CARDIOLOGY

DISORDERS
CARDIOVASCULAR SYSTEM
 CORONARY ARTERY DISEASE/CORONARY ATHEROSCLEROSIS
- hardening or narrowing of coronary artery (LADA) d/t fatty plaque

Coronary Arteriosclerosis - physiology; stiffening of CA →VC→ ↑ BP→ elderly

RISK FACTOR

NON MODIFIABLE MODIFIABLE

1. Age 1. HPN
2. Gender 2. Hyperlipidemia (Increased LDL/Total Cholesterol)
3. Race (Afroamerican) 3. Obesity (BMI: ≥30)
4. Family history/Gen. Pred 4. OCP/HRT (estrogen)
a. A. Recessive ( both parents-C. Fibrosis,SCA) 5. C. Smoking (Nicotine →VC → CO → Hypoxemia)
b. A. Dominant(1 parent - DS, Huntington’s) 6. Sedentary lifestyle
c. X-linked (Hemophilia,Color blindness) 7. Alcoholism
8. Diet
PATHOPHYSIOLOGY:
DIAGNOSTIC EXAM: 3. Fibric Acid Derivatives
1. BLOOD LIPID PROFILE MOA:↓ Tg
Endothelial Cell injury
LDL: <160mg/dL a. Gemfibrozil
↓
HDL: >40mg/dL b. Clofibrate
Platelet adhesion
Tg: <200mg/dL 4. Niacin - multiple side effects
(Macrophages, LDL)
Total: <200mg/dL
↓ NURSING MANAGEMENT:
NC: NPO x 12 hours (√) Water
Atheroma I. KNOWLEDGE DEFICIT
2. STRESS ECG TEST/ TREADMILL TEST
↓ II. INEFFECTIVE HEALTH MAINTENANCE
- most common
Plaque ruptures A. Health Maintenance
3. ESR, CRP: ↑= inflammation
↓ 1. Proper diet
4. CORONARY ANGIOGRAPHY - confirmatory
Thrombogenesis a. Fat: ( ↓ Sat, ↓Transfat; ↑ Unsat)
- xray with CM dye
↓ b. CHO: ( ↓ Simple; ↑ Complex)
- Cardiac Catheterization
OCCLUSION c. Fiber: ↑ fruits, vegs →↓ cholesterol
SITE: Femoral Artery/Brachial Artery
↓ d. Sodium: ↓ canned/preserved foods
NC: √ for allergies
Decrease Myocardial Tissue Perfusion
CVA/stroke: C. Angiography e. Potassium: ↑ fruits
↓ ↓ P.Embolism: P. Angiography 2. Regular physical exercise
Angina Pectoris ↓ DVT: Venography (√) Aerobic: Brisk walking x 30min for
↓ 2-3x/week
Myocardial Necrosis MANAGEMENT: Isometric: Muscle development
↓ 1. Statins: Simvastin 3. Smoking cessation
Myocardial Infarction MOA: Inhibit HMG CO-A Reductase 4. Moderate alcoholism - Red wine
- ↓ liver cholesterol synthesis
SYMPTOMS: NC: SE: Myalgia AE: Hepatotoxicity
1. Asymptomatic 2. Bile Acid Synthesis
2. Chest pain MOA: Bind with bile acid→↑fat absorption
a. Cholestyramine
b. Colestipol
 ANGINA PECTORIS
- artery d/t myocardial ischemia secondary to Atheroma
CAUSES:
P WAVE: Atrial Dep <0.11 sec
1. C. Atherosclerosis
QRS: Vent. depol <0.12 sec
2. Thrombosis
T WAVE: Vent. repol
3. Embolism (travels)
U WAVE NORMAL: Purkinje’s fiber
4. Exertion/Exercise
U WAVE ABNORMAL: Hypokalemia
5. Emotional stress
PR INTERVAL: 0.12-0.20sec
6. Eating a heavy meal
QT: 0.32-0.40
7. Exposure to cold - VC
8. Hyperthyroidism
9. Anemia ( Decrease Hgb) = decrease Oxygen

PATHOPHYSIOLOGY:

Coronary Atherosclerosis
↓
1. ST downsloping/depression
dec. myocardial tissue perfusion
↓
myocardial ischemia
↓
anaerobic metabolism
2. T Wave Inversion
↓
increase Lactic Acid
↓
Chest pain

