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56 Cards in this Set
- Front
- Back
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What is Virchow's Triad?
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Hypercoagubiltiy
Damage to endotheimlieum Venus stasis |
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What are three complications of DVT?
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Phlegmasia Cerulea Dolens-
Pulmonary Embolism Chronic Venous Insufficienc |
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What are the three diagnositic test used to confirm DVTs?
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Venogram
Duplex Scan- gold standard Doppler Flow studies- easiest D dimer- Blood test |
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What is the D-Dimer test?
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D-Dimer: assesses thrombin and plasmin activity in the blood
Normal: negative, none detectable Abnormal: positive Suggestive of DVT, PE |
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What are some nursing interventions?
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Bedrest- 3-5 days on a heparin drip
Elevate limb Compression stocking Monitor for signs of PE Monitor pulses distal to thrombus, edema, calf circumference Pain relief (NSAIDS, analgesics) |
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What are anticoagulats and what do they do?
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Heparin, Cumadin, Lovanox
They stop clots from forming but do not disolve clots. |
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What is the ranges for aPTT normal and thearputic, and what is the cure for too much heparin?
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Normal: aPTT : 24-36 seconds
Therapeutic- on heparin: 46-70 seconds Protamine sulfate |
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What is used to measure warfarins effeect and haparins effect?
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Warfarin-INR
Heparin-aPTT |
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What are the rages for INR(tharputic and normal)?
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Normal INR: .75- 1.25
Therapeutic: 2-3 |
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How long does it take for Warfarin to take effect?
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48-72 hrs
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What is a surgical intervention for prevention of PE?
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Vena Cava Interruption Device
Greenfield Filter Filter clots without disturbing blood flow |
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Define: Thrombophlebitis?
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A clot and inflammation in a vain
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How many surgical pt develop dvt?
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5%
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What is life threatening pe or DVT?
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PE
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Virchows Triad?
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Hypercoagulation
endothelial dammageproceses. Venus stasis |
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What contributes to endothelial dammage?
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endothelial dammage- dammage to the inside of the vains occurs from, local decreases of fibrinolytic proceses and physical truma. Antibiotics, chemo agents
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What contributes to Hypercoagubiltiy?
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anemias, systemic infections, smoking, BCP.
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What contributes to Venus stasis?
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Low mucle tone/activity and valve dammage.
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What problems does a dvt cause?
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Decreased tissue profusion and reduced to flow.
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What are the Clinical manifestations of a DVT?
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SOME PT. ARE ASYMTOMANIC
Typically- unilateral edema, pain, warm skin, slightly elivated tenderness, calf tenderness, If a clot is in the suppiror vana cava causes uperextremity swelling. Infiroir vana cava, lower extermity swelling. |
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Homan sighn?
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Calf Pain with dorsaflextion-not a very relible indicator.
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What is Phlegmasia Cerulea Dolens?
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Occurs in some cased.
The exessive swelling causes no/reduced proffusion. They get intense cyanosis. |
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Prevention and prohalaxsis of DVT?
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Get ptl. out of bed,3 times a day walk around in hall way, ankle rotations, AED (TED HOSE-measure pt., toe hole bottom of foot, no rinkles, ruber on top cant be rolled down).
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What are some diagnostic test for DVT?
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Doppler Flow studies- noninvasive
Duplex Scan- gold standard Venogram- X-ray with contrast Determine the location and extent of clot D-Dimer-blood test, should be -, test from thrombin activity in blood. Tells us that a situation is suggestive of cllott. -good screen er. |
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What are Nursing Interventions for DVT?
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Bed Rest 3-5 days with elevated limb.
Montir for sighns of PE. Monitor pulses distal to thrombus(pedal) Measure Edema-+1- +4 MORE OBJECTIVLY FOR EDEMA-Measure calf circumfrence with tape, mark spot so it is measured in same spot. |
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What is the protocol for a heprarin drip?
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Bedrest- 3-5 days on a heparin drip
Then it takes 48-72hrs for cumadin to reach thearputic levele |
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What is normal and tharputic aPtt antidote?
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Normal: aPTT : 24-36 seconds
Therapeutic- on heparin: 46-70 seconds Antidote: Protamine Sulfate |
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How long do we keep pt on warfarin for and how long does it take to reach thearputic level?
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Warfarin orally for 3-6 months
Must reach therapeutic level before discontinuing Heparin(48-72 hrs) |
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What is used to measure warfarin efficency?
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INR
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What is the normal and tharputic INR? Antidote?
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Normal INR: .75- 1.25
Therapeutic: 2-3 Antidote: Vitamin K |
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w
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d
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How long does a pt need to be anticoagulated for?
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4-6months
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What does a thrombolytic agent do?
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break down clots
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What is heprin induced thrombocytopenia?
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Platlet counts drop
-it is like an alergic reaction, when this happens the pt. need to be put on an alternative? |
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What is argatroband?
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It is a direct thromnin inhinbitor
Alt to heparin Monitor aPtt It is weight based liked heprin |
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What is a fierudins?
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alt to heprin
No antidote so you much be carful with dosing. |
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Surgical prevention interventions for PE.
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Vena Cava interuption device (Green field filters)
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What happens to a clot after the Green field filter catches it?
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the boddies system will take care of it.
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WHat are some different types of embolisms
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Air embolisms-
Fat embolisms-may occure whe u break ur femur. |
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What are common manifestations for a PE?
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Unexplained Anxiety, dyspnea, tackypnea and Tacky cardia.
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What is Pulmanary infarction?
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occlusion of a large vessle in the lung.
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What is the ventilation perfusion scan?
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A diagnostic test for PE.
Pts. are injected with a radioactive isotope, while breathing in radiactive gasses and take a picture of this and get a good map of there lungs. |
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What is a spiral CT scan?
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A 3D pic of the lungs.
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What is Pulmonary Angiography?
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Contrast die is used to help map the lung.
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What do we measure artieal blood gas for? In terms of PE>
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Hypoxemia can suggest a PE.
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What is the treatment for a PE?
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Same as DVT.
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What are three urinary manifestations of renal disease?
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polyuria, oliguria, anuria.
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What happens to your metabolic system when you have renal disease?
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elvated BUN and creatnine,
Hyperlipidimia, hyperinsulanemia, hyperkalemia, hypocalemia, |
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What are does renal disease do to your hemotologic system?
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Anemia
Platlet abnormalities |
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What are does renal disease do to your cardiovascular system?
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Hypertension
Heart failure Left ventricular hypertrophy Peripheral edema Dysrhythmias |
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What does renal disease do to your respiratory system?
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Kussmaul respiration (deep rapid) d/t metabolic acidosis
Dyspnea d/t fluid volume overload Pulmonary edema d/t fluid volume overload |
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What does renal disease do to your neurological system?
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Altered mental ability
Decreased ability to concentrate Lethargy Fatigue Seizures Coma |
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What does renal disease do to your musculoskelatal system?
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Syndrome of skeletal changes
Result of alterations in calcium and phosphate metabolism Weaken bones, increase fracture risk |
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What does renal disease do to your integumentary system?
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Yellow-gray discoloration of the skin
Uremic frost Dry, pale skin Dry, brittle hair Thin nails Pruritus |
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What does renal disease do to your reporductive system?
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Infertility
Decreased libido Low sperm counts Sexual dysfunction |
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What psychological changes occurs with renal disease ?
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Personality and behavioral changes
Emotional ability Withdrawal Depression |
