Term
| 3 major factors that trigger any coagulation disorder |
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Definition
| vascular damage (endothelial damage to lining of vessels), hypercoagulable state (more prone to clotting), stasis of circulatory system (immobility) |
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Term
| things that can cause vascular damage |
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Definition
| cellulitis, thrombophebitis, atherosclerosis, catheter placement |
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Term
| things that can cause a hypercoagulable state |
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Definition
| recent major surgery, trauma, malignancy, pregnancy, inherited disorders such as Factor V Leiden deficiency/Protein S/Protein C definiency, infections, sepsis, inflammatory bowel disease, autoimmune diseases |
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Term
| strong risk factors of DVT |
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Definition
| fractures or hip pelvis or leg, hip or knee replacement, orthopedic procedures |
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Term
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Definition
| arthroscopic surgeries, central line placements, malignancy, heart failure, hormone replacement therapy, oral contraceptives |
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Term
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Definition
| bed rest >3 days, immobility due to sitting, increased age |
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Term
| symptoms of DVT or venous embolism |
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Definition
| unilateral swelling, leg or calf pain. can get PE- chest pain, SOB, inc warmth and erythema of skin at site of clot |
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Term
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Definition
| dorsiflex foot, pain is pos indicator for DVT |
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Term
| things that can give you a point for Well's cxriteria for DVT |
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Definition
| active cancer, calf swelling >3cm compared to other side, unilateral swollen superficial veins (alternate diagnosis at least as likely is -2 pts). overall <3 points = high risk (75%), do diagnostic testing like US of LE, 1-2 pts is mod risk, 1 pt is low risk |
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Term
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Definition
| if DVT is a possibility but there are 10 or more things in the differential more likely, use d-dimer to rule out, if neg ruled out, if pos US or CT scan |
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Term
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Definition
| venous doppler/US (looks at compressability/echoability of the lumen, there can be respiratory variation- if there's a clot, not compressible and won't see open lumen and will see decresed flow), then CT or MRI venogram |
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Term
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Definition
| some reduction in size over 3 months, complete resolution in 50% by 9 months, or can get bigger and cause PE or recanalize where blood flows thorugh a hole in middle or get post-thrombotic syndrome or venous gangrene |
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Term
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Definition
| bloodflow is so diminished that tissue starts to die and get necrotic tissue |
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Term
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Definition
| prevention, prophylax post-surgery or at risk patients |
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Term
| low risk vs high risk DVT treatment non-surgical |
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Definition
| 0- low risk, ambulation. 1-2- SCD, compression socks. 3-4- mod, sequential compression device and maybe low-dose heparin or Lovenox, >5- high risk, compression device + heparin + lovenox |
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Term
| post surgery DVT treatment |
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Definition
| very low risk- early and aggressive ambutation. low risk- mechanical prophylaxis, intermitten pneumatic contraption. mod riksk- mod dose low molecular weisght heparin, unfractionated heparin\, stockings, combinations |
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Term
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Definition
short-term: prevent extension of clot, getting bigger, and development of PE, not removing clot- body will take care of it
long-term: prevent recurrence |
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Term
| heparin-induced thrombocytopenia |
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Definition
| need to monitor pts on low-molecular weight heparin or unfractionated heparin for this. plts react w the heparin and are targeted for destruction -> become thrombocytopenic. check plts on day 3 and 7, if hasn't dropped by then will be okay |
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Term
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Definition
| Heparin (dec PE risk by 75%)starting bolus 80 units per kilo then 18 units per kilo per hr by IV infusion (adjust based on PTT) or Lovenox followed by oral warfarin or Coumadin (long term use reduces risk of recurrence) (initial dose 5-10 mg). start heparin and coumadin on same day, heparin takes 4-8 hrs to reach adequate dose, coumadin takes a few days |
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Term
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Definition
| indicated for ileofemoral or femoral popliteal DVTs but must be done within 1st 10 days, risk of PE and bleeding complications |
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Term
| IVC inferior vena cava filters |
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Definition
| indicated for recurrent DVT and PE in people who have been adequately anticoagulated or if there is a contraindication to anticoagulation, give to pts receiving chemotherapy then take out afterwards, not indicated as prophylaxis, can still get PEs. complications: hematoma, hypotension, tachycardia, PEs, DVTs |
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Term
| superficial thrombophlebitis |
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Definition
| common from prolonged IV use, IV goes subcu and get inflammatory response, tenderness,redness, maybe a palpable clot,. DVTs are rare in upper extremities. arterial thrombosis in upper extremity more common w central lines than venous thrombosis w IVs in place. treatment is get rid of offending agent- IV, line, warm compresses, elevation, NSAIDs, body will get rid of it |
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Term
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Definition
| genetic predisposition, usually a macro-circulatory dysfunction, increased venous pressure impairs blood return due to valve incompetence, obstruction, or dysfunctional muscle pump, when you controct your muscles in yoru extremities, pushes venous blood through venous system and have valves that stop backflow. if those valves don't close completely get pooling of venous blood-> edema, swelling. can also be micro-circulatory: collagen epithelial damage or pericapillary edema, swelling in the tissues pushes on the venous system causing dec venous return and pooling |
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Term
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Definition
| clinical signs, etiological classification, anatomical distribution, pathophysiological dysfunction. helps evaluate risk of DVT and testing to perform |
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Term
| varicose veins, are waht, pathophys, diagnosis, treatment |
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Definition
| valve dysfuction or separation causes backflow of blood, pooling, inc tissue fluids, edema, swelling, veins become distended and get more and more swollen. Signs/Symptoms: progressive dilation of veins, leg pain (heaviness or aching), leg swelling, darkening of skin from blood discoloring the tissues, , restless legs, burning, itching. diagnosis- done by physical exam. Treatments- only indicated in severe pain, cramps, heaviness, pigmentation, can develop ulcerations in skin due to poor venous return or treat for cosmetic reasons. Treatment options: compression stockings, sclerotherapy (vein stripping), ablation (rip out varicose veins)- injection or vein stripping, pts not at risk for developing any other complications, don't need to treat |
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Term
| normal lymphatic fluid movement vs lymphedema |
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Definition
| normally have a pressure gradient that allows tissue fluid to go into lymphatic or vascular system and be taken away. as tissue expands in swelling, this collapses the blood vessel capillaries to prevent further build up of fluid. swelling in turn opens up lymph vessels to allow greater fluid return. if something stops the lymph drainage or stops the vessels from being able to prevent further build up of fluid, get lymphedema |
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Term
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Definition
| can be congenital, can be due to parasite, surgery/lymph node excision with cancer (seen a lot in women w breast cancer who had axillary lymph nodes in armpit removed) , tumor invasion/tumor cells can block lymphatic drainage, infection, trauma, cardiac failure (heart not pumping hard enough to get good venous return), hepatic failure (lack of albumin, can't maintain pressure), renal failure, hyperthyroidism, antihypertensive drugs |
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Term
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Definition
| peau d'orange skin, painless leg swelling, |
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Term
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Definition
| elevation and compression, antibiotics if worreid about infection (prone to lymphangitis- treat w oral penicillins or first gen cephalosporins and compression devices), stretching, exercise can help, surgery is prone to failure and not usually recommended |
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