TYPES:
1. STABLE: <15min; precipitated by the 4 E’s
3. Flat T Wave
- relieved by rest & NTG
2. UNSTABLE: >15min; unpredictable; unrelieved
- at rest; “Pre Infarction Angina”
3. PRINZMETAL/VARIANT: at night; d/t c. spasm→pain→↑
SNS
4. INTRACTABLE: not relieve; severe
5. SILENT: Asymptomatic
2. C. Angiography
SYMPTOMS: 3. ESR/CRP
1. Precardial/sternal/substernal/chest pain 4. Stress ECG w/o chest pain
2. SNS: ↑PR & RR
3. CCS - VC MANGEMENT:
4. Pallor; Cyanosis I. NITRATES - NTG (ISDN:ISMN)
5. Anxiety MOA: Dilates veins →dilates arteries = ↓ preload (venous return)
NC: 1. ROUTE: SL with chest pain
DIAGNOSTIC EXAM: No chest pain: Oral, Patch = Prophylaxis
1. ECG - most common; w/ chest pain
 4. NTG SL X 3 every 5min
2. Administer: NTG X 3doses every 5mins =15mins 5. Stop smoking
>15min →unstable → rush to ER → >30min → M.I 6. CBR
3. Store: Dark amber container for 6 months
4. SE: Headache; O. Hypotension = VD HOME EMERGENCY
5. PROBLEM: Tolerance - avoid NTG at H.S 1. Positioning 1. Positioning
2. V/S 2. V/S
II. ANTIPLATELETS 3. NTG 3. Oxygen
1. Aspirin 4. Rush - unstable 4. NTG - IV infusion
2. Clopidogrel
3. Ticlopidine SURGICAL MANAGEMENT:
4. Dipyridamole 1. CABG - Coronary Artery Bypass Graph
MOA: Inhibit platelet aggregation - open heart surgery (blood vessels)
- prevent ARTERIAL thrombosis - Troracotomy/Sternotomy
NC: 1. Toxicity - Tinnitus→ASA (Salicylate)
2. SE: Gi bleeding; PUD - all Antiplatelets

III. BETA BLOCKES (-olol)

1. Metoprolol
MOA: Inhibit B1 receptors in the heart
- decrease heart rate = to promote adequate myocardial
tissue perfusion
Cephalic Vein
IMA - Internal Mammary Artery
Basilic Vein
Greater Saphenous Vein - most common

2. PTCAngiography or Cardiac Catheterization

- closed heart surgery
systole = systemic ↓PR - ballon- tipped catheter = compression
diastole = coronary ↑PR

NC: 1. SE: Bradycardia; BC

2. CI: B. Asthma; COPD
3. Check the apical pulse (PMI)

IV. CALCIUM CHANNEL BLOCKER (-dipine)

1. Felodipine
MOA: Inhibit Calcium influx across the myo.cells = ↓ HR
NC: 1. SE: ↓ PR
2. Apical pulse

NURSING MANAGEMENT:
I. INEFFECTIVE TISSUE PERFUSION: CARDIAC
1. Assess v/s
2. POS: Semi-fowlers
3. Admin Oxygen
 ACUTE MYOCARDIAL INFARCTION
-chest pain d/t myocardial necrosis

CAUSES: 2. C. Angiography
1. C. Atherosclerosis/CAD 3. Serum Cardiac Enzymes
2. Thrombosis A. Troponin I - longest; confirmatory
3. Embolism B. CKMB Necrotic
4. Trauma C. AST except ALT = liver Myocardial
D. Myoglobin - 1st to rise (1hour) Cells
SYMPTOMS: E. LDH
1. Chest pain >30min Chest pain = Normal Serum Troponin = A.P
2. Levine's sign Chest pain = ↑ = M.I
3. SNS: ↑ PR & RR 4. CBC - ↑ WBC
4. Pallor/cyanosis 5. ESR/CRP - ↑
5. Sense of impending boom - fatal
MANAGEMENT:
DIAGNOSTIC EXAM: I. NARCOTIC/OPOIDS/ANALGESIC
I. ECG - 12 leads 1. Morphine - most potent
1. Pathologic Q Wave 2. Fentanyl
3. Meperidine
4. Nalbuphine
5. Codaine - cough
MOA: ↓ Preload (venous return); ↓ Afterload (force)
2. ST Elevation - ↓ myocardial oxygen demand
- ↓ anxiety
NC: 1. ROUTE: IV
2. SE: a. N&V
b. Addiction
3. T Wave Inversion c. Resp. depression
d. Constipation
e. Constriction of pupils
f. Itchiness/pruritus
g. Hypotension
3. Check the RR; BP
“iTs a Sin to fa-Q” 4. PROBLEM: Tolerance
1. Pathologic Q wave: Infarction - late sign 5. Use IV infusion pump = accurate
2. ST Elevation: Injury - early sign 6. ANTAGONIST: Naloxone (NARCAN) IV; Naltrexone
3. T wave Inversion: Ischemia II. THROMBOLYTICS
1. t-PA
2. Streptokinase
3. Alteplase
Zone of INFARCTION MOA: Stimulates Plasminogen - dissolution of clot
Zone of INJURY
INDICATION: MI; CVA; Pulmonary Embolism
Zone of ISCHEMIA
NC: 1. SE: bleeding
2. ANTAGONIST: AMINO CARPROIC ACID
3. Admin within 3 hours
III. ANTIPLATELETS c. Ventricular Tachycardia: >6PVC = Amiodarone; Lidocaine
- Prevent ARTERIAL thrombosis
IV. ANTICOAGULANT
- Prevent VENOUS thrombosis
1. Heparin (Parenteral) SQ; IV - PTT
2. Warfarin (Coumadin) Oral - PT or INR
SE: Bleeding
V. NITRATES - promote VD
VI. LAXATIVE d. Ventricular Fibrillation: Erratic/disorganized
1. Lactulose at H.S

