Introduction Mrs Beecham’s condition requires immediate attention and frequent monitoring during hospitalisation to prevent and reduce the risk of further damage to Mrs Beecham’s future health. The risk of recurrent DVT is high post hospitalisation. Therefore, it is crucial to educate Mrs Beecham how to identify recurrent symptoms of DVT and when to seek medical attention, to discuss the complications of untreated DVT, encourage lifestyle changes, importance of continuous thrombolytic therapy and compression therapy. Recurrent DVT is influenced by risk factors such as immobility, smoking, diabetes and age. Effective discharge planning is crucial to Mrs Beecham’s care particularly when the patient is at risk of recurrent DVT. The general risk of DVT recurrence needs to be explained to the patient and a decision involving patient preferences should also be made. Pathophysiology Venous Thromboembolism is defined as clot formation in the vein, categorised as Deep vein thrombosis (DVT). Clot formation in DVT is usually found in the deep veins such as the leg or arm. DVT is associated with inflammation (oedema), pain, discolouration (cyanosis) or could also be Asymptomatic (Bosque, 2012). The causes of clot formation (thrombosis) include vessel wall damage, stasis or low flow, and hypercoagulability. Venous stasis can occur as a result of anything that slows or obstructs the flow of venous blood (Kaushal (Kevin) Patel, ‘medscape’). Therefore, inflammation (oedema) of the limb is caused by obstruction (thrombi) resulting to insufficient blood flow. The patient may also be present with discolouration (cyanosis) and pain. Deep Vein Thrombosis may be caused by provoking factors such as smoking, trauma, surgery, heart failure, age, immobility or could occur spontaneously. In contrast, a number of options exist for the treatment of acute DVT; unfractionated heparin (UFH), low-molecular weight heparin (LMWH), fondaparinux and vitamin K antagonists. Anticoagulant therapy has been shown to effectively reduce thrombus progression, mortality and post-traumatic-syndrome. Compression therapy is also used for the treatment of acute Deep vein thrombosis. (Edig, 2016). Risk of recurrent Deep Vein thrombosis In addition, prophylaxis is commonly stopped when the patient is discharged from hospital. Considering Mrs Beecham’s medical history, there is a high risk of recurrent Deep Vein Thrombosis when discharged. There are several well-established risk factors for DVT, including immobilisation, surgery, smoking and age. Mrs Beecham is at high risk of recurrent DVT due to her poor mobility (osteoarthritis), diabetic condition and emphysema status. During her hospital stay, Mrs Beecham was treated with thrombolytic therapy and compression therapy. Patients developing DVT while in hospital may be safely mobilized, provided that adequate anticoagulation is immediately initiated. (Edig, 2016). Venous stasis, hypercoagulability, and endothelial injury are the three major pathophysiological pathways implicated in thromboembolic disease.
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Studies have established significant diabetes-related abnormalities in coagulability and endothelial function. Diabetes mellitus has been considered as a potential risk factor for idiopathic (unknown cause of disease) Deep Vein Thrombosis (DVT) (karim Gariani, 2016). Moreover, DVT is a frequent and potentially fatal complication of patients with COPD. Deep Vein Thrombosis account for many deaths in patients with chronic obstructive pulmonary disease (COPD) (Victor F. Trapson, 2005). The potential influence of inflammation on coagulation offers further potential to contribute to thrombogenesis in all smokers. Plasma fibrinogen levels are elevated in smokers and are further elevated during acute COPD exacerbation.
Research has also shown that DVT can occur as a result of prolonged immobility, especially in the elderly. The superficial veins and the deep veins are the two major groups of veins in the leg. The function of these veins is to return venous blood upward to the heart. These veins also have many one-way valves that keep the blood from flowing back down. Restriction of blood flow from the legs causes a build-up of pressure, which in turn forces fluid into the leg called oedema. Therefore, thrombus formation occurs when there is a reduced of blood flow due to physical inactivity (‘Deep Vein Thrombosis’, 2013). Discharge plan education needs and support requirements Effective discharge planning is crucial to Mrs Beecham’s care particularly when the patient is at risk of recurrent DVT. The general risk of DVT recurrence needs to be explained to the patient and a decision involving patient preferences should be made. The continuation of using prophylactic anticoagulant dosages to prevent recurrent DVT is important to
Studies have established significant diabetes-related abnormalities in coagulability and endothelial function. Diabetes mellitus has been considered as a potential risk factor for idiopathic (unknown cause of disease) Deep Vein Thrombosis (DVT) (karim Gariani, 2016). Moreover, DVT is a frequent and potentially fatal complication of patients with COPD. Deep Vein Thrombosis account for many deaths in patients with chronic obstructive pulmonary disease (COPD) (Victor F. Trapson, 2005). The potential influence of inflammation on coagulation offers further potential to contribute to thrombogenesis in all smokers. Plasma fibrinogen levels are elevated in smokers and are further elevated during acute COPD exacerbation.
Research has also shown that DVT can occur as a result of prolonged immobility, especially in the elderly. The superficial veins and the deep veins are the two major groups of veins in the leg. The function of these veins is to return venous blood upward to the heart. These veins also have many one-way valves that keep the blood from flowing back down. Restriction of blood flow from the legs causes a build-up of pressure, which in turn forces fluid into the leg called oedema. Therefore, thrombus formation occurs when there is a reduced of blood flow due to physical inactivity (‘Deep Vein Thrombosis’, 2013). Discharge plan education needs and support requirements Effective discharge planning is crucial to Mrs Beecham’s care particularly when the patient is at risk of recurrent DVT. The general risk of DVT recurrence needs to be explained to the patient and a decision involving patient preferences should be made. The continuation of using prophylactic anticoagulant dosages to prevent recurrent DVT is important to