DISORDERS OF VENOUS CIRCULATION

occlusive disorders and ineffective venous blood flow

THE CLIENT WITH A VENOUS THROMBOSIS

venous thrombosis (thrombophlebitis) is a condition in which a blood clot forms on the wall of a a vein
dvt - a complication of surgery
factors associated with venous thrombosis
immobilization, mi, heart failure, stroke, postop
surgery
cancer
trauma
pregnancy and delivery
hormone therapy
coagulation disorders

PATHOPHYSIOLOGY

virchow’s triad - stasis, damage and increased coag

DVT - primarily in calf and pelvis
DVT MANIFESTATIONS
asymptomatic
dull, aching pain, esp when walking
tenderness, swelling, warmth, erythema
cyanosis
edema
DVT COMPLICATIONS
chronic venous insufficiency
pulmonary embolism

SVT - iv, pregnant women, saphenous (pancreatic ca)

SVT MANIFESTATIONS
localized pain and tenderness
redness and warmth
palpable cord
swelling and redness

INTERDISCIPLINARY CARE

focus on preventing further clotting, extension of the clot and addressing underlying causes

DIAGNOSIS

duplex venous ultrasonography; plethysmography, mri, ascending contrast venography

PROPHYLAXIS

lmw heparins, oral anti coag, elevate foot/flex knees, compression devices, ted hose, early mobilization, ankle flexion

MEDICATIONS

anticoagulants, fibrinolytics, nsaids

TREATMENTS
relieve symptoms and reduce inflammation
SVT- apply warm moist compresses, extremity rest, anti-inflammatory agents
DVT - bed rest, legs elevated 15-20 with knees slightly flexed above level of heart, teds, compression, walking, avoid
standing, don’t cross legs or wear tight fitting garments or stocking that bind

SURGERY

venous thrombectomy, vena cava filter when coag therapy is contraindicated, possible ligation of the saphenous vein

NURSING CARE

HEALTH PROMOTION

position client to promote venous return, avoid pillows under knees or positions where hips and knees are sharply
flexed, ambulate asap, teach ankle flexion and extension, ted hose and compression, avoid crossing legs

ASSESSMENT

health history, physical exam, diagnostic test (clotting studies)

NURSING DIAGNOSIS AND INTERVENTIONS

preventative measures, pain, tissue perfusion and integrity, potential adverse effects of prescribed treatments.

PAIN

related to inflammation, edema; regularly assess, measure calf, warm, moist heat 4x a day, maintain bed rest

INEFFECTIVE TISSUE PERFUSION: PERIPHERAL

thrombi occlude vessel, inflammatory response, vessel spasm; assess skin; evaluate extremities at all times, use mild
soaps to clean, dry and moisturize, egg crate mattress, sheep skin, position changes.

INEFFECTIVE PROTECTION

monitor lab

IMPAIRED PHYSICAL MOBILITY

prolonged bed rest might cause constipation, joint contractures, atrophy, boredom. encourage rom, position changes,
deep breathing and coughing, increased fluid and fiber intake, encourage ambulation, diversional activities

RISK FOR INEFFECTIVE TISSUE PERFUSION; CARDIOPULMONARY

pulmonary embolism; assess respiratory status, initiate 02 therapy, elevate bed, reassure.

COMMUNITY BASED CARE

explain disease, treatment measures, appropriate heat application, prevent future episodes of venous thrombosis,
follow up and lab test.