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    Venous Disorder: Venous Thrombosis, Chronic Venous Insufficiency, Varicose Veins

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    hitesh315
    This document discusses venous disorders including venous thrombosis, chronic venous insufficiency, and varicose veins. It provides in-depth information on the pathophysiology, risk factors, signs and symptoms, diagnostic testing, and treatment including medications and nursing care for conditions such as deep vein thrombosis, superficial vein thrombosis, and chronic venous insufficiency. Treatment involves anticoagulants, compression stockings, elevation of the legs, and wound care for ulcers in the case of chronic venous insufficiency. The nursing process aims to address pain, prevent complications, improve mobility, and provide patient education on disease management and prevention.

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    Venous Disorder: Venous Thrombosis, Chronic Venous Insufficiency, Varicose Veins

    Uploaded by

    hitesh315
    156 views53 pages
    This document discusses venous disorders including venous thrombosis, chronic venous insufficiency, and varicose veins. It provides in-depth information on the pathophysiology, risk factors, signs and symptoms, diagnostic testing, and treatment including medications and nursing care for conditions such as deep vein thrombosis, superficial vein thrombosis, and chronic venous insufficiency. Treatment involves anticoagulants, compression stockings, elevation of the legs, and wound care for ulcers in the case of chronic venous insufficiency. The nursing process aims to address pain, prevent complications, improve mobility, and provide patient education on disease management and prevention.

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    This document discusses venous disorders including venous thrombosis, chronic venous insufficiency, and varicose veins. It provides in-depth information on the pathophysiology, risk factors, signs and symptoms, diagnostic testing, and treatment including medications and nursing care for conditions such as deep vein thrombosis, superficial vein thrombosis, and chronic venous insufficiency. Treatment involves anticoagulants, compression stockings, elevation of the legs, and wound care for ulcers in the case of chronic venous insufficiency. The nursing process aims to address pain, prevent complications, improve mobility, and provide patient education on disease management and prevention.

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    156 views53 pages

    Venous Disorder: Venous Thrombosis, Chronic Venous Insufficiency, Varicose Veins

    Uploaded by

    hitesh315
    This document discusses venous disorders including venous thrombosis, chronic venous insufficiency, and varicose veins. It provides in-depth information on the pathophysiology, risk factors, signs and symptoms, diagnostic testing, and treatment including medications and nursing care for conditions such as deep vein thrombosis, superficial vein thrombosis, and chronic venous insufficiency. Treatment involves anticoagulants, compression stockings, elevation of the legs, and wound care for ulcers in the case of chronic venous insufficiency. The nursing process aims to address pain, prevent complications, improve mobility, and provide patient education on disease management and prevention.

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    The key takeaways are that venous thrombosis can occur when there is stasis of blood, increased coagulability, or injury to the vessel wall. Major risk factors include immobilization, surgery, oral contraceptives, and advanced age. The main complications are chronic venous insufficiency and pulmonary embolism.

    Major risk factors for developing venous thrombosis include immobilization, obesity, surgery, oral contraceptives, pregnancy, advanced age, and altered coagulation states.

    The main complications of venous thrombosis are chronic venous insufficiency and pulmonary embolism.

    Venous Disorder

    Dr Hitesh Patel
    Associate professor
    Surgery Department
    GMERS Medical College ,Gotri

    Venous Thrombosis, Chronic


    Venous Insufficiency,
    Varicose Veins

    (Venous Thrombosis (Thrombophlebitis)


    Condition in which a blood clot (thrombus)
    forms on wall of vein and partially or
    completely blocks flow of blood back to the
    heartmore common
    Usually due to slow movement of blood
    Thrombi can form in either arteries or
    veins; platelet aggregation is more likely
    due to the slower movement of blood

    Factors Associated
    Bed rest
    IV catheters
    Immobilization
    Obesity
    MI
    CHF
    CA of breast,
    pancreas, prostate,
    ovary

