Prevention of Deep Vein Thrombosis Free-Samples for Students

Question: Discuss about the Post-Operative Deep Vein Thrombosis. Answer: Post-operative deep vein thrombosis. Deep vein thrombosis is a condition in which there is formation of a clot in the deep venous of the leg occluding normal blood flow. It is manifested by leg pain, edema, erythema and tenderness(Blann, (2015)). In most cases it occurs as a complication following surgery which involved decreased mobility or prolonged bed rest with reduced ambulation (post-op deep venous thrombosis)(Blann, (2015)). Pathophysiology of DVT. Muscle movement usually increases the rate of backflow of blood from the lower parts of the feet to the inferior vena cava. However during decreased or be in immobile state the blood tend to flow backward slowly creating stasis(Cassidy, (2014).). This blood therefore forms a clot due to the accumulation of the clotting factors within the same point causing occlusion of blood flow. It therefore causes formation of thrombi which can easily dislodge and becoming emboli which can lodge in small vessels like the pulmonary and coronary arteries. Relevant history for deep venous thrombosis. Previous knee surgery which poses a greater risk for formation of blood clots that may clog the veins. A history hyperlipidemia. High cholesterol levels in the blood plasma increases blood viscosity reducing the speed of blood flow(Blann, (2015)). As a result blood clots tend to form on the walls of the blood vessels. History of hospitalization decrease ambulation hence causing decreased exercise on the calf muscle lowering rate of backflow of blood. Stress as a result of feeling of overdependence on their to perform daily leaving Risk factors to DVT occurrences. Age-people above 60 years are susceptible to developing DVT due to reduce muscle tone and decreased activity hence reducing the rate of blood flow causing stasis(Blann, (2015)). Prolonged bed rest-the lower limbs remain still for some time restricting calf muscles contraction to facilitate blood flow exacerbating risk for clot formation. Heart failure-people with this condition have limited heart and lung function. The hearth inability to pump blood cause a lot of blood accumulation especially in the lower extremities forming clots(Sun, (2014). Surgery-injury to the veins may increase chances of a thrombi being formed due to high delivery of the clotting factors to the site of injury. Sitting for long period of time-this reduces the calf muscle motility lowering blood flow rate. Musculoskeletal system. Health history. Present history of knee replacement surgery. History of decreased activities of the daily living due to chronic pain while undergoing activities. Past history of osteoarthritis affecting the knee joint. General appearance. The lower extremities of the patient cannot withstand the weight of the body for a long period due to increased pain in the knees. He is anxious of overdependence on others and anticipation of other possible complications. Physical examination. Gait and mobility-he has malalignment of the lower limbs, pain and fatigue when walking or standing, limited mobility due to stiffness of the knee joint and muscle weakness. Posture-the client is leaning on his right side following the knee surgery. Joint function-he has limited range of motion evidenced by pain in attempt to move the knee joint. Skin-has no signs of edema. Cardiovascular system. Health history. History of angina, hypertension and hyperlipidemia. History of pain joint. History of decreased level of activities. The patient easily fatigued when performing tasks of daily living. General appearance. The client is alert and oriented to place, person and time. Physical examination. Inspection-the client has facial grimace, no cyanosis, no pallor, no jaundice. Palpation-there is increased radial pulse rate, edema on the extremities, increased venous pressure. Auscultation-there is presences of heart murmurs and galloping sounds, apical pulse is fast and pounding(Schoenfeld, 2013). Risk assessment. The client is at risk of developing heart failure. This is attributed by the possibility of the dislodgement of a thrombi that might lodge in the coronary artery decreased heart muscle perfusion leading to myocardial ischemia(Schoenfeld, 2013). Hypertension also, can cause heart failure as well as narrowed blood vessels due to cholesterol deposition. This makes the heart to work with a lot of effort to overcome resistance(Moghadamyeghaneh, . (2014). ). Risk for pulmonary embolism caused by the deposition of