NCM 103

VENOUS DISORDERS

By Chimmy Dora
& the Temple of Kyeme
 VENOUS DISORDERS
Venous disorders cause reduction in
venous blood flow, causing blood stasis.

May also cause:

Coagulation defects
Edema formation
Tissue breakdown
Increased susceptibility to infection
 Deep Vein Thrombosis (DVT)
Deep vein
thrombosis
(DVT), is the
formation of
a blood
clot (thrombus)
within a deep vein,
most commonly
the legs.
 Clinical Manifestations:
Nonspecific signs may
include pain
Swelling because the
outflow of venous blood is
inhibited
Redness
Warmness of the affected
extremity
Engorged superficial veins.
 Is DVT life threatening?
Nakakamatay ba itechiwa?
NO!!!
Pulmonary embolism, is the potentially life-
threatening complication. Caused by the
detachment (embolization) of a clot that
travels to the lungs. Together, DVT and
pulmonary embolism constitute a single
disease process known as VENOUS
THROMBOEMBOLISM.

VTE ang PETMALU, hindi ang DVT. Ganoin!

Venous Thromboembolism
DVT and PE make up this condition
The incidence of VTE is 10-20% in general
medical patients and up to 80% in
critically ill patients.
Studies says that 5-10% ofd all in-hospital
deaths are result of PE.
PATHOPHYSIOLOGY:
Virchow's triad:
Changes to the blood vessel wall
Increased tendency to clot
(hypercoagulability)
A decreased blood flow rate (venous
stasis)
Complications:
Chronic venous occlussion
Pulmonary emboli from dislodged thrombi
Valvular destruction:
o Chronic venous insufficiency
o Increased venous pressure
o Varicosities
o Venous ulcers
Venous obstruction:
o Increased distal pressure
o Fluid stasis
o Edema
o Venous gangrene
Clinical Manifestations of VTE:
The signs and symptoms are nonspecific
Exception is Phlegmasia Cerulea Dolens
(massive iliofemoral venous thrombosis),
in which the entire extremity becomes
massively swollen, tense, painful, and cool
to the touch
Venous gangrene (40-60% of cases)
poor prognosis for survival
(Bed rest reduces blood flow in the legs by
at least 50%)
 Venous Gangrene

Phlegmasia Cerulea
Dolens
ASSESSMENT & DIAGNOSTIC FINDINGS
Patients with history of varicose veins,
hypercoagulation, neoplastic disease,
cardiovascular disease, or recent major
surgery/injury are at high risk.
Othe patient at high risk are older, adults, obese,
and women taking contraceptives.
Limb pain, feeling of heaviness, functional
impairment, edema, and ankle engorgement.
The amount of swelling by measuring via tape
measure.
DVT can also be diagnosed with the use
of imaging devices such as ultrasound.
Prevention:
Patient with a history of VTE are at risk for new
episodes.
Depending upon the risk for DVT, different preventive
measures are recommended. Walking and calf
exercises reduce venous stasis because leg muscle
contractions compress the veins and pump blood up
towards the heart.
High risk patients should be identified to provide
preventive measures.
Stockings.
Low-molecular-weight heparin (LMWH) a class
of anticoagulant medications. For of prevention
blood clots (also treatment).
EG: Dalteparin and Enoxaparin
Lifestyle changes: smoking cessation, weight loss, and
regular exercise.
Medications:
Unfractionated heparin (UFH), is medication
which is used as an anticoagulant (blood
thinner). Specifically it is used to treat and
prevent deep vein thrombosis, pulmonary embolism,
and arterial thromboembolism. It is also used in the
treatment of heart attacks and unstable angina. It is
given by injection into a vein.
Low-molecular-weight heparin (LMWH) a class
of anticoagulant medications. For of prevention blood
clots (also treatment).
EG: Dalteparin and Enoxaparin
Factor Xa (FXa) is given daily subcutaneously at a
fixed dose, has a half-life of 17 hoursand is exreted
unchanged via the kidneys.
Thrombolytic therapy is the use of drugs to break
up or dissolve blood clots 50%. It can be catheter-
directed.
Nursing Management:

If patient is receiving anticoagulant theraphy,

the nurse must frequently monitor the aPTT,
prothrombyn time, INR, ACT, hemoglobin
and hematocrit values, platelet, and
fibrinogen level.
Close observation is also required for
bleeding.
*If bleeding occurs, it must be reported
immediately and anticoagulant therapy discontinued*
Monitoring and Managing Potential
Complications:
Bleeding
Thrombocytopenia
Drug interactions
PROVIDING COMFORT
Compression theraphy
Gerontologic Considerations
Positioning the body
Encouraging exercise
Promoting community and home-based
care
NEXT TOPIC BES
 Varicose Veins
Aka Varicosities
Abnormally dilated, torturous, superficial
veins caused by incompetent venous valves.
 Most commonly occurs in the lower
extremeties, saphenous veins, or the lower
trunk, but can occur elsewhere in the body.
Occurs in 16-40% in women, 12-40% in
men, and increased incidence correlating
with aging.
Most commonly in people whose job
requires a lot of standing.
Hereditary weakness of veins can be a
factor.
Pregnancy due to hormonal effects as well.
Clinical Manifestations:
Aching, heavy legs (often worse at night and after exercise).
Appearance of spider veins (telangiectasia) in the affected leg.
Ankle swelling, especially in the evening.
A brownish-yellow shiny skin discoloration near the affected
veins.
Redness, dryness, and itchiness of areas of skin, termed stasis
dermatitis or venous eczema, because of waste products
building up in the leg.
Cramps may develop especially when making a sudden move
as standing up.
Minor injuries to the area may bleed more than normal or
take a long time to heal.
Restless legs syndrome appears to be a common overlapping
clinical syndrome in patients with varicose veins and
other chronic venous insufficiency.
Assessment and Diagnostic Findings:
Duplex ultrasound scan documents the
anatomic site of reflux and provides a
quantitative measure of the severity.
Venography involves injecting a
radiopaque contrast agents into the vein
so it can be visualized through Xray. Not
routinely performed though.
Prevention:
Avoid activites that may cause venous stasis.
Wear tight socks that leaves mark on the skin.
Crossing the legs and changing positions.
Standing and sitting for long periods.
Elevating the legs higher than the heart level
when tired.
Using of stairs instead of elevators.
Swimming.
Weight reduction for over-weight people.
Stockings.
Medical Management:
Ligation and Stripping - Ligation means the
surgical tying of veins through a small incision in the
skin to prevent pooling of blood. Ligation may be
used in conjunction with vein stripping, or removal
of the vein. In many instances, the vein is removed
using a minimally invasive surgical procedure
called venous ablation.
Thermal Ablation - also called laser therapy, is a
newer technique that uses a laser or high-frequency
radio waves to create intense local heat in the
varicose vein or incompetent vein.
Sclerotherapy - Sclerotherapy is a procedure
used to treat blood vessels or blood vessel
malformations and also those of the lymphatic
system. A medicine is injected into the vessels,
which makes them shrink.
Nursing Management
For ligation and stripping, it can be done in an
outpatient setting, or in the hospital. Nursing
measures are the same.
Bed rest is discouraged. Encouraged to walk
every hour for 5-10 minutes for the first 24
hours if he/she can.
Stocking are worn for 1 week.
We, nurses assist patients with leg exercises.
Foot of the bed should be elevated.
Standing and sitting is discouraged.
Promoting Comfort and Understanding:
Analgesics helps the patient move affected
extremities comfortably (also for
sclerotheraphy).
Dressings are inspected for bleeding regularly.
Sensation of Pins & Needles must alert the
nurse.
Hypersensitivity to touch may indicate nerve
injury during surgery because saphenous
veins and nerves are close.
Avoid lotion temporarily.
Apply sunscreen or zinc oxide to the
incisional area.
THE END
Special thanks to:

Mang
Maning
Ice
Cream