    MS
    Oral contraceptives
    Pregnancy
    Childbirth
    Surgery >age 40
    Altered coagulability
    states

    Pathophysiology: Virchows Triangle


    Statis of blood
    Increased blood coagulability
    Injury to vessel wall
    2 of 3 factors must be present for
    thrombi to form

    A thrombus forms..
    Trauma to the lining of the vein brings
    tissues in contact w/platelets that
    aggregate
    Deposit of fibrin, leukocytes &
    erythrocytes into the platelet clump
    causes a thrombus
    At first, the thrombus floats in the vein;
    within 7-10 days it sticks to the vein wall,
    but a portion may still float in the vessel
    Pieces may break loose & become
    traveling emboli
    Fibroblasts invade thrombus, scar the
    vein, & destroy venous valves--permanent

    Deep Vein Thrombosis

    (DVT)

    Most likely to occur in deep


    veins of the calf (80%)
    25% of thrombi that occur in
    calf will extend to the
    popliteal & femoral veins
    Pulmonary Embolism may be
    the first sign of DVT

    DVT Manifestations
    When clot is in formative stage, may notice no
    symptoms
    Usually profound tenderness; affected extremity
    may be larger (unilateral edema)
    Dull aching esp when walking: Most common
    Severe pain, esp when walking
    Cyanosis of extremity
    Slightly elevated temp
    General malaise

    Homans Sign
    Was long considered classic manifestation
    this is no longer true
    Sign is not specific to DVT & can be
    elicited by any condition of the calf
    As calf muscles contract, there is risk of
    detaching thrombus from the wall

    Major Complications of
    Thrombophlebitis
    Chronic venous insufficiency
    Pulmonary embolism

    Superficial Vein Thrombosis

    (SVT)

    Thrombi form primarily in upper


    extremities
    Primary cause: trauma to venous wall assoc
    w/venous catheters, repeated venous
    punctures, use of strong IV solutions the
    produce inflammatory response

    SVT Manifestations
    Dull, aching pain over affected area: KEY
    Marked redness along vein
    Increased warmth over area of
    inflammation
    Palpable cordlike structure
    More immediate attention is required if
    edema, chills, high fever; suggests
    complications of inflammation

    Collaborative Care:
    Thrombophlebitis
    1.
    2.
    3.

    Tx focus: inflammatory process,


    prevention of further clotting,
    extension & restoration of blood flow
    Must be differentiated from cellulitis,
    calf strain, contusion, lymphatic
    obstruction
    Med tx: use of meds, treat
    inflammation/infection, dissolve clots

    Lab & Diagnostics


    Duplex venous ultrasonography
    Plethysmography : lg & superficial veins
    Magnetic Resonance Imaging
    Ascending contrast venography (most
    accurate)
    Doppler ultrasound

    Conservative Therapy: SVT


    Prophylaxis: LMW Heparin
    Prevention is Key!: post op clients leg exercises,
    TEDs(compression stocking), ambulate asap, no leg
    crossing, loose fitting clothes, exercise
    Focus: relief of symptoms and reversal of
    inflammatory process
    Apply warm, moist compresses over affected area
    & administer anti-inflammatory agents as
    prescribed
    Some clients may require antibiotics (therapeutic
    or prophylactic)

    Conservative Therapy: DVT


    Anticoagulants may be prescribed for severe
    cases
    Strict bedrest until symptoms of tenderness &
    edema resolve
    Legs elevated, knees slightly flexed, above heart
    level to promote venous return & discourage
    venous pooling
    TEDs or pneumatic compression devices

    Medications
    Anti-inflammatories
    Anticoagulants***
    Thrombolytics
    Antibiotics

    Anti-inflammatories
    NSAIDs
    Indomethacin (Indocin)
    Naproxen (Naprosyn)
    When used w/warm, moist compresses,
    NSAIDs bring symptomatic relief to most
    clients w/SVT

