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What is a DVT?
blood clot in vein (usually lower extremity)
What are the risk factors for a patient developing a DVT –
surgery pts (fx, replacement, immobile pts, obese, blood clotting disorder, injury to your veins, pregnancy, smoking, birth control pills, heart failure
What are the signs and symptoms of a DVT (think STRAW!!!)
- Anti-coagulant therapy
Why would you see the DVT pt 1st?
Blood clot can travel to the lungs and turn into pulmonary edema
What is the 1st nursing action for the patient with a DVT?
Bedrest/immoblize – to stop the DVT from traveling
How is a DVT diagnosed?
What a Doppler ultrasound
What is the treatment of DVT?
IV Heparin then coumadin (monitor PTT and PT/INR)
What are the discharge instructions for patient with a DVT?
- Childbearing women should never use estrogen
- Do not cross your legs
- 3 times a day elevate ankles above the heart to promote venous return to the heart
- Stand and sit 2 hours at a time
- Airplane rides only a couple of hours at a time if longer pt should use Lovenox
What is a Fat Embolism?
Occlusion of pulmonary artery, usually the long bone as well as crushed bone injury like a pelvic fracture (note: pelvic fracture patients are also at risk for hemorrhaging); could also occur with significant burns/liposuction
What are the signs and symptoms of a Fat Embolism?
- Pulse Ox < 90%
- CLASSIC HALLMARK SYMPTOM VEST PETECHIAE (petechiae will appear anywhere the vest touches the body)
What is the first nursing action for a patient with a Fat Embolism?
Oxygen followed by positioning the patient in the high fowler’s position
How is a Fat Embolism Diagnosed?
Chest X-ray, ABG’s, VQ Scan
What is the treatment for Fat Embolism?
Steroids and patient will be intubated
Why would you se this patient 1st?
Patient is not getting any blood to the left side of the heart – this condition is deadly!!!
What is compartment syndrome?
It is an arterial issue where the patient’s circulation is compromise (involves increased pressure in the muscles)
What are the risk factors for compartment syndrome?
Patients with a cast, crush injuries, and penetrating injuries
What are the signs of symptoms of compartment syndrome?
The 5 P’s – paresthesia, pain, pallor, paralysis and pulseness + the 2 C’s – color and coolness
What is the first nursing intervention for compartment syndrome?
Call the doctor unless the patient is in traction, in this case the nurse should remove the weights/release the traction
Why would you see the patient with suspected compartment syndrome first?
Because this if the pressure is not relieved the patient could loss their limb
What is frostbite?
When the skin is exposed to very extreme cold temperatures (arterial issue)
What are the signs and symptoms of frostbite?
- Skin is cool, pale, and hard (mild to moderate)
- Initially parathesia, numbness and tingling
What body parts are at risk?
What type of people/patients are at risk for frostbite?
- Patients with Peripheral Vascular Disease
- Patients on Beta Blockers
Why would you see the patient with an arterial issue first?
Because the patient could lose their limb
What complications can develop with frostbite?
- Patient could lose a limb
What is the treatment for frostbite?
- Remove patient from the cold elements
- Remove jewelry and wet clothes
- Warm patient’s extremity (medicate the patient first!!!)
- Re-warm body part in tepid water (lukewarm water) over 20-30 minutes
- Patient should feel burning and throbbing
- Skin color will turn from white to red
- Note: It is not a good sign if the patient does not feel anything!!!
How do you prevent frostbite?
- 2 pair of socks cotton first then wool on top
- Mittens are better than gloves (mittens keep fingers together and warmer)
- No drinking alcohol (it thins the blood out)
- Never attempt to warm a patient if it’s any chance that the patient is going back out into the cold!!!
- Note: If a patient is already frostbitten, more cold over re-warmed skin causes vasodilation
What is a TIA (Transient Ischemic Attack)?
- The narrowing of a cerebral artery (still a blockage).
- A precursor to a stroke usually within 30 days a stroke will occur if left untreated!
What are the signs and symptoms of a TIA (in behavioral terms)?
Agitation, restlessness, anxiety, crankiness, confusions due to decreased blood oxygen flow to the brain
What are the signs and symptoms of a TIA?
- Blurred vision
- Transient Hemiparesis
- Difficulty articulating (Dysarthria)
How long do signs and symptoms of a TIA last?
Less than 24 hours sometimes less than 2 – 3 hours
What are the risk factors or causes of TIA?
- Uncontrolled HTN
- Sedentary lifestyle
- Birth control
- Cardiovascular Disease
What is the first nursing action for a patient experiencing a TIA
- Oxygen (because brain cells are dying from lack of oxygen)
- Second a CAT Scan will be done (you need to know what your are working with in this case Ischemic CVA)???
The medications used to treat TIA are
- Antiplatelets, Anti-coagulants
- Heparin (in the hospital)
What are you going to teach the patient with a TIA?
- Stop smoking
- BMI should be less than 30
- Exercise everyday at least 30 minutes
- DASH Diet - (high fruits, veggies, fiber, and Ca; low fat, sodium)
- Oils good to use when cooking are Canola and Olive Oils
- CAD Diet – low cholesterol (total fat less than 30% and saturated less than 7%)