  • 8/8/2019 DVT & varicose veins

    21/30

    NURSING RESPONSIBILITIES

    a. Monitor prothrombin time (PT) daily; dosage is

    adjusted to maintain PT at 1.5-2.5 times normal

    b. Obtain careful medication history

    c. Advise client to withhold dose and to notify thephysician for signsof bleeding

    d. Instruct to use soft toothbrush and to floss

    gently

  • 8/8/2019 DVT & varicose veins

    22/30

    e. Alert client to factors that may affect anti-coagulant response (high fat diet or sudden

    increases in vitamin K-rich foods)

    f. Always have vitamin K (antidote for warfarin

    toxicity) available at hand.

  • 8/8/2019 DVT & varicose veins

    23/30

    VARICOSE VEINS

    Dilated veins that occur most often in the lowerextremities and trunk

    Vessels dilate and valves become stretched and

    incompetent with resultant venous

    pooling/edema

    Most common between ages 30-50

  • 8/8/2019 DVT & varicose veins

    24/30

    RISK FACTORS

    a. Congenital weakness of the veinsb. Thrombophlebitis

    c. Pregnancy

    d. Obesitye. Heart disease

  • 8/8/2019 DVT & varicose veins

    25/30

    ASSESSMENT

    SYSTEMIC

    MANIFESTATIONS

    Pain after prolonged

    standing (relieved byelevation)

    Swollen, dilated, tortous skin

    veins

    Leg heaviness and

    dependent edema

  • 8/8/2019 DVT & varicose veins

    26/30

    DIAGNOSTIC TESTS

    BRODIE-TRENDELENBURG TEST Medical test to determine valvular incompetence

    in superficial vein. A finger is placed over the

    lower (distal) part of the vein being examined.

    The upper (proximal) part of the vein is then

    tapped (percussed). If the impulse is felt by the

    finger placed at the lower end, it indicates

    incompetence of valves in that vein

    Varicose veins distend very quickly (less than 35

    seconds)

  • 8/8/2019 DVT & varicose veins

    27/30

    DOPPLER

    ULTRASOUND Decreased or no

    blood flow heard after

    the calf or thigh

    compression

    DUPLEX SCAN

  • 8/8/2019 DVT & varicose veins

    28/30

    NURSING INTERVENTIONS

    1. Monitor and improve clients cardio-circulatorystate measure circumference of ankle and

    calf daily

    2. Provide adequate rest

    3. Instruct to avoid prolonged standing and sitting

    and to change position frequently

    4. Elevate legs when tired

    5. Provide client health teaching and dischargeplanning: same as in thrombophlebitis

  • 8/8/2019 DVT & varicose veins

    29/30

    6. Provide dependent and other collaborative

    nursing interventions:a. Apply anti-embolic stockings

    b. Prepare client for vein ligation (ligation of the

    saphenous vein where it joins the femoral vein

    and stripping the saphenous vein system fromgroin to ankle)

    - provide routine preoperative care

    - keep affected extremity elevated above thelevel of the heart to prevent edema

  • 8/8/2019 DVT & varicose veins

    30/30

    - Apply elastic bandages and stockings, which

    should be removed every 8 hours for shortperiods and then reapplied

    - Assist in getting out of bed within 24 hours

    - Assess for increased bleeding, particularly the

    groin area