venous stasis (blood flow reduced-immobility, obesity, Hx of varicosities, spinal cord injury, age >65)
vessel wall damage (creates a site for clot formation-sugery, trauma, motion injury, local vein injury, central venous cather)
altered coagulation (pt who abruptly stops taking antcoagulants, oral contraceptives, polycythemia, PRO deficiency (C&S), septecemia, hyperhomocystemia, increased factes II, VII, IX, XI.
DVT=deep venous thrombosis is an obstruction of deep vein bc no venous blood flow;
DVT + PE make up the condition Venous Thromboembolis.
INR (2-3 is normal).
Antagonist for OD=Vit K.
→interactions with food high in K need to be taught
Assessment: pts at risk include
-elderly, obese, Hx of varicose veins, hypercoagulation, neoplastic disease, CV disease, recent major surgery or injury.
Key concern: limb pain, feeling of heaviness, functional impairment, ankle engorgement, and edeam; differences in leg circumfrance bilaterally from thigh to ankle; increase in the surface temperature of the leg, particularly the calf or ankle; areas of tenderness or superficial thombosis .
apt, INR, platlet count; aPTT , PT, ACT, hemoglobin, hematocrit values, fibrinogen level depending on which medication is being given.
Close monitoring for bleeding (principal complication of anticoag therapy is spontaneous bleed→nose bleeds, brusies, bleeding gums) may need to give antagonist.
Risk of protamine sulfate is bradycardia and hypoension. , if reported anticoagulant meds are discoutinued.
goal BMI 18.5 - 24.9kg/m2,
DASH diet (rich in fruit & veggies)
low fat, salt resriticion 2.4g/day (takes 2-3 mo to adjust to the reduction),
physical activity 30 min a day (10 minutes at a time 3x a day, brisk walk, swim, bike),
moderate alcohol intake (men 2 drinks, women 1 drink).
Goal is to control HTN, there is not always a cure unless we know the cause! The nurse can help te pt achieve BP control through education about managing BP
target organ damage, Angina, shortness of breath, altered speech, altered vision, nosebleeds, headaches, dizziness, balance problems, nocturia,
Cardiovascular assessment: apical and peripheral pulses
Forearm supported at heart level on firm surface, Both feet on ground,
No smoking for 30 minutes before ,
Sit quietly for 5 minutes before,
Watch for postural hypotension (supine to sitting with drop of 10 mm Hg),
Appropriate cuff size, If cuff size too large=BP inappropriately low,
If cuff size too small = BP falsely elevated, Center cuff bladder directly over brachial artery,
Take BP in both arms (< 5 mm Hg difference), Subsequent readings in higher arm, Assessment based on average of 2 readings