Deep vein thrombosis from medical surgical nursing

1. SUBJECT- MEDICAL SURGICAL NURSING
TOPIC- DEEP VEIN THROMBOSIS

2. OBJECTIVES
 To introduce the topic.
 To define deep vein thrombosis(DVT).
 To enlist risk factors.
 To enlist etiology.
 To explain pathophysiology, clinical manifestation & diagnostic
evaluation of deep vein thrombosis.
 To explain management & prevention of deep vein thrombosis.

3. INTRODUCTION
 DVT occurs in pelvic veins or in the deep veins of the lower
extremities in postoperative patients.
 The incidence of DVT varies between 10% and 40% depending on the
complexity of the surgery or the severity of the underlying illness.
 DVT is most common after hip surgery, followed by retropubic
prostatectomy and general thoracic or abdominal surgery.

4. DEFINITION
 Deep vein thrombosis (DVT) is a vascular disorder occuring when a
blood clot develops in a vein deep in the body.

5. RISK FACTORS
 Obesity
 Prolonged immobility
 Cancer
 Smoking
 Estrogen use
 Advancing age
 Varicose veins
 Dehydration
 Splenectomy
 Orthopedic procedures

6. ETIOLOGY
 Injury to the intimal layer of the vein wall
 Venous stasis
 Hypercoagulopathy
 Polycythemia.

7. PATHOPHYSIOLOGY
Venous stasis occurs when blood flow is reduced, when veins are dilated,
and when skeletal muscle contraction is reduced.
Damage to the intimal lining of blood vessels creates a site for clot
formation.
Phlebitis & Platelet aggregation
Fragmentation of the thrombus due to elevated venous pressure.
After an acute episode of DVT, recanalization or reestablishment of the
lumen of the vessel occurs.

8. CLINICAL MANIFESTATIONS
 Asymptomatic
 Pulmonary embolism
 Homans’ sign-discomfort in the upper calf during forced
dorsiflexion of the foot.
 Phlebothrombosis.
 Pain or cramp in the calf or thigh, progressing to painful
swelling of the entire leg.

9. CLINICAL MANIFESTATIONS
 Low grade fever
 Chills
 Perspiration
 Marked tenderness over the anteromedial surface of the
thigh.
 Unilateral leg swelling
 Redness or warmth of the leg, dilated veins

10. DIAGNOSTIC EVALUATION
 History Collection
 Physical Examination
 Plethysmography- Non invasive test used to visualize changes of
blood flow through veins. Its often used along with Doppler USG
 MRI

11.  D-dimer blood test- It is a product of fibrin
degradation and is indicative of
fibrinolysis, which occurs with thrombosis.
 Venous duplex USG
 Venography(Ascending contrast )

12. MANAGEMENT
 I. MEDICAL MANAGEMENT
 A. NON- PHARMACOLOGICAL MANAGEMENT
 Oxygen therapy
 Ambulation
 Elevation of leg

13.  B. PHARMACOLOGICAL MANAGEMENT
 Anticoagulants- Heparin, LMWH, Warfarin
 Antithrombotics- Alteplase
 NSAIDs
 Antiplatelets- Aspirin

14. Surgical Management
 Thrombectomy

15. NURSING MANAGEMENT
 ASSESSMENT
 Assess vital signs
 Assess skin condition
 Assess for mobility
 Level of intensity of pain

16. DIAGNOSIS
 Impaired Gas Exchange related to altered blood flow to
alveoli
 Ineffective peripheral tissue perfusion related to interruption
of venous blood flow.
 Risk for impaired physical mobility related to discomfort
and safety precautions.
 Acute pain related to tenderness and swelling in leg
 Deficient knowledge regarding disease condition related to
lack of information and misinterpretation.

17. INTERVENTION
 Impaired Gas Exchange related to altered blood flow to
alveoli
 Assess vital signs- SpO2 & respiratory rate
 Observe for generalized duskiness and cyanosis in the
earlobes, lips, tongue, and buccal membranes..
 Provide fowler’s position
 Provide oxygen therapy to patient

18. INTERVENTION
 Ineffective peripheral tissue perfusion related to
interruption of venous blood flow.
 Assess for the signs and symptoms of deep vein thrombosis
 Encourage bed rest.
 Provide warm, moist heat to the affected site.
 Apply knee compression stockings as prescribed.
 Administer anticoagulants such as heparin/warfarin as
prescribed by physician

19. Risk for impaired physical mobility related to
discomfort and safety precautions.
 Assess patient’s mobility
 Elevation of the affected extremity
 Provide compression stockings
 Provide warm application

20. Hyperthermia related to infectious process
 Monitor temperature daily; every 4 hours if fever present.
 If patient begins chilling, recheck temperature when chilling
subsides.
 Monitor for signs of dehydration: dry skin and mucous
membranes, thirst, weakness, hypotension.
 Encourage oral fluids if not contraindicated.
 Administer antipyretic such as acetaminophen

21. Acute pain related to inflammatory response in
affected vein
 Assess level, intensity & location of pain
 Elevate leg of the patient
 Apply a warm compress to the affected leg using a 2-hour-
on, 2-hour-off schedule around the clock.
 Administer analgesics as prescribed by physician.

22. Deficient Knowledge related to unfamiliarity with the
disease, management and prevention
 Assess knowledge level of patients regarding disease,
management and prevention
 Instruct the client to take medications as indicated,
explaining their use, dosages, and side effects in layman
language.
 Inform the client of the need for regular laboratory testing
while on oral anticoagulation.
 Provide teaching regarding the safety measures while on
anticoagulant therapy such as the use of an electric razor,
the use of a soft toothbrush.
 Instruct the client to avoid rubbing or massaging the calf.

23. COMPLICATIONS
 Chronic Venous insufficiency
 Pulmonary embolism

24. PREVENTION
 Hydrate patient adequately postoperatively to prevent
hemoconcentration.
 Encourage leg exercises and ambulate patient as soon as
permitted by surgeon.
 Avoid restricting devices, such as tight straps, that can
constrict and impair circulation.
 Avoid rubbing or massaging calves and thighs.
 Encourage walking and exercises in bed to decrease venous
pressure and promote blood flow.

25. PREVENTION
 Refrain from inserting IV cannula into legs or feet of adults.
 Prevent the use of bed rolls or knee gatches in patients at
risk because there is danger of constricting the vessels under
the knee.
 Instruct the patient to avoid standing or sitting in one place
for prolonged periods and crossing legs to prevent edema.

26.  Prevent swelling and stagnation of venous blood by
applying appropriately fitting elastic stockings or wrapping
the legs from the toes to the groin with elastic bandage.
 Provide compression stockings
 Provide warm application on affected leg.