Deep vein thrombosis is a serious health condition often associated with fatal consequences. The patient presents with many risk factors that increase her chances of developing DVT. The patient has had a re-current DVT condition which could be an indicator that she has an inheriting blood clot disorder. This disorder makes the patient’s blood clot with ease. This inherited condition does not cause health complication, unless it is facilitated by other associated risk factors (Aubry, Etheridge, & Couturier, 2012).
Disease pathophysiology and treatment
DVT occurs when a thrombus (blood clot) forms in one of the patients deep veins in their body- normally in the legs. The disease pathophysiology indicates that the disease could be arising from a triad of possible alterations in the venous system. This includes the injury of the vessel wall, changes in blood flow patterns (venous status) and changes in blood constituency (hypercoagulability). These changes occur due to various factors such as pathologies, treatments and therapies. Blood vessel injury can occur due to trauma, invasive treatments of surgery (Aubry, Etheridge, & Couturier, 2012).
Venous stasis is mainly common in patients on prolonged bed rest which causes changes in blood circulation. Patient medication can alter the coagulation of the blood. The most causative agent for this patient is venous stasis and hypercoagulability. Venous stasis is suspected because the patient is old and presents with multiple comorbidities that make her remain at rest for a long time. Hypercoagulability is suspected because the patient is under many medications that could be interacting, affecting coaguability of blood. Additionally, the patient smokes and uses alcohol, additional factors associated with the alterations of her blood constituencies (Songwathana, Promlek & Naka, 2011).
Treatment of deep vein thrombosis aimed at preventing blood clotting from becoming bigger and also to ensure that the clot does not break loose causing further complications such as pulmonary embolism. After this, the next goal is to ensure that risk factors that could lead to re-current DVT are addressed. The main treatment includes blood thinners/ anticoagulant which help in decreasing the ability of the blood to clot (Dunphy et al., 2012).
The medication helps reduce risks of developing additional clots. In this case, the patient is given an infusion of heparin (appropriate doasage) for few days. Upon discharge, the patient is given warfarin. The patient is also given compression stockings which helps prevent edema associated with DVT. Other treatments such as use of filters and clot-busters will be considered if the aforementioned medication regimen fails to improve patient condition (Kibbe, Pearce, & Yao, 2010).
Patient’s rick factors
In this regard, the patient is at high risk of recurrent DVT because of the following risk factors. To start with, the patient has osteoporosis complication on her RT knee. This implies that her normal lifestyle comprises of prolonged rest. When patient legs remain still for a prolonged duration, the calf muscles fails to contract effectively to facilitate blood circulation, this increases the likely hood of re-current DVT (Songwathana, Promlek & Naka, 2010). The patient is smokes which increases her risk of DVT. Smoking by products affects the blood clotting and circulation, which further increases her risk for recurrent DVT. Cardiovascular disease complications increase the risk for DVT. This is attributable to the fact that she already has limited heart function, which exacerbates even with minor symptoms of DVT. The age also increases risk factors for DVT. The patient is 74 years (above 60 years) which increases risk for DVT (Kibbe, Pearce, & Yao, 2010).
The patient should be educated on common indicators of the onset of DVT. Generally, the patient experiences general body weakness. This symptom is nonspecific as many health conditions make the patient to be generally weak (Bagot & Tait, 2012). However, if the patient experiences oedema in the affected extremity and feels a bumpy knotty vein, she should seek medical attention immediately. The patient is likely to experience throbbing aching pain on the affected extremity especially during movement (Dunphy et al., 2012).
Nursing Care plans (Songwathana, Promlek & Naka, 2011);
a) Maintain tissue perfusion to manage the thrombus
b) Minimize patient paint to promote maximum patient comfort
c) Prevention of further complication
d) Providing patient education on the disease process and treatment regimen
Discharge the patient when:
a) Tissue perfusion improved in the limb affected
b) Pain and discomfort is resolved
c) Further complication is prevented
d) Disease prognosis and therapeutic needs is well understood
e) Care plan is put in place to meet further needs after discharge
|Discharge item||Procedure steps suggested||RN Initials once completed|
|Reconciliation of medication||RN discusses with the patient/caregiver the post discharge medication including the interaction and side effects. Patient understands the alternative medications and their consequences Patient/caregiver given list of post-discharge medication-pharmacists involved if necessary. Patient should call in for any new prescriptions Confirms medication are available in the pharmacy and covered by patients medical cover post discharge RN describes the benefits for medication adherence|
|Transition record||RN completes written transition/discharge summary Discharge plan reconciled with the transition record and care plan clinical guidelines|
|Patient instructions||Patient/caregiver provided with simple instructions for primary language of the patient and the care provider. The format is individualised in a manner that patient and caregiver understands, no use of clinical abbreviations Patient advised not to stop or introduce new treatment without talking to the physician Patient/care giver is educated on the vital signs and symptoms for recurrent DVT|
|Follow up||Patient appointment for follow-up care is done Patient provided with name, address, phone number of healthcare provider, date and time is indicated. Reason for the visit is written in a way that the patient and caregiver understands Patient/caregiver is encouraged to carry with them the medication list to healthcare provider involved in delivery of their care|
Patient counselling for DVT and anti-coagulant therapy
The healthcare provider should review the disease pathophysiology describing possible complications and their clinical manifestation. The patient is taught about the symptoms that they should do if they experience pain, swelling tenderness, redness or other discolouration of the affected leg, rapid pulse, shortness of breath, chest pains, coughing up of blood and raid pulse (Schulman, 2014). These adverse reactions should be checked when taking anticoagulants. The patient should contact her healthcare provider immediately (Davies, Lumsden, & Vykoukal, 2011). This increases the patient/care giver knowledge base from which they can make informed choices.
The patient should be advised to balance between activity and rest. Rest is important as it reduces oxygen demands and nutrients demands of the compromised tissues. The risks for fragmentation of thrombus are reduced significantly. Attaining the balance is important as it prevents further exhaustion. However, prolonged rest is dangerous too. The patient is referred to a physiotherapist to identify the most appropriate individualized activity program (Nyamekye & Merker, 2012).
The RN role is not only treating the disease, but to ensure that the patient obtains holistic healing. This implies that the RN should explore the predisposing factors that could be promoting re-current for DVT. The patient should be given more information on prescription assistance programs if RN identifies concerns of medication cost (Moneta, 2011). Additionally, the patient should be encouraged to stop smoking and should be enrolled in smoking cessation programs. The patient health status requires her to sit for a prolonged time. Therefore, RN should discuss with the patient on measures that can be used to promote blood flow in the extremities. This includes stretching or short walking distances after every three to four hours. The initiation of this new lifestyle will help change behaviors and will prevent DVT re-current (Dunphy et al., 2012).
The patient/care giver should be educated on the importance of adhering to anticoagulant medication to full treatment regimen. This helps in reducing risk factors for re-current DVT. The patient discussion is tailored to the mode of administration. This includes ensuring that the patient is comfortable with the parenteral agent. For oral anticoagulant that requires monitoring of INR, the patient or care giver must be educated on monitoring schedule and requirements. If on the course of the treatment the dosage regimen will change, the schedule is reviewed with the patient to ensure that they understand it (Huether & McCance, 2012). Understanding of these processes is important as it promotes cooperation of the prescribed therapy and reduces the chances of ineffective or improper use of therapeutic measures. This helps in promoting her safety by minimizing risks of deleterious side effects due to inadequate therapeutic responses (Dunphy et al., 2012).
Once the patient is discharged, they need to take steps that will help improve their quality of life. This includes activities such as checking regular medication and treatments. For instance, the patient under warfarin medications needs to have regular blood test to check blood clotting (Ghanny & Crowther, 2011). Their diets should be monitored because foods rich in vitamin K (green leafy vegetables, multivitamins, and bananas) interact with warfarin medication by increasing prothrombin activity. The blood thinners should be taken as directed. The patient should look out for excessive bleeding, normally a side effect for blood thinners medications. Patient safety must be maintained to avoid activities that will cause blood injuries. Other measures such as use of compression stockings should be used to minimize blood clots (Carlson & Pfadt, 2012).
ReferencesAubry,, F., Etheridge, F., & Couturier, Y.,(2012). Facilitating Change Among Nursing Assistants in Long Term Care. The Online Journal Of Issues In Nursing, 18(6)
Bagot, C., & Tait, C. (2012). Deep vein thrombosis: diagnosis, prevention and treatment. Prescriber, 23(6), 43-48.
Carlson, D., & Pfadt, E. (2012). Preventing deep vein thrombosis in perioperative patients. OR Nurse, 6(5), 14-20. http://dx.doi.org/10.1097/01.orn.0000418810.59376.38
Nyamekye, I., & Merker, L. (2012). Management of proximal deep vein thrombosis. Phlebology, 27(Supplement 2), 61-72.
Schulman, S. (2014). Distal deep vein thrombosis â€“ a benign disease?. Thrombosis Research, 134(1), 5-6.
Songwathana, P., Promlek, K., & Naka, K. (2010). Evaluation of clinical nursing practice guideline for preventing deep vein thrombosis in critically ill trauma patients. Australasian Emergency Nursing Journal, 13(4), 148. E., & Vorobyeva, N. (2013). P-016 Hereditary factors of the risk of deep venous [deep vein] thrombosis. Thrombosis Research, 131, S80.