Deep Vein Thrombosis Josh Vrona, Hunter Dolan, Erin McCann.
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Transcript of Deep Vein Thrombosis Josh Vrona, Hunter Dolan, Erin McCann.
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Deep Vein ThrombosisJosh Vrona, Hunter Dolan, Erin McCann
Signs and Symptoms of a DVT
50% of patients do not have symptoms
Swelling in leg; red, discolored, or white skin; tachycardia, fever, warm skin over affected area; aching, tiredness, tenderness, and leg pain.
Defining the Problem
DVTs are caused by damage to the inner lining in the vein Examples: surgery, serious injuries, inflammatory responses
Blood Flow becomes slower and sluggish due to a decrease in motion, which causes the blood to be thicker than normal and therefore, more likely to clot.
Contributing factors: genetics, prolonged bed rest, injury, surgery, pregnancy, birth control pills, HRT, obesity, smoking, cancer, heart failure, age (>60), inflammatory bowel disease
Defining the Problem
Complications: Pulmonary Embolism, Postphlebitic syndrome
Scope of problem: According to the CDC it is thought that as many as 900,000 people could be affected each year. 60-100,000 Americans die of DVT/PE Among people who have had a DVT, 50% will have
complications Surveillance studies have found that the absolute risk of DVT is
10-20% among general medical patients, and up to 40-60% in patients having hip surgery, knee surgery, or major trauma.
Implications for Patient
At an increase risk for developing another blood clot
Need to be aware of new leg pain, swelling, or redness
Increased risk for bleeding d/t anticoagulant use
Need to wear an alert bracelet that says they are on anticoagulants
Aim to reduce their risk of bleeding
Implications for Institution
“In 2001, the Agency for healthcare research and quality began a campaign to combat med error in order to improve patient safety. The use of appropriate VTE prophylaxis was included in this.”
“The National Voluntary Consensus Standards for Prevention and Care of Venous Thromboembolism is a policy created by the National Quality Forum that states “Every healthcare organization shall have a written policy appropriate for its scope that is evidenced based and that drives continuous quality improvement related to venous thromboembolism risk assessment, prophylaxis, diagnosis and treatment.”
Implications for Institution
The mean hospital cost per readmission for recurrent DVT was $11,862
Medicare will no longer pay hospitals for additional costs considered to be hospital acquired conditions
Private health care plans and other health care purchasers have their own nonpayment policies, but most are the same as Medicare.
Implications for Healthcare Resources
Very expensive to care for these patients
DVT patients average $16,000 more in medical costs than patients without a DVT.
If a DVT is the primary diagnosis the average cost is $10,800
Recommendations
For patient care: anticoagulants for at least 3 months, thrombolytic therapy, vena cava filter
Prevention/prophylaxis: Anticoagulant medications (heparin, lovenox, coumadin), moving lower legs, bending knees frequently, getting up to walk as soon as the patient is able to, pneumatic compression device, elastic stockings
Nursing Role
Assessment: look for signs and symptoms of a DVT (leg pain, ankle engorgement, swelling, differences in leg circumference, temperature changes, feeling of heaviness in affected limb, Homan’s sign)
Planning: Take prophylactic measures, get patient up and walking as soon as possible
Nursing Role
Interventions: Prophylactic measures, frequent assessment for signs of a DVT, monitor anticoagulant therapy, monitor for and manage potential complications (bleeding, PE), work with PT to get patient up and moving, provide rest and comfort (if they have a DVT-bed rest, analgesics, warm compress, elevation of extremity)
Evaluation: Pt will not develop a DVT, Pt will not develop a PE, absence of SOB, monitor patients PT and INR
Spectrum’s Initiatives
Education Materials
Teach them about their medication regimen Example: how to take it, complications, when to see
a doctor, blood tests needed
Teach them how to prevent DVTs Walking/moving whenever possible, wearing PCDs,
continuing medications prescribed
Teach them risk factors and signs that indicate a DVT
Conclusion
DVTs are a preventable complication
They are an extremely expensive medical cost so nurses should take every precaution possible to prevent them
The nurses responsibilities include assessing the patient for signs of a DVT, monitoring therapy initiated to prevent or treat a DVT, and keep patients as mobile as possible
Sources
http://www.nhlbi.nih.gov/health/health-topics/topics/dvt/causes
http://www.mayoclinic.org/diseases-conditions/deep-vein-thrombosis/basics/complications/con-20031922
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4379443/
http://surgery.med.miami.edu/vascular-and-endovascular/patient-care-services/dvt
http://nursingfile.com/nursing-care-plan/nursing-interventions/nursing-management-of-deep-vein-thrombosis.html
Sources
http://www.mayoclinic.org/diseases-conditions/deep-vein-thrombosis/basics/risk-factors/con-20031922
http://www.uptodate.com/contents/deep-vein-thrombosis-dvt-beyond-the-basics
http://www.cmsa.org/portals/0/pdf/CMAG_DVT.pdf
http://www.nbch.org/nbch/files/ccLibraryFiles/Filename/000000001630/HAC%20Payment%20Policy%20Toolkit%20(final%20version)%20081109.pdf
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