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THROMBOPHLEBITIS: DEEP VEIN THROMBOSIS (INCLUDING PULMONARY EMBOLI CONSIDERATIONS) Thrombophlebitis is a condition in which a clot forms in a vein, associated with inflammation/trauma of the vein wall or a partial obstruction of the vein. Clot formation is related to (1) stasis of blood flow, (2) abnormalities in the vessel walls, and (3) alterations in the clotting mechanism (Virchow’s triad). Young women and the elderly are at greatest risk. Thrombophlebitis can affect superficial or deep veins. Although both conditions can cause symptoms, deep vein thrombosis (DVT) is more serious in terms of potential complications, including pulmonary embolism, postphlebotic syndrome, chronic venous insufficiency, and vein valve destruction. Note: Approximately 50% of patients with DVT are asymptomatic. CARE SETTING Primarily treated at the community level, with short inpatient stay generally indicated in the presence of embolization. RELATED CONCERNS Surgical intervention Ventilatory assistance (mechanical) Fractures Psychosocial aspects of care Patient Assessment Database ACTIVITY/REST May report: Occupation that requires sitting or standing for long periods of time Prolonged immobility (e.g., fractured hip/orthopedic trauma, long hospitalization/bedrest, prolonged sitting or travel without adequate exercise, complicated pregnancy); spinal cord injury/paralysis; progressive debilitating condition Pain with activity/prolonged standing Fatigue/weakness of affected extremity, general malaise May exhibit: Generalized or extremity weakness CIRCULATION May report: History of previous peripheral vascular disease, venous thrombosis, varicose veins Presence of other predisposing factors, e.g., hypertension (pregnancy-induced), diabetes mellitus, MI/valvular heart disease, thrombotic cerebrovascular accident, blood dyscrasias May exhibit: Tachycardia Peripheral pulse may be diminished in the affected extremity (DVT) Varicosities and/or hardened, bumpy/knotty vein (thrombus) Skin color/temperature in affected extremity (calf/thigh): pale, cool, edematous (DVT); pinkish red, warm along the course of the vein (superficial) Positive Homans’ sign (absence does not rule out DVT, because only about 33% of patients have a positive sign) FOOD/FLUID May exhibit: Poor skin turgor, dry mucous membranes (dehydration predisposes to hypercoagulability) Obesity (predisposes to stasis and pelvic vein pressure) Edema of affected extremity (present with thrombus in small veins or major venous trunks) PAIN/DISCOMFORT May report: Throbbing, tenderness, aching pain aggravated by standing or movement of affected extremity, groin tenderness May exhibit: Guarding of affected extremity SAFETY May report: History of direct or indirect injury to extremity or vein (e.g., major trauma/fractures,
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orthopedic/pelvic surgery, prolonged labor with fetal head pressure on pelvic veins, venous cannulation or catheterization/intravenous therapy)
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