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DVT PE 0109 - PulmonaryEmbolism KarenL.OBrien MSN,RN FALL10...

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Deep Vein Thrombosis and  Pulmonary Embolism  Karen L. O’Brien MSN, RN FALL 10
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Problems of Oxygenation Ventilation-pulmonary Transport-hematologic Perfusion -cardiovascular, vascular
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Deep Vein Thrombosis (DVT) Results from THROMOPHELBITIS of  larger deeper vein 5% of all surgical patients will develop  this complication Can result in embolization from the  deep vein to the lungs
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Etiology: Virchow’s Triad Venous Stasis Damage of endothelium Hypercoagulability of blood
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Etiology: Three Factors Venous Stasis Dysfunction valves Inactive muscles Endothelial damage Trauma, external pressure Local decrease in fibrinolytic properties Antibiotics, K+, chemo, contrast media IV catheters, bone fracture, DM, burns Hypercoagulability Hematologic disorders: polycythemia, malignancies,  anemias, systemic infections (endotoxins) Smoking, BCP: smoking + BCP =  HIGH RISK
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Risk Factors Abd/pelvic surgery Advanced aged Antithrombin II deficiency A-Fib Cerebrovascular disease Smoking CHF Drug abuse Estrogen TX, BCP Excessive Vit E HX thrombophlebitis Prostatectomy Anemia Dehydration IV therapy MI Neoplasms Obesity Post-partum Pregnancy Prolonged immobility Sepsis Trauma Venous catheters
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Pathophysiology RBC, WBC, platelets, fibrin stick together =  THROMBUS Enlarges, develops “tail” Occludes lumen of vessel (partial or  complete) Can be covered in endothelial cells and  lyszed  (which is good)   OR Detach and result in  EMBOLI   (which is bad) From venous circulation to heart, lodges in  pulmonary circulation
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http://www.nlm.nih.gov/medlineplus/ency/imagepages/8984.htm
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Manifestations Asymptomatic  OR Unilateral edema Pain Warm skin Temp > 100.4 F Calf tenderness SVC: upper extremity, neck, face and back edema vs  IVC: lower extremity edema Cyanosis Homan’s Sign:Pain in calf w/ dorsiflexion-  not reliable  indicator 
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http://www.nlm.nih.gov/medlineplus/ency/imagepages/2549.htm
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