NURS 620 Adult Health Exams Prep |
Comprehensive Study Materials
Risk factors for DVT - ANS •Genetic clotting disorders
•Immobility, prolonged bedrest, inactivity
•Paralysis
•Injury/trauma
•Surgery/dehydration
•Oral contraceptives/hormonal replacement therapy
•Overweight and obesity states
•Tobacco use
•Cancer/malignancy
•Prolonged sitting
•Family hx of DVT or PE
•Age of 60+
•Heart failure/CV conditions
•Bowel diseases that have an inflammatory etiology
•Pregnancy/postpartum
•Varicose veins
Symptoms of DVT - ANS •Sometimes asymptomatic
•Swelling in affected extremity-usually unilateral
•Pain in the calf
•Leg cramps/tenderness/soreness
•Erythema
•Pallor
•Cyanosis
,Physical assessment for DVT - ANS •Vascular assessment- palpation of peripheral pulses
• Evaluation of capillary refill
•Neurological exam-motor, sensory, reflex deficits may occur
•Homan's sign-pain in the posterior calf or knee with forced dorsiflexion of foot
What happens after DVT sometimes? - ANS PE
•DVT- occurs deep in veins
•Phlebitis -occurs in superficial veins
•33% to 40% of individuals with Dx of DVT
develop a subsequent Pulmonary
Emboli (PE)
•15 percent mortality rate
PE symptoms/signs - ANS •SOB/DOE
•HTN
•Tachypnea\tachycardia
•Diaphoresis
•Hemoptysis
•Low grade fever
•Chest pain
•Cough
Diagnosis of DVT - ANS •Wells score
•Compression USG
• Venography- reference gold standard for dx
,•MRI
•D-Dimer measurements-d dimer is a fragmented protein that has a negative predictive value (i.e.
results of D-Dimer negative= unlikely VTE- Different for geriatric patients
New anticoag agents - ANS •Savayse *edoxaban (approved ) Jan, 2015
•Xarelto- no monitoring (linked to internal bleeding events recently)
•Pradaxa-blocks thrombin
•Eliquis- used mostly for stroke prevention
Patient education for DVT - ANS •Avoid prolonged immobility
•Avoid as possible estrogen therapy in women
•Early ambulation-post surgical
•Hydration
•Compression stockings
, •Take meds as directed
•Avoid tight fitting clothing-hose, stockings
•Low K diet in pts with Warfarin therapy
Make sure your teaching about medications- especially anticoagulants.
Symptoms to explore for respiratory - ANS •Cough
•Dyspnea
-On exertion
-At rest
-Constant or intermittent
•Associated symptoms
•Chest pain/pleuritic pain
•Fever, chills
•Sputum production
-Color
-Quality
-Consistency
•PND
•Wheezing
•Night sweats
•Hemoptysis
HPI habit questions for respiratory - ANS •Tobacco use- vaping?
-Pack years
•Exposure to allergens
•Travel
•Medications- ace inhibitors
-Prescription
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