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⚠️ Diminisyon Risk · Leson 5 sou 6 · 6 min

Prevansyon DVT ak Pulmonary Embolism Ou Pa Dwe Rate a

DVT Prevention and the Pulmonary Embolism You Must Not Miss

🫁 Yon pasyan k ap refè apre yon hip replacement chita ap pale, apre sa toudenkou li kenbe pwatrin li, li pran souf epi li di li santi li pral mouri. Saturation li se 84%. 60 segonn ki vin apre yo se yon kesyon egzamen.

🫁 A client recovering from a hip replacement is sitting up chatting, then suddenly grabs her chest, gasps and says she feels like she is going to die. Her saturation is 84%. The next 60 seconds are an exam question.

💡 Ide prensipal

Anpeche l ak mouvman, compression ak antikoagilan. DVT: yon sèl janm anfle ak cho, pa masaje. PE: dyspnea toudenkou ak doulè pwatrin: chita dwat, oksijèn, rapid response, heparin.

Prevent with movement, compression and anticoagulants. DVT: one swollen warm leg, do not massage. PE: sudden dyspnea and chest pain: sit up, oxygen, rapid response, heparin.

🧠 Poukisa sa enpòtan

VIRCHOW'S TRIAD esplike risk kayo a: venous stasis, blesi veso ak hypercoagulability, kidonk immobility, operasyon, kansè, gwosès, estrogen ak dehydration ogmante risk la. ANPECHE deep vein thrombosis ak ambulation bonè, egzèsis janm, aparèy intermittent compression oswa ba antiembolism jan yo te bay lòd la, hydration ak antikoagilan prophylactic. Siy DVT: anfleman nan yon sèl janm, chalè, woujè ak sansiblite; mezire sikonferans molè a epi konpare bò yo; pa masaje janm nan; Homans' sign pa fyab epi yo pa rekòmande l ankò. Trete ak anticoagulation epi, souvan, ambulation kontinye dapre lòd. PULMONARY EMBOLISM: dyspnea toudenkou, doulè pwatrin pleuritic, tachycardia, tachypnea, hypoxemia, tous, enkyetid ak yon santiman desten iminan, pafwa hemoptysis. Aksyon imedya: leve tèt kabann nan, aplike oksijèn, rete ak pasyan an, rele ekip rapid response la, jwenn aksè IV, epi atann anticoagulation (heparin), CT pulmonary angiography ak petèt thrombolytics. Anseye pasyan ki pral kite lopital epi ki sou antikoagilan sou prekosyon senyman ak siy yon nouvo kayo.

VIRCHOW'S TRIAD explains clot risk: venous stasis, vessel injury and hypercoagulability, so immobility, surgery, cancer, pregnancy, estrogen and dehydration raise the risk. PREVENT deep vein thrombosis with early ambulation, leg exercises, intermittent compression devices or antiembolism stockings as ordered, hydration and prophylactic anticoagulants. DVT signs: unilateral leg swelling, warmth, redness and tenderness; measure calf circumference and compare sides; do not massage the leg; Homans' sign is unreliable and no longer recommended. Treat with anticoagulation and, often, continued ambulation per order. PULMONARY EMBOLISM: sudden dyspnea, pleuritic chest pain, tachycardia, tachypnea, hypoxemia, cough, anxiety and a feeling of doom, sometimes hemoptysis. Immediate actions: raise the head of the bed, apply oxygen, stay with the client, call the rapid response team, obtain IV access, and anticipate anticoagulation (heparin), CT pulmonary angiography and possibly thrombolytics. Teach discharge clients on anticoagulants about bleeding precautions and the signs of a new clot.

🏥 Nan lavi reyèl

⚡ Enfimyè a leve tèt kabann nan, li mete yon non-rebreather sou pasyan k ap pran souf la, epi li rele ekip rapid response la pandan kòlèg li mete yon dezyèm IV. Li pa kite chanm nan pou l al chèche founisè a. Yon CT konfime yon pulmonary embolism epi yon perfusion heparin kòmanse. Sekans kòrèk egzamen an se sa ki kenbe enfimyè a bò kabann nan ak oksijèn an ap koule.

⚡ The nurse raises the head of the bed, puts a non-rebreather on the gasping client, and calls the rapid response team while her colleague places a second IV. She does not leave the room to find the provider. A CT confirms a pulmonary embolism and a heparin infusion begins. The exam's correct sequence is the one that keeps the nurse at the bedside and the oxygen flowing.

📌 Sa pou retni

  • Stasis, blesi veso, hypercoagulability: triyad risk laStasis, vessel injury, hypercoagulability: the risk triad
  • DVT: anfleman nan yon sèl bò, chalè, sansiblite; pa janm masajeDVT: unilateral swelling, warmth, tenderness; never massage
  • PE: dyspnea toudenkou ak doulè pleuritic: dwat, oksijèn, rapid response, anticoagulatePE: sudden dyspnea and pleuritic pain: upright, oxygen, rapid response, anticoagulate

📖 Tèm nan leson sa a

Anboli pilmonè (Pulmonary embolism): Yon kayo ki bloke nan poumon an, ki lakòz dispne sibit, doulè pwatrin plewitik, takikadi ak ipoksemi.

D-dimer: Yon fragman dekonpozisyon kayo, nòmalman anba apeprè 0.5 mcg/mL (500 ng/mL); yon valè nòmal ede eskli DVT ak anboli pilmonè, pandan yon valè wo pa espesifik epi li monte nan DIC, chiriji, gwosès ak enfeksyon.

✅ Teste tèt ou

Yon pasyan apre operasyon toudenkou fè dyspnea, doulè pwatrin ak yon saturation oksijèn 85%. Kisa enfimyè a ta dwe fè anvan?A post-operative client suddenly develops dyspnea, chest pain and an oxygen saturation of 85%. What should the nurse do first?
  1. Kite pou l avize founisè aLeave to notify the provider
  2. Chita pasyan an dwat epi aplike oksijènSit the client up and apply oxygen
  3. Fè pasyan an mache pou amelyore sikilasyon anAmbulate the client to improve circulation
  4. Bay antikoagilan oral ki te pwograme aAdminister the scheduled oral anticoagulant

Repons: B · Chita pasyan an dwat epi aplike oksijèn

Sa yