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Acute Venous disorders
- find self study guide
- VTE/DVT- thrombophlebitis of deep vein
- - inc risk women, > 40, hospitalized pts, prior DVT, venous stasis, pregnancy, malignancy
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Virschow's triad
- 2 of 3 must be present for thrombi to form
- - venous stasis
- - hypercoag
- - injury to venous wall
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Patho venous
- damage to venous wall attracts platelets & chemotactic agents, along w/stasis or hypercoag, thrombus
- platelets adhere to endothelium and form clot
- valves may be destroyed
- range from 1mm to big enough to occlude vein
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venous management
- **prevention
- compression stockings, venodynes
- meds- ASA, heparin, lovenox
- active & passive ROM
- early ambulation
- no pillows under the knee postop
- avoid long periods of sitting/standing
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Venous manifestations
- about 1/2 asymptomatic
- ** localized pain, & unilateral leg swelling
- redness, warmth
- dilated veins
- US venous duplex scanning
- * first sign may be PE
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medical management venous- medical
- BR 5x 7 days
- monitor for PE
- leg elevation about 6"
- anticoag therapy- heparin, enoxaparin, warfarin (cont 3-6 months)
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Nx considerations acute venous
- goal- prevent existing thrombi from embolizing, prevent new thrombus
- Monitor PTT, PT/INR, H&H, plt
- bleeding precautions
- teach about anticoag
- analgesics PRN
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surgical management- acute venous
- venous thrombectomy- rarely done
- umbrella procedure- IVC filter- inserted into IVC to trap large embolism
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chronic venous disorders/insuffciency
- follows most severe cases of DVT 'post thrombotic syndrome'
- 20% have no history of DVT
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patho chronic venous
- decreased venous return inc pressure, destroys valves and causes venous stasis
- - inc hydostatic pressure- leakage
- hemosiderin
- flow is now bidirectional
- very high venous pressure exerted at the ankle
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chronic venous manifestations
- chronically swollen limbs
- thick, coarse, brownish skin, esp at ankles
- venous stasis ulcerations
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chronic venous management
- goals- inc venous return, dec pressure
- elevate legs above level of heart
- avoid prolong standing or sitting
- avoid crossing legs, dangling legs, constrictive clothing
- sleep with FOB eleva 6 "
- balance diet
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chronic venous management
- graduated pressure stockings
- antiembolic stockings
- - review proper fitting
- smoking cessation
- good foot care qd
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Varicose veins
- review sheet
- loss of valvuar cometence & constant high venous pressure can cause distention & tortuosity of superfical veins
- increased prevalence w/age- peaks 50-60's
- more common in women until 70 than equal
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varicose veins manifestations
- appearance
- aching, heavy feeling
- itching
- moderate swelling
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diagnostic tests- varicose veins
- note venous pressure changes during walking
- doppler flowmetry
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medical management varicose veins
- compression stockings
- teach to avoid prolong sitting/standing, constictive clothing
- elevate legs 6"
- walk for exercise
- wt loss prn
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surgical management varicose
- sclerotherapy
- vein ligation
- endovenous laser therapy (EVLT)
- - shrinks/closes vein with laser
- - quick, outpatient procedure
- - 98% success rate
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