NURSING MANGEMENT:
I. ACUTE PAIN
II. INEFFECTIVE BREATHING PATTERN
1. Assess V/S
2. Assess PS: Severe paiN- 7 to 10 = Neurogenic Shock
Cardiogenic Shock: Pump failure e. Asystole: Flat liner = CPR
3. POS: Semi-fowlers
4. Admin oxygen at 2-3LPM via nasal cannula
5. Admin Morphine IV a.o
6. CBR without BRP - bedside commode
III. INEFFECTIVE TISSUE PERFUSION: CARDIAC
1. WOF sx of DECREASE TISSUE PERFUSION
a. Restlessness 2. Heart Failure
b. Pallor/cyanosis 3. Dressler’s Syndrome = Pericarditis
c. CRT >3sec =↓ blood supply (NORMAL: 2-3 sec)
d. Oliguria
2. Admin laxative at H.S to prevent vagal stimulation - bradycardia
3. Holter monitoring X 24 hours
- lead II, VI
4. WOF complication
1. Dysrhythmia
a. Bradycardia: <60bpm = Atropine Sulfate 4. Neurogenic Shock d/t severe paiN
5. Cardiogenic Shock d/t pump failure
6. Cardiac Tamponade - compression of the heart d/t
accumulation of fluids
Sx: Pulsus Paradoxus - ↓SBP >10 on deep expiration
Mngt: Pericardio-centesis

b. PVC: wide & bizarre QRS = Lidocaine

 HEART FAILURE
- inability of the heart to pump adequate cardiac output
SYMPTOMS HEART FAILURE:
CO= SV X HR “COSH”
1. S4
Normal: 4-6 L/min
2. Cyanosis
SV = amount of blood in 1 stroke 60-80mL/min
3. Oliguria
HR = 60-100/min
4. Dec. pulses - peripheral
BP = CO X SVR (TPR)

DIAGNOSTIC EXAM:
VC VD
1. Echocardiography - UTS -ejection fraction
Normal: >60%
BP BP
2. ECG - prolonged PR/QRS
Causes:
3. ABG - Met. Acidosis
1. CAD
4. Hemodynamic monitoring
2. Chronic HPN
a. CVP: ↑ RHF, hypervolemia
3. CHD
↓ DHN, hypovolemia
4. P. Embolism
Normal: 2-6mmHg
5. Pericarditis
b. PCWP/PAP: ↑ LHF, Hypervolemia
6. Cardiomyopathy
↓ Hypovolemia, DHN
PATHOPHYSIOLOGY: Normal: 8-12mmHg
RHF LHF 5. CXR - cardiomegaly
-venous congestion - pulmonary congestion PMI: 6th ICS LMAL

dec. Cardiac output MANAGEMENT:

