Diagnosis
- Condition is typically characterized by presence of blood clots
- They are situated in the lower part of the body, often the legs
- The clots lead the limb to swell noticeably
- The clot is in a deep vein, complicating detection
- Many of the symptoms are shared with other conditions
Differential Diagnosis
- Chronic venous insufficiency can create similar symptoms
- Can be differentiated through the presence of varicose veins
- Duplex ultrasound will detect the different condition
- Myxedema can create similar-appearing clots along blood vessels
- Can be detected through thyroid function tests
Pathophysiology
- Blood clots or thromboses form within deep veins
- Veins are obstructed as a result, blood flow is impeded
- Vascular integrity of lower limbs may be compromised
- Tends to lead to various cardiovascular conditions
- Complications extend up to death, especially if pulmonary embolism develops
Signs and Symptoms
- Leg swelling, often more on the left leg than the right
- Redness in the affected area, possibly with pain
- Tenderness in the location around where the thrombus is located
- Pyrexia and the associated symptoms
- Erythema, oedema, and others, including cardiovascular condition symptoms (Baldwin, 2020)
Diagnostic Tests
- Physical check for presence of blood clots
- D-timer blood test, likely to be elevated
- Duplex ultrasound to detect blood clots
- Venography, but ultrasound is less invasive and preferable
- MRI scan, particularly relevant for abdomen DVT
Assessment Technique
- Begin with a physical examination, looking for clots
- Consider patient’s history, classify their risk of having DVT
- Conduct duplex ultrasound and a d-timer test
- Follow up with repeated ultrasounds or venography if necessary
- These steps should predict DVT with a high probability
Lifestyle Interventions
- Diet adjustments to avoid interfering with medication
- Regular movement to exercise legs
- Avoid tight clothing that may interfere with leg blood circulation
- Compression stockings to avoid clotting may be advisable
- Reduction in activities that can cause bleeding while blood thinners are in use
Non-Medicinal Interventions
- Surgery may be necessary in rare cases
- Venous thrombectomy, the direct removal of a thrombus
- Vena cava interruption devices may also be used
- Rarely, their installation can result in complications
- Venous congestion is the most significant problem (Brown et al., 2019)
Medicinal Interventions
- Anticoagulants are typically used for the condition
- Consist of three categories: vitamin K antagonists, thrombin inhibitors, and factor Xa inhibitors (Brown et al., 2019)
- Warfarin is the primary vitamin K antagonist
- Thrombin inhibitors can be direct or indirect
- Fondaparinux is an example of a factor Xa inhibitor (Brown et al., 2019)
Anticoagulant Usage Notes
- Anticoagulants complicate injections due to wounds closing slower
- Intramuscular injections should be avoided while they are in use
- Venepunctures should be minimized wherever possible
- The use of small-gauge needles is advised
- Manual pressure should be applied for 10 minutes or longer at the site (Brown et al., 2019)
Treatment Details
- Patient should avoid blowing their nose forcefully
- Shaving should be done with electric razors
- Soft toothbrushes or oral swabs should be used for oral hygiene
- Stool softeners may be administered to avoid straining
- Fall and skin breakdown assessments are necessary
Prevention
- Regular medical check-ups if in a risk group
- Regular physical activity, avoid sitting without moving for extended periods
- This recommendation includes driving cars or using other transport
- Physical fitness, removal of excess weight
- Minimization of harmful habits such as smoking
References
Baldwin, A. (ed.). (2020). Oxford handbook of clinical specialties (11th ed.). Oxford University Press.
Brown, D., Edwards, H., Buckley, T., Aitken, R. L., Lewis, S. L., Bucher, L., Heitkemper, M. M., Harding, M. M., Kwong, J., & Roberts, D. (2019). Lewis’s medical-surgical nursing: Assessment and management of clinical problems (5th ed.). Elsevier Health Sciences.