an emboli within the narrowed blood vessels. Strategies to meet clients need. Pain management. The nurse should assess and rate the pain using the pain rating scale. This helps on determining the type of analgesia to be used. Administer weak opioids such as codeine to cater for both the angina and the knee joint pain(Sun, (2014). This is done while addressing the underlying cause to improve the clients comfort. Coping mechanism; to enable the patient to have the optimum functionality as much as possible. This done through education of the client on the mechanisms of performing activities with minimum energy input for example alternating between standing and sitting(Schoenfeld, 2013). Prevention of DVT. The client has a higher risk of developing DVT and therefore is supposed to be under close monitoring. Use of serial duplex ultrasound scans which can identify smallest forming clots. Constantly also the client should be on medications(Cassidy, (2014).); blood thinners to dissolve any clot that is present from getting bigger, or prevent the formation of a clot. In addition use pneumatic intermittent compression stockings due to decreased mobility(Domeij-Arverud, (2015). According to (Moghadamyeghaneh, . (2014). ) Use of anticoagulants before surgery and after surgery has proved to be effective method of preventing DVT. However some researchers claim that the use of anticoagulants prior to surgery may pose greater risk to postoperative bleeding hence not advisable unless the client has a history of blood clot(Cassidy, (2014).). Use of anticoagulants should be used after surgery in cases where the clients rate of mobility is reduced especially in old age where the client has to be in bed rest for long. Also, following hip or knee replacement(Moghadamyeghaneh, . (2014). ). The client is old and has knee surgery hence there great immobility. Therefore use of blood thinners can help to greater extent in preventing DVT to this client. In North American in the year 1980s use of Doppler ultrasonography scanning became the principle diagnostic tool and use of anticoagulants for management as well as prevention(Moghadamyeghaneh, . (2014). ). Evaluation. Doctors should monitor the client and prescribe the age appropriate medications and make referrals when possible. Nurses on the other should take part in assessing the client, monitoring the progress, advocate for the patient, administer prescribe medication and report any complication, health education to the patient drug compliance and prepare for the follow up. The nurse should ensure that the physiotherapist attend to the client to meet ambulation needs. Also the nurse should check with the doctor to ensure the client is given an appointment date for follow up. Strategies Evaluate pain through direct interaction with the patient. Also act the patient on the ability to undertake the current activities with minimum distress(Cassidy, (2014).). Use the ultrasound scan to check the clot formation constantly to identify if the current medication is meeting the intended need of prevention of thrombi formation. References (Blann, (. B. (2013). Deep vein thrombosis: A multispecialty approach. x. New Delhi: Elsevier. (Cassidy, (. A. (. (2014). ). Graduated compression stockings for prevention of deep vein thrombosis.. The Cochrane Library. (Moghadamyeghaneh, .. (. (2014).). Heparin?based treatment to prevent symptomatic deep venous thrombosis, pulmonary embolism or death in general medical inpatients is not supported by best evidence. Blann, A. .. ((2015)). Deep Vein Thrombosis and Pulmonary Embolism: A Guide for Practitioners. London: M K Update Ltd. Cassidy, M. R. ((2014).). Reducing postoperative venous thromboembolism complications with a standardized risk-stratified prophylaxis protocol and mobilization program . . Journal of the American College of Surgeons, 1095-1104. Domeij-Arverud, E. L. ((2015). ). Intermittent pneumatic compression reduces the risk of deep vein thrombosis during post-operative lower limb immobilisation. . Bone Joint J, 675-680. Moghadamyeghaneh, Z. H. (. (2014). ). A nationwide analysis of postoperative deep vein thrombosis and pulmonary embolism in colon and rectal surgery. journal of Gastrointestinal Surgery, 1994- 2169. Schoenfeld, A. J. (2013). Patient-based and surgical characteristics associated with the acute development of deep venous thrombosis and pulmonary embolism after spine surger. 1892-1898. Sun, Y. C. ( (2014). ). Deep venous thrombosis after knee arthroscopy: a systematic review and meta-analysis. Arthroscopy: . 406-412, 406-412.