I. Digitalis - Digoxin (Lanoxin)
Inc. SNS RAAS ADH MOA: Stimulate Calcium influx across myocardial cells
- stregthen myocardial contraction
VC AI Water retention (+) Inotropic - strengthen
(-) Chronotropic - dec. Heart rate
BP AII congestion NC: 1. Digitalis Toxicity
PR - initial/early GIT symptoms (a-d)
Aldosterone RHF LHF a. anorexia
b. N&V
Na H20 retention c. Abdominal pain
d. diarrhea
SYMPTOMS: e. halos, BOV
RHF LHF f. dysrhythmia
1. Edema-ankle 1. Dyspnea on exertion 2. ANTIDOTE: DIGOXIN IMMUNE FAB (DIGIBIND)
2. Wt. gain d/t edema 2. PND 3. Diet: hyperkalemia
3. JVD 3. Crackles Hypokalemia=digoxin toxicity=dsyrhythmia=death
4. Hemorrhoids 4. Frothy blood tinged sputum 4. SE: Bradycardia
5. Hepatomegaly 5. Orthopnea >2pillows 5. Check apical pulse
6. Ascites 6. Fatigue (√) APICAL PULSE
7. Anorexia 1. Beta Blocker
2. Calcium channel blocker
3. Digoxin
II. Sympathomimetics
a. dopamine (+) Inotropic
DSYRHYTHMIA
b. dobutamine (+) Inotropic - abnormal cardiac rhythm
NC: 1. SE: tachycardia
2. Check apical pulse I. SINUS TACHYCARDIA >100bpm
III. Diuretics - SA node
1. Potassium Wasting CAUSE: ↑SNS
a. Loop diuretics - furosemide ECG: Regular ↑100
- in the ascending loop of Henle
MOA: Inhibits Na - H20 & Potassium reabsorption
= Na , K , H2O excretion
NC: 1. SE: hypokalemia
2. admin AM
3. Onset: 10min (IV)
b. Thiazide (Hydrochlorothiazide)
MOA: in the distal tubule MANAGEMENT:
2. Potassium Sparing (Spironolactone) - Aldactone 1. BB
MOA: Inhibits Na H20 reabsorption 2. CCB
Inhibits Aldosterone = ↓ Na H2O 3. Digoxin
NC: 1. SE: Hyperkalemia; DHN
2. Monitor ECG II. SINUS BRADYCARIDA <60bpm
3. Monitor serum K CAUSE: 1. Vagal stimulation
4. Digitalis + Spironolactone 2. Sleep
HYPERKALEMIA HYPOKALEMIA 3. Athletes
1. Peaked T wave 1. Flat/short T wave ECG: Regular
2. ST elevation 2. ST depression
3. Prolonged QRS 3. U wave
IV. ACE Inhibitors (-pril)
V. Beta blocker
VI. Calcium Channel Blocker

MANAGEMENT: Atropine Sulfate

NURSING MANAGEMENT
I. Decrease Cardiac Output
III. SUPRAVENTRICULAR TACHYCARDIA/PAT
1. V/S; Pulse Oxy; ABG
2. POS: High fowlers CAUSE: ↑SNS
3. Admin Digoxin - Inotropic ECG: 100-200 bpm; ectopic P wave
MANAGEMENT: Adenosine
4. CBR
1. Vagal maneuver - bearing
5. Admin oxygen - to increased oxygen supply
2. Carotid massage
II. Fluid Volume Excess
1. Monitor I&O; abd’l girth; UO = Normal: 30-60mL/hr; BW
2. Diuretics in the AM
3. Diet: ↓ sat; ↓Simple CHO
↓Na ; ↓ Transfat
4. CBR to ↑urine formation; ↑GFR
5. OFI ↓ = previous 24hrs UO + 500mL (insensible fluids)
a. Perspiration
b. Respiration
c. stools
IV. ATRIAL FLUTTER 200-350bpm
ECG: Sawtoothed P Wave
MANAGEMENT:
1. BB (sotalol)
2. CCB (Verapamil, Diltiazem)
3. Unstable: Cardioversion

VII. PVC - wide & bizarre QRS

MANAGEMENT:
1. Lidocaine (IV)
2. Amiodarone

V. ATRIAL FIBRILLATION >300-600bpm

VR: >150bpm
ECG: No visible P wave
MANAGEMENT:
1. Cardioversion
2. Anticoagulant
3. Antiplaelets VIII. VENTRICULAR TACHYCARDIA > 6PVC
MANAGEMENT:
1. Amiodarone
2. Lidocaine
3. Pulseless → Defib

