Caring for Clients with Infectious & Inflammatory Disorders of the Heart

and Blood Vessels

Inflammatory Disorders of the Peripheral Blood Vessels
Disorders
Thrombophlebitis
Deep vein thrombosis (DVT)
Buerger’s disease
Thrombophlebitis
Deep vein thrombosis, DVT
Contributing factors
Immobility (venous stasis of blood)
Trauma
Sepsis
Clotting problems
Cancer
Obesity
Oral hormone replacement
Dehydration

Assessment findings
Treatment is aimed at Prevention
Early movement
Mechanical prophylaxes
Compression elastic stockings
Sequential compression devices (SCD)
Pneumatic compression devices
Pharmacologic prophylaxis
Aspirin
Coumadin
Heparin
LMWH- Lovenox

Treatment
Complete bed rest
Anticoagulant therapy
Warm wet packs
Thrombectomy
Vena cava filter (Greenfield filter)
Nursing Process for Thrombophlebitis
Assessment
Hx of blood clots or past orthopedic surgery
High risk lifestyles or medical treatment
Assess for Homan’s sign, inspect extremities
Diagnosis
Pain related to venous inflammation
Ineffective Tissue Perfusion related to localized swelling secondary
to the inflammatory response and impaired venous circulation
Nursing Process for Thrombophlebitis
Planning
Prevention for bedridden
Promote activity and exercise
Ankle-pumping exercises
TED hose (elastic stocking)
 venous compression devices
Prevention for recurrences
Avoid prolonged sitting, crossing legs
Elevate legs, active movement, wear hose, and drinking fluids
liberally
Long term anticoagulant therapy
Watch for signs –nosebleeds, bleeding easily
Nursing Process for Thrombophlebitis
Interventions
Administer prescribed non-narcotic analgesics and anti-
inflammatory agents.
Support and handle extremity gently
Elevate the affected extremity, do not bend at knees
Apply warm, moist compresses

Potential complications (PC) of Thrombophlebitis

Pulmonary embolus
Maintain bed rest
Administer prescribed anticoagulant
Ted hose
Bleeding
Monitor lab values (PTT, PT, INR)
Keep antidotes for overdose of anticoagulants
Monitor for signs of bleeding (skin, gums, stools)
 Apply direct pressure if bleeding occurs

Anticoagulants
Heparin & Coumadin
Prevents the formation of a blood clot
Does not effect existing thrombus
Body will dissolve over time

Anticoagulants

Heparin
Low-molecular weight heparin
Lovenox
Fragmin
Coumadin
Aspirin (antiplatelet)

Lab values
Heparin
Activated partial thromboplastin time (APTT or PTT)
LMWH
No effect on lab values
Coumadin
Prothrombin time and international normalized ration
(PT & INR)

Thrombolytic Therapy
May be used to dissolve the thrombus
Streptokinase
Urokinase
TPA tissue plasminogen activator
High risk for bleeding
Used only in emergency situation
Used only in good candidates
Monitoring
Adverse drug reaction
Bleeding
Inspect urine & stool for any GI bleeding
 Skin for bruising
 Avoid skin cuts

Reverse Effects
Heparin
Protamine sulfate
Coumadin
Vitamin K
Avoid foods high for therapeutic
dark leafy vegetables
Frozen fresh plasma
Buerger’s Disease (Thromboangiitis Obliterans)
Inflammatory lesions along small arteries and veins
Arteries prone to spasm
More common in men
Smoking aggravates the condition
Causes gangrene

Nursing Process for Buerger’s Disease

Assessment
Cold feet with numbness, burning and tingling
Intermittent claudication, leg cramps after exercise
Pain at rest
Skin mottled purplish-red and appears thin and shiny
Black gangrenous areas on toes and heels
Nursing Process for Buerger’s Disease
Teaching topics
Smoking cessation
Performing prescribed exercises
Avoid caffeine, tobacco products, and OTC drugs
Prevent trauma to extremities
Avoid prolonged exposure to the cold
Nursing Process for Buerger’s Disease
Medical management/nursing interventions
Tobacco is restricted
Buerger-Allen exercises
Analgesics
 Wet-to-dry dressings
Results in Gangrene