4 resumes daily activities free of pain i deep vein

4. Resumes daily activities; free of pain .
I. DEEP VEIN THROMBOSIS (THROMBOPHLEBITIS ): formation of a blood clot in an inflamed vein, secondary to phlebitis or
partial obstruction; may lead to venous insufficiency and pulmonary embolism . Deep vein thrombosis (DVT ) is most serious form.
A. Pathophysiology: endothelial inflammation → formation of platelet plug (blood clot) → slowing of blood flow → increase in
procoagulants in local area → initiation of clotting mechanisms.
B. Risk factors:
1. Immobility/stasis—prolonged sitting, bedrest, obesity , pregnancy.
2. Venous disease; history DVT .
3. Age—increased incidence in elderly.
4. Gender—more often women.
5. Hypercoagulability of blood .
6. Intimal damage—IVs, drug abuse .
7. Fractures .
8. Oral contraceptives (related to estrogen content).
A. Assessment:
1. Subjective data:
a. Calf stiffness, soreness.
b. Severe pain : walking, dorsiflexion of foot ( Homans’ sign —may be unreliable).
1. Objective data:
a. Vein: redness, heat, hardness, threadiness.
b. Limb: swollen, pale, cold.
c. Vital signs: low-grade fever .
d. Diagnostic tests: venogram, impedance plethysmography (electrical resistance to blood flow), ultrasonography.
A. Analysis/nursing diagnosis:
1. Altered peripheral tissue perfusion related to venous stasis.
2. Pain related to inflammation .
3. Activity intolerance related to leg pain .

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4. Risk for injury related to potential pulmonary emboli.
A. Nursing care plan/implementation:
1. Goal: provide rest, comfort, and relief from pain .
a. Bedrest until therapeutic level of heparin reached (5 to 7 days with traditional heparin ; after 24 hours with low-
molecular-weight heparin ).
b. Position: as ordered; usually extremity elevated; watch for pressure points.
c. Apply warm, moist heat to affected area as prescribed (cold may also be ordered).
d. Assess progress of affected area: swelling, pain , soreness, temperature , color.
e. Administer analgesics as ordered.
1. Goal: prevent complications.
a. Observe for signs of embolism (pain at site of embolism ); allergic reaction (anaphylactic shock ) with streptokinase.
b. Precautions: no rubbing or massage of limb.
c. Medications: anticoagulants (sodium heparin , enoxaparin, warfarin [Coumadin]); streptokinase (Varidase), tissue
plasminogen activator ( Table 6.23 ).
d. Bleeding: hematuria , epistaxis , ecchymosis . Check INR levels.
e. Skin care, to relieve increased redness/ maceration from hot or cold applications.
f. ROM: unaffected limb.
1. Goal: health teaching.
a. Precautions: tight garters, girdles; sitting with legs crossed; oral contraceptives.
b. Preventive measures: walking daily, swimming several times weekly if possible, wading, rest periods with legs elevated,
elastic stockings (may remove at bedtime).