VI. AV BLOCK - blockage between SA & AV NODE

SYMPTOMS:
1. Bradycardia
2. Syncope
Primary: Asymptomatic - Prolonged PR X. ASYSTOLE/ CARDIAC STANDSTILL - flat liner
Secondary: MANAGEMENT:
A. Mobitz Type I 1. CPR
Sx: Asymptomatic - no QRS 2. Epinephrine IV/ET
B. Mobitz Type II 3. Defib - last resort
1. Syncope→pacemaker; Atropine →Prolonged PR
Tertiary: V. Fib = Asystole →Pacemaker TO ALL DSYRHYTHMIA
NC: PACEMAKER SYMPTOMS: ↓ Cardiac Output
1. Avoid high voltage equipment 1. Pallor
2. Manual razor 2. Cyanosis
3. Apical pulse & temp 3. Irreg. pulse
4. COMPLICATION: Infection 4. Changes in LOC ↓
5. Avoid contact sportspa 5. Palpitations (Tachycardia)
6. DOB
PACEMAKER 7. Chest pain
 CPR - BLS (CAB) VASCULAR DISORDER
RTERIES EINS
OVEntilation PUlse - deep - superficial
O - bright red - dark red
C-hest compression - Oxygenated blood - deoxygenated blood
- pulsation - valces
INIDACTION: - arterioles - venules
1. Pulselessness
2. Breathlessness
O2 CO2
NC:
1. Check the LOC - unresponsive Capillaries
2. Chest compression 100-120bpm ARTERIAL INSUFFICIENCY VENOUS INSUFFICIENCY
3. Open the airway 1. Buerger’s Disease 1. DVT
(-) Cervical SCI: Jaw Thrust Maneuver 2. Raynaud’s Disease 2. Thrombophlebitis
(+) Cervical SCI: Head tilt chin lift 3. HPN
4. Ventilation: 2 rescue breaths 4. Aneurysm - central
5. Pulse
ADULT: carotid >7y/o BUERGER'S DISEASE RAYNAUD'S DISEASE
CHILD: femoral THROMBO-ANGIITIS OBLITERANS WHITE-BLUE-RED DISEASE
INFANT/BABY: brachial - inflammation of the arterioles of the - acute spasm of the arterioles of
6. Ratio 30:2 (5cycles) feet & toes the hands
!!!STOP!!! - blood clots RF: 1. Female
1. (+) Pulse; Breathing RF: 1. Male 2. Gen. pred
2. EMS/Medics 2. C. Smoking 3. Cold exposure
3. Exhaustion SX: 1. Intermittent claudication SX: 1. Pallor (white)
- calf pain on exertion 2. Cyanosis (blue)
CARDIOVERSION DEFIBRILLATION 2. Cold toes 3. Erythema (red)
- synchronized - asynchronized 3. Thick nails 4. ↓Peripheral pulse
- 50-100 joules - 200-360 joules 4. Thin skin 5. Cool skin
- sedate the patient - no sedation 5. Gangrene/ulcer DX: 1. PE & History
1. QRS 6. ↓ Peripheral pulse
2. R wave DX: 1. Angiography
INDICATION INDICATION 2. Doppler UTS
1. A. Fib 1. V. Fib 3. PE & Hx
2. V. Tach 2. Pulseless V.Tach MANAGEMENT: Buerger’s & Raynaud’s
3. SVT/A. Flutter 3. Asystole/C.Standstill 1. Vasodilators - NTG, Hydralazine
2. Analgesics - NSAIDs
3. Amputation - for Buerger’s only
NURSING MANAGEMENT:
I. Ineffective Tissue Perfusion: Peripheral
1. Assess skin color, peripheral pulse, skin temp
2. POS: Place the ext. below/ dependently/ reverse trendelenburg
3. Stop smoking
4. Admin Pentoxifylline (Buerger’s) - ↓to RBC viscosity
5. Avoid cold temp →VC
 ANEURYSM HYPERTENSION
- arterial vasoconstriction ≥140/90
- permanent distention of a part of an ARTERY CLASSIFICATION SYSTOLE DIASTOLE
Pre-HPN 120-139 80-99
CAUSES: Stage I 140-159 90-99
1. Hyperlipidemia/Atherosclerosis Stage II 160-179 100-109
2. Chronic HPN HPN Crisis ≥180/120
3. AV malformation NORMAL BP: 90 - 120
60 - 80
TYPES: TYPES: 1. PRIMARY: essential HPN; without cause; RF 95%
CEREBRAL A. THORACIC A. ABDOMINAL A. 2. SECONDARY: with cause (RF,HF,Hyperthy,LF); 5%