    Anticoagulants

    For DVT, most common tx to prevent propagation of


    thrombus & subsequent PE
    Initial bolus of 7500 to 10,000 u of heparin, then
    continuous heparin infusion started (via pump)
    Daily dosage is calculated based on results of APTT
    (activated partial thromboplastin time)
    Desired: APTT is 1.5 to 2 times normal APTT value
    Oral anticoagulation w/warfarin is started first
    week: important to overlap 4-5 daysfull effect of
    warfarin is delayed
    Warfarin: PT should exceed normal value by 1.5-2.5
    times/INR 2-3
    Oral anticoagulant tx may last from 2-6 months,
    depending on extent of disease (single occurrence vs
    PE)

    Thrombolytics

    Streptokinase,urokinase,tpA
    Dissolve blood clots by imitating natural enzymatic
    processes
    Have been shown to destroy venous thrombi that
    are < 72 hrs old
    More rapid & efficient than heparin while also
    preventing additional damage to venous valves
    Side effect of hemorrhage is more common than
    w/conventional heparinization

    Antibiotics
    Limited to specific tx of identified
    infections
    SVT; develop bacteremia, Staphlococcus
    If blood cultures are positive, antibiotics
    are started to prevent systemic sepsis

    Surgery

    Most clients are tx w/meds and


    conservative tx
    Venous thrombectomy; done when
    thrombi are lodged in femoral vein &
    excision of clots is required to prevent
    PE or to prevent gangrene
    Also can insert filtering devices into
    inferior vena cava via femoral or jugular
    vein; used forpts who cant take
    anticoagulants & are at risk for PE
    or have recurrent problems
    Most common filter used: Greenfield
    filter, assoc w/97% success rate in
    preventing the recurrence of PE

    Nursing Process
    Addresses clients responses to illness,
    primarily in areas of pain mgt, education re:
    disease process/med tx, & interventions to
    reduce inflammation & prevent
    complications. Prevention is very
    important! Provide info re: causes to
    venous thrombosis to all high risk clients

    Nursing Diagnoses
    Pain
    Ineffective Protection
    Impaired Physical Mobility
    Risk for Ineffetive Tissue Perfusion:
    Peripheral

    Pain: r/t inflammation of vein caused by


    thrombotic process

    Assess client level of pain on regular basis


    using 0-10 scale
    Measure diameter of calf & thigh of
    affected extremity on admission & QD
    Apply warm, moist heat to extremity 4 x
    QD (compresses or Aqua-K pad)
    Maintain BR and teach client rationale

    Ineffective Tissue Perfusion: r/t obstruction of


    blood flow & triggering of inflammatory response
    & subsequent swelling/pain
    Assess peripheral pulses, skin integrity, capillary
    refill times, & color of extremities at least once q
    shift
    Elevate extremities; keep knees slightly flexed
    and legs above heart level
    Maintain use of TEDs as ordered, remove only for
    short periods (30-60 min) during daily hygiene
    Use of mild soaps, lotions to clean leg/foot
    Assess skin q shift
    Positioning aids: eggcrate /sheepskin

    Ineffective Perfusion: Result of obstruction of


    blood flow & triggering of inflammatory response
    & subsequent swelling/pain
    Administer & monitor effectiveness of analgesics,
    anticoagulants, thrombolytics, antibiotics
    Before administering anticoagulants, check lab
    values (APTT/PTT)
    Position changes q 2 hrs while awake

    Impaired Physical Mobility r/t prolonged bedrest


    (constipation, joint stiffening, muscle atrophy,
    boredom)
    Encourage active or perform passive Range
    Of Motion exercises at least 1 x qshift
    Increase fluid intake & dietary fiber
    Provide progressive ambulation within
    ordered guidelines
    Diversional activities

    Other Nursing Dx
    Ineffective Protection r/t anticoagulant tx;
    Monitor lab results: INR (PT) aPTT,
    Assess regularly of evidence of bleeding

    Risk for Ineffective Tissue Perfusion:


    Cardiopulmonary
    Frequent assessment of respiratory status: Respiratory
    distress, & O2 Sat

    Chronic Venous Insufficiency


    1.
    2.

