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Varicose Veins and DVTs template



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QuestionsAnswers
Description of Varicose VeinVeins in which valves become incompetent and allow blood flow in the reverse direction resulting in dilated, tortuous, elongated veins
Assessment Findings of Varicose VeinsLeg aching/burning/cramping Fatigue Orthostatic edema Visibly dilated and tortuous veins in lower extremities Symptoms may be worse during menses
Nonpharmacologic Management of Varicose VeinsSupport Hose Avoid long periods of standing in one place Surgical ligation and stripping Endovenous saphenous vein obliteration Weight loss if obese Pt education
Follow-Up for DVTsUsually on oral anticoagulation therapy for 3-12 months depending on etiology
Description of Deep Vein ThrombosisThe presence of a blood clot in the venous system of the extremities or the pelvis which may migrate to the lungs
Etiologies of DVTsHypercoagulable: Oral contraceptives, Blood dyscrasias, Malignant tumors, Pregnancy Stasis: Postoperative period, Postpartum, Pregnancy Trauma: Injury to the epithelium of the vein, Hypercoagulability, Stasis Septic: Especially from the placement of an indwelling catheter in a vein
Risk Factors for DVTsImmobility Malignancy Trauma, especially crush injuries Obesity Pregnancy with hypertension, eclampsia, Increasing Age, Oral Contraceptive use, Smoking, Postoperative status Placement of an indwelling catheter
Assessment Findings with DVTsAsymptomatic; especially initially Pain, warmth, erythema, tenderness, swelling of effected extremity Selling without tenderness of the extremity Palpable cord over the involved vein Positive Homan sign (Calf pain with dorsiflexion of the foot); low sensitivity and specificity
Diagnostic Studies is DVTsD-dimer: If negative, DVT, PE highly unlikely US: inability to compress affected venous segment is diagnostic of thrombus Contrast venography CBC: Elevated white count in sepsis
Nonpharmacologic Management of DVTsHospitalization required for acute DVT for anticoagulation therapy until pt transitioned to Coumadin Pt education
Pharmacologic Management of DVTsHeparin, unfractionated heparin, or low molecular weight heparin Antibiotics if sepsis suspected
Pregnancy Considerations in DVTsWarfarin and NSAIDs are contraindicated Heparin is a large molecule and does not cross placenta



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