Introduction
Deep vein thrombosis (DVT) is the medical term for a blood clot that forms in a vein, most frequently in the lower part of the leg. Symptoms can include discomfort, inflammation, redness of the limb, and dilatation of the surface veins because the blood clot inhibits blood flow through the obstructed area. About a third of those with DVT develop a potentially fatal pulmonary embolism (PE) (Sebastian et al., 2022). When a clot fragment breaks off and circulates through the blood to the heart and lungs, it can fully or partially block a pulmonary artery, causing PE. Chest pain during breathing, irregular heartbeat, and shortness of breath are all possible symptoms of PE.
Issues That Impact the Medical-Surgical Patient
Older people are disproportionately affected by DVT and PE, and the frequency of both conditions is substantially lower in children than in adults. DVT afflicts roughly one in every 100,000 persons annually, but the rate is higher in those over 50 (Lewis et al., 2019). The rate of occurrence skyrockets after age 50, peaking at roughly 1,000 new cases per 100,000 persons each year in the age group between 85 and 89 (Lewis et al., 2019).
For unknown causes, African American males and females are 30% more likely to get a DVT than Caucasians (Lewis et al., 2019). Men are more likely to have DVT after 50 than women (Lewis et al., 2019). In addition, people with preexisting medical problems that interfere with blood clotting are at a greater risk of developing DVT.
Treatment with oral anticoagulants has been shown to reduce the incidence of DVT by half. While helpful in preventing DVT, oral anticoagulants were associated with a twofold increase in the risk of severe bleeding while providing only marginal benefits. Low-risk DVT patients should be encouraged to walk as much as possible, and further protection can be gained using mechanical prophylaxis (Sebastian et al., 2022).
Unless there are obvious contraindications, patients at increased risk of DVT should be considered for guideline-based anticoagulant therapy with LMWH, Unfractionated Heparin (UFH), or vitamin K antagonists. A potential new preventative option, fondaparinux, is a relatively recent medication (Azboy et al., 2020). Aspirin’s role in deep vein thrombosis prevention is still up for debate.
Comparison
Hospital inpatients should receive the proper DVT prophylaxis to lessen the likelihood of fatal and nonfatal pulmonary embolisms and other post-thrombotic sequelae. Facilitating medical professionals’ adherence to best practices in DVT prophylaxis is crucial (Lewis et al., 2018). According to the meta-analysis of strategies to increase compliance with instructions, previously used paper-anchored audit and response techniques were less effective at increasing rates of prevention in comparison to modern practices, education, or communication of guidelines.
Evidence-Based Practice
The chance of forming a blood clot is elevated after surgery, particularly on the hip, pelvic girdle, or knee. Prolonged inactivity throughout the healing phase can raise the risk of blood clot formation. Anticoagulants may be prescribed to some hospitalized patients to reduce the likelihood of DVT while recovering from surgery, particularly involving the bones, joints, or surgery for cancer. Other preventative treatments may be utilized in hospitalized patients with a low to moderate risk of blood clots.
After surgery, some patients, for instance, require inflatable compression devices (Lewis et al., 2019). These inflatable bands are wrapped around the legs during and immediately after surgery. These devices use light pressure to boost circulation and reduce the risk of blood clots, and patients may be advised to use compression stockings. The chance of developing a blood clot and DVT, as well as the risk of chronic inflammation in the legs, can be reduced by beginning to walk as soon as possible after surgery.
Areas for Health Education
The risk of developing a DVT is significantly increased by being hospitalized or having recently had surgery. Age, obesity, infection, immobility, hormone medication, smoking, pregnancy, and air travel are all additional risk factors for DVT. Word of this public health problem must be shared throughout the country, as many people are unaware of the dangers of DVT.
Due to the increased risk of DVT and PE associated with immobility, patients having surgery should be closely watched for the onset of these conditions. Patients should be assessed to ensure they receive the best preventative care possible (Astle et al., 2018). Patients undergoing surgery can be partially protected from blood clots using Low Molecular Weight Heparin (LMWH). LMWH is an anticoagulant that prevents blood clot formation by rendering the essential enzyme thrombin ineffective.
Postoperative patients can benefit from increased ambulatory movement, another preventative approach. Patients with a higher risk of developing blood clots can benefit from regular walking (Astle et al., 2018). In addition, individuals who are confined to a wheelchair or bed can benefit from intermittent pneumatic compression (IPC). IPC machines inflate and deflate an air bladder placed over the thigh or calf, compressing the muscle to promote blood flow. Aspirin is an effective preventative for some people because it thins the blood and facilitates its distribution throughout the body.
Conclusion
The symptoms of PE can include chest pain, heart palpitations, and shortness of breath. It has been proven that the risk of developing DVT can be cut in half with the help of oral anticoagulants. The effectiveness of aspirin for preventing DVT has not been conclusively shown. Postoperatively, patients, especially those who have had hip, pelvic girdle, or knee surgery, are at increased risk for developing blood clots. The danger of blood clot formation is increased if the patient remains inactive for an extended period throughout the healing process.
References
Ackley, B. J., Ladwig, G. B., Makic, M. B. F., Martinez-Kratz, M. R., & Zanotti, M. (2019). Nursing diagnosis handbook: An evidence-based guide to planning care (12th ed.). Elsevier.
Astle, B. J., Duggleby, W., Potter, P. A., Perry, A. G., Stockert, P. A., & Hall, A. (2018). Canadian fundamentals of nursing (6th ed.). Elsevier.
Azboy, I., Groff, H., Goswami, K., Vahedian, M., & Parvizi, J. (2020). Low-dose aspirin is adequate for venous thromboembolism prevention following total joint arthroplasty: A systematic review. The Journal of Arthroplasty, 35(3), 886-892.
Doenges, M. E., Moorhouse, M. F., & Murr, A. C. (2022).Nurse’s pocket guide: Diagnoses, prioritized interventions, and rationales (16th ed.). FA Davis.
Lewis, S. L., Bucher, L., Heitkemper, M. M., Harding, M. M., Barry, M., Lok, J., Tyerman, J., & Goldsworthy, S. (2018). Medical-surgical nursing in Canada (4th ed.). Elsevier.
Lewis, T. C., Cortes, J., Altshuler, D., & Papadopoulos, J. (2019). Venous thromboembolism prophylaxis: A narrative review with a focus on the high-risk critically ill patient. Journal of Intensive Care Medicine, 34(12), 877-888.
Sebastian, S., Joseph, R. M., Salvation, P. A., Joseph, M., Cherian, M. M., & Saldanha, S. J. (2022). Risk assessment and preventive strategies of Deep Vein Thrombosis among patients admitted in Intensive Care Units of a selected hospital in Mangaluru. Asian Journal of Nursing Education and Research, 12(4), 405-408.