    Disorder involving stasis of blood in


    lower extremities as result of
    obstruction & reflux of venous valves
    Assoc w/changes in venous circulation
    resulting from thrombophlebitis &
    valvular incompetence, varicose veins

    Clinical Manifestions
    Lower leg edema
    Itching
    Brown pigmentation/Cyanosis of skin of lower
    leg/foot
    Fibrosis/hardness of subcutaneous tissues
    Stasis ulcers over ankle, most often medial

    Complication: Ulcer development


    Blood pools in lower limb and peripheral circulation
    slows; insufficient oxygen & nutrients to cells
    Cells die causing formation of venous stasis ulcers
    In attempt to heal stasis ulcer, body increases
    supply of oxygen, nutrients, and energy to area;
    but it does not reach the diseased tissues due to
    impaired circulation = enlarged ulcers

    Complication: Ulcer development


    Congested venous circulation prevents
    biochemicals from immune system to diseased
    tissues, interfering w/normal inflammatory
    response. Increases risk for wound infection
    Area around stasis ulcers appear shiny, atrophic, &
    cyanotic, w/brownish pigmentation. May have
    eczema or stasis dermatitis, scar tissue
    Slight trauma will result in serious tissue
    breakdown

    Assessment: Lab & Diagnostics


    No specific labs or diagnostic tests
    Diagnosis is usually based on clinical
    findings
    Interview data
    Family Hx
    Past medical Hx
    Physical exam

    Possible Nursing Diagnoses


    Ineffective health maintenance r/t lack of
    knowledge
    Ineffective tissue perfusion: peripheral r/t
    incompetent venous valves
    Anxiety r/t inability to control chronic disease
    Disturbed Body image r/t edema & statis ulcers
    Risk for infection r/t ulcerations
    Impaired physical mobility r/t pain & lower leg
    edema
    Impaired skin integrity r/t stasis ulcers

    Nursing Interventions/Teaching
    BR, w/feet elevated above heart level
    Avoid long periods of standing walk as much as
    possible
    Avoid anything that pinches skin (knee-highs)
    While sitting, do not cross legs & avoid pressure
    behind knees
    Elastic support hose/TEDs
    Follow guidelines for care of legs & feet

    Other Interventions
    Ulcer may be treated w/semirigid boot applied to
    affected area; device may be made of Unnas
    paste or Gauzetex bandage. Changed q 1-2 wks
    Surgery for large, chronic ulcers; Incompetent
    veins ligated, ulcer excised, skin grafted

    Medications: Topical Agents &/or


    Antibiotics
    Acute weeping dermatitis: wet compresses
    w/boric acid, Burows soln, isotonic saline 4 x qd
    for 1 hr intervals, followed w/topical ointments
    (0.5% hydrocortisone cream)
    Subsiding/Chronic: continue use of hydrocortisone
    cream. Other: zinc oxide ointment, broadspectrum antifungal creams (clotrimizole/Lotrimin,
    miconazole/Monistat)
    Ulcerations: saline compresses to promote wound
    healing or prepare for skin graft

    Evaluationthe client
    Verbalizes s/s infection; remains free of
    infection
    Verbalizes understanding of disease
    process, tx, regimen, limitations & is
    compliant
    Demonstrates improved perfusion skin
    color & reduction/absence of edema
    Displays increasing tolerance to activity
    Pain/discomfort relieved

    Varicose Veins
    Irregular, tortuous veins with
    incompetent valves

    Varicose Veins
    May develop anywhere in body, but most develop in
    lower extremities
    Vein in legs most often affected: Long Saphenous
    Occur in 1 out of 5 people; more common females >
    35; Whites > Blacks; familial tendency
    Causes
    Severe damage or trauma to saphenous vein
    Effects of gravity produced by long periods of standing

