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Nursing Care Management 109
Care for Mother and Child at Risk Prepared by:
Sharmaine S. Pero, RN Clinical Instructor Learning outcomes:
Students will be able to discuss the signs and
symptoms of DVT Identify nursing care management for DVT DVT (Deep Vein Thrombosis) What is deep vein thrombosis?
Deep vein thrombosis or DVT occurs when blood
clot(s) form in the deep-seated veins. It is common to occur in the legs during pregnancy due to increased pressure or strain on the lower body. These blood clots can have serious consequences when not attended in time. Why does it occur to Pregnancy? Hormonal changes- can make the veins and valves smooth that can lead to impaired functioning.
Increased blood volume while the number of veins remains the
same
Significant increase in weight
Clotting factor of a woman in the final months increases.
Sometimes, the clotting proteins can increase a lot more than usual and the blood cells can clump together to form clots in the veins. How to diagnose? Diagnosis: To diagnose , your doctor will ask you about your symptoms. You'll also have a physical exam so that your doctor can check for areas of swelling, tenderness or changes in skin color.
D-dimer blood test. D dimer is a type of protein produced by blood
clots. Almost all people with severe DVT have increased blood levels of D dimer. A normal result on a D-dimer test often can help rule out PE
Duplex Ultrasound. This noninvasive test uses sound waves to create
pictures of how blood flows through your veins. It's the standard test for diagnosing DVT. For the test, a technician gently moves a small hand-held device (transducer) on your skin over the body area being studied. Sometimes a series of ultrasounds are done over several days to determine whether a blood clot is growing or to check for a new one. Venography. A dye is injected into a large vein in your foot or ankle. An X-ray creates an image of the veins in your legs and feet, to look for clots. The test is invasive, so it's rarely performed. Other tests, such as ultrasound, often are done first.
Magnetic resonance imaging (MRI) scan. This test
may be done to diagnose DVT in veins of the abdomen. Clinical manifestations: Intense pain, cramping, burning sensation, and discoloration of the skin around the blood clot. Risk Factors: Deep vein thrombosis usually doesn’t cause any major symptoms. It doesn’t pose any risk to the unborn baby unless any serious complications arise.
Carrying one or more baby
Bleeding after delivery Fertility treatment (hormones) Inherited blood clotting problems >35 y.o Cesarean Section Having another surgery or injury Smoking Prolonged sitting down Certain medical conditions including heart condition, cancer or diabetes The three main goals of DVT are: Treatment and •Prevent the clot from getting bigger. •Prevent the clot from breaking loose and Management traveling to the lungs. •Reduce your chances of another DVT Management: Secondary PPH
The treatment of deep vein thrombosis during pregnancy is not
very complex. You may have to consult a hematologist and a vascular specialist along with your regular gynecologist. The doctors will prescribe anticoagulation therapy to dissolve the blood and provide fast relief from the symptoms.
In anticoagulation therapy, you will have to take heparin and
some other injections. Heparin prevents the existing clot from growing, stops new clots from forming, and dissolves the existing clots by making the blood thinner.
You may have to take these injections for the rest of your pregnancy. The doctor will stop the therapy 2-3 weeks before your delivery. However, there is a great risk of deep vein thrombosis postpartum. Therefore, you may have to take heparin for about 6 weeks after delivery as well. How to prevent DVT? Make sure that you avoid wearing heels and choose comfortable flat footwear to avoid excess pressure on the veins and calf muscles.
Keep yourself hydrated. Having caffeinated and carbonated beverages that
have dehydrating effects on the vascular system, making them prone to deep vein thrombosis.
If you have a history of deep vein thrombosis, you can consult
your doctor and take some preventive anti-coagulating medicines.
Keep your legs moving. This will ensure the proper circulation of blood in the veins and prevent the blood cells from clumping together.
Wear compression stockings for 8-10 hours a day during
pregnancy after consulting the doctor. Remember to remove them while sleeping. Thank You
