MedSurg I Venous Disorders

olanjones's version from 2016-12-06 18:17

Venous Disorders

Question Answer
Phlebitisinflammation of the walls of small cannulated veins of the hand or arm; s/s = pain, tenderness, warmth, erythema, swelling, and a palpable cord.
Phlebitis RF & TxRF: mechanical irritation from the catheter, infusion of irritating medications, & catheter location; Tx: Remove catheter, elevate (if edematous), Apply warm, moist heat & administer oral/topical NSAIDs
Varicose veins (varicosities)dilated (3 mm or larger in diameter), tortuous subcutaneous veins commonly found in the saphenous vein system - can be primary or secondary to another condition
Varicose veins RFFH of venous disease, weakness of veins, female, use of oral contraceptives or HT, tobacco use, age, obesity, pregnancy, history of VTE, venous obstruction, thrombophilia, or occupations with prolonged standing or sitting.
Varicose veins Txrest with limb elevation; elastic compression stockings; & exercise (walking); Venoactive drugs; Sclerotherapy; Laser therapy; Surgical ligation or ablation (not indicated if only a cosmetic problem)
What is the most common venous disorder?Venous Thrombosis: a clot in conjunction with inflammation

Venous Thrombosis

Question Answer
Two main classifications1. Superficial (65% of IV patients get - usually minor & resolves) 2. Deep vein (usually iliac/femoral, can produce emboli which can migrate --> = PE!!!)
RF (Virchow’s Triad)1. Venous stasis (poor blood return to the heart) 2. Damaged endothelium (trauma, IVs, DM, burns) 3. Blood hypercoagulability (clotting problems, anemia, cancer, pregnancy/postpartum, BC)
S/S of Superficial ThrombPalpable/firm/sub-q cord, redness/warmth/edema, Can be in upper or lower extremities (may become septic if undiagnosed)
Tx of Superficial ThrombElevate, warm moist heat, TED hose, ASA/NSAIDs, Remove IV (emboli are rare)
DVT ManisEdema, pain (possibly to palpation), warmth, cyanosis, elevated temperature (Not always symptomatic though... is Dx with Doppler & venogram) **Homan’s sign not considered reliable
Complications of DVTPulmonary Embolism (most serious), Chronic Venous insufficiency, Phlegmasia cerulea dolens (blue, painful leg)
S/S of PE & Immediate interventionS/S: sudden chest pain & dyspnea, deteriorating vitals. IF this happens: ↑ HOB, Admin O2, Notify physician (Stay with your patient)
DVT Prevention/ProphylaxisEarly ambulation (OOB X 3 daily with meals in chair), Position changes (dorsiflexion & rotate ankles Q2), TED hose (measure and apply correctly) & ICDs (NOT IF ALREADY HAS A CLOT)
Purpose of Anticoagulant txIf no clot, it is preventative; If clot, used to stop growth, stop new development, or decrease chance to throw emboli
Warfarin Blood test & AntidotePT/INR (therapeutic INR btwn 2-3); Vitamin K
Heparin Blood test & AntidoteaPTT (therapeutic btwn 46-70 sec); Protamine sulfate
DVT NDRisk for impaired skin integrity: perfusion; PC bleeding; PC PE
DVT NIWatch labs, Observe for bleeding (including stool & urine), Protect skin, Watch injection sites
DVT Home careEliminate modifiable risk factors, Teaching - S/S of PE, Meds (bleeding risk), Diet (vit K, hydration), Rest & exercise (avoid leg crossing, prolonged sitting/standing)

Chronic Venous Insufficiency

Question Answer
CVI ManisRetrograde flow, persistent edema, ↑ pigmentation from hemosiderin deposition (leathery, brownish skin), varicosities, ulcers (usually above lateral/medial malleolus), & cyanosis in dependent position
CausesVein incompetence, DVT, valve incompetence (venous backs up --> ↑hydrostatic pressure --> fluid and blood cells “pushed” into the interstitial space --> edema)
TreatmentCompression (assess arterial circulation first), Biological dressings (Transparent film, hydro-colliods, impregnated gauze), Nutrition (adequate calories, proteins, Vit A, C, & Zinc - MUST CONTROL DM), Weight loss
Nursing ManagementAvoid limb trauma, Proper skin care & Compression (fit & replace Q 6 months), Proper foot & leg care (moisturizing), Appropriate activity & positioning (Avoid long periods of standing/sitting, Elevate legs above heart) **Teaching is key because recurrence is high

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