    Types

    Primary: no deep veins involved


    Secondary: caused by obstruction of deep veins (Most
    Common)

    Pathophysiology
    Major cause: sustained stretching of vascular wall
    die to long-standing increased intravenous
    pressure
    Valves become incompetent because they cannot
    close properly due to stretching
    Prolonged standing, the force of gravity, lack of
    lower limb exercise, & incompetent venous valves
    all weaken muscle-pumping mechanism, & return of
    venous blood to heart decreases
    As client stands for long time, blood pools and
    vessel wall continues to stretch, and valves
    become increasingly incompetent

    Normal vs Abnormal

    Clinical Manifestations
    Severe, aching pain in leg
    Leg fatigue &/or heaviness
    Itching over affected leg (stasis
    dermatitis)
    Feelings of heat in the leg
    Visibly dilated veins
    Thin, discolored skin above ankles
    Complications: insufficiency, stasis ulcers,
    chronic stasis dermatitis, thrombophlebitis

    Assessment: Labs & Diagnostics


    No specfic labs
    Diagnostics
    Doppler ultrasound flow tests &
    angiographic studies or Duplex Doppler
    ultrasound
    Trendelenburg tests assists w/diagnosis

    Collaborative Interventions
    Conservative measures include
    antiembolism stockings and regular walking
    & leg elevation
    Mild analgesics may relieve pain
    Compression sclerotherapy & vein stripping
    are surgical techniques that may alleviate
    the major symptoms of varicose veins.

    Nursing Process
    Focus:
    Restore venous circulation
    Relieve symptoms
    Prevent complications
    Promote behaviors that minimize symptoms

    Nursing Dx: chronic pain r/t prolonged interruption in


    return of venous blood to heart & subsequent pooling of
    blood in extremity

    Assess pain
    Teach & reinforce methods for relieving pain
    that do not involve use of analgesics
    Encourage discussion of possible
    relationships between pain and life stressors
    Collaborate w/client to determine pain
    control plan
    Regularly evaluate effectiveness of
    interventions used to minimize pain

    Nursing Dx: Ineffective tissue perfusion r/t

    insufficient supply of nutrients/oxygen & incompetent


    valves
    Assess peripheral pulses, capillary refill time, skin
    temp, and degree of edema
    Teach client use of antiembolic stockingsremove
    daily for 30-60 minutes
    Teach to exercise extremities at regular intervals
    Teach client to elevate affected extremities to
    reduce tissue congestion and promote return of
    venous blood to heart

    Nursing Dx: Ineffective tissue perfusion r/t

    insufficient supply of nutrients/oxygen & incompetent


    valves
    Assess skin on lower extremities for warmth,
    erythema, moisture, signs of breakdown
    Teach about daily skin hygiene
    Teach client to protect extremities from external
    forces that may cause skin breakdown
    Encourage adequate nutrition and fluid intake

    Nursing Dx: Risk for peripheral neurovascular


    dysfunction
    Assess circulation, sensation, & motion in lower
    extremities
    Teach to avoid flexing the extremity & to maintain
    positions that promote effective neurovascular
    function
    Teach client/family to report and signs of
    impaired neurovascular function, such as
    numbness, coldness, pain, or tingling of extremity
    Teach about importance of maintaining safety and
    adhering to plan of care

    Other Nursing Dx
    Risk for infection r/t disruption
    incontinuity of skin
    Impaired home health maintenance
    r/t prescribed postural limitations
    Anxiety r/t possible need for surgery

    Evaluation
    Skin is of normal color,temp,
    nontender, nonswollen, intact
    Client actively moves extremity;
    verbalizes reduced pain

    Other info
    Home Care

    Teach clients how to adapt to accommodate


    prescribed health regimen (eg: daily walks,
    TEDs, elevate legs)

    Older Adult

    Foster acceptance of interventions


    Safety when walking
    Strategies for minimizing standing &
    incorporating activity into the job
    May require home-based care

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