SX: ↑ICP SX SX: 1. Chest pain SX: 1. Pulsatile abd’l mass SYMPTOMS: 1. Asymptomatic
- severe HA 2. DOB 2. Constipation 2. Nuchal HA
POS: semi-fowlers 3. cough 3. Bruits (auscultate) 3. BOV
4. Dysphagia 4. Thrills (palpate) 4. Epistaxis
5. Confusion
RUPTURED ANEURYSM: DIAGNOSTIC EXAM:
1. ↑ BP → shock 1. BP Monitoring - average of 2-3 readings on separate occasions
2. Severe pain 2. CXR
3. Sensation of “tearing” 3. Blood chem to detect the
4. Internal hemorrhage ↑ PR ↑RR 4. UA - CHON underlying
5. ECG cause
DIAGNOSTIC EXAM: MANAGEMENT:
1. CT scan 1. ACE INHIBITOR
2. Abdomial UTS MOA: BLOCK THE CONVERSION OF AI→AII
3. CXR NC: 1. SE: Cough (CAPTOPRIL)
2. AE: ↑K
MANAGEMENT: 2. BB -olol
I. Antilipidemics - Statins 3. CCB -dipine
II. Anti-HPN 4. Diuretics - Thiazide
5. Vasodilators - Hydralazine
SURGICAL MANAGEMENT: MOA: Smooth muscle relaxation
1. Stent SE: O.Hypotention
2. Surgical resection >5cm NC: 1. danging of legs
2. gradual change of position
NURSING MANAGEMENT: 6. Centrally Acting Sympatholytics
I. Ineffective Tissue Perfusion - clonidine (Catapres); methyldopa
1. V/S MOA: Inhibits SNS
2. POS: Flat on bed NC: 1. SE: drowsiness
3. Admin Anti-HPN 2. Admin at H.S
4. Avoid abdominal palpation 7. Angiotensin Receptor Blockers - Sartan
5. Avoid valsava maneuver NURSING MANAGEMENT:
II. Risk for Injury/ Risk for FVD I. Knowledge Deficit
II. Ineffective Health Maintenance
1. Diet: ↓Na ↓Fat (Atherosclerosis; Hyperlipidemia)
2. Regular physical exercise
 DEEP VEIN THROMBOSIS 3. ANTAGONIST: Protamine Sulfate
4. Use IV infusion pump - “accurate”
- formation of blood clots
5. Enoxa/dalte = SQ ———-Abdomen: 90degrees
THROMBOPHLEBITIS
UA/thigh: 45degrees
- with inflammation of vein
UA/thigh-Obese: 90degrees
COMPLICATION: Pulmonary Embolism
3. Warfarin (Coumadin) - oral
RISK FACTORS:
MOA: Inhibits Vit. K dependent CF X,IX,VII,II (1972)
1. Obesity >30 BMI
NC:
2. Sedentary lifestyle
1. Check for PT X 1.5 - 2
3. OCP (estrogen) ↑ Blood viscosity
- INR = Normal: 2-3sec
4. Hip/ortho/abdominal/pelvic surgeries
5.Pregnant
10—-12 sec
VIRCHOW'S TRIAD: DVT
X 1.5 2
1. Stasis of venous blood
15—24 sec
2. Damage to the veins
2. SE: Bleeding
3. Coagulability
3. ANTAGONIST: Vit. K
SYMPTOMS:
4. Avoid green leafy vegetables
1. Edema
2. Homan's sign - dorsiflexion
NUSING MANAGEMENT:
3. Pain/tenderness - dolor
I. Ineffective Tissue Perfusion: Peripheral
4. Erythema - rubor
5. Swelling - tumor
thrombophlebitis 1. Assess for symptoms of hypoxia, delayed CRT
2. POS: elevated the affected extremity
6. Warm - calor
3. Compression stockings
7. Impaired mobility - functio laesa
- before arising from the bed
DIAGNOSTIC EXAM:
4. Avoid prolong sitting, standing, massage , long travel
1. Venography
II. Acute Pain: Thrombophlebitis
2. Duplex UTS
1. Warm compress
MANAGEMENT:
2. NSAIDs
1. Thrombolytics
(X) Aspirin (√) Naproxen
- to "dissolve"
- Fibrinolytics
2. Anticoagulants
1. Heparin
2. LMW Heparins
a. Enoxaparin
b. Dalteparin
MOA: Inhibits conversion of fibrinogen to fibrin
- prothrombin to thrombin
NC:
1. Check the PTT ↑ x 1.5 - 2
30–45 sec (Normal value)
X 1.5 2
45—90 sec (Therapeutic range)
2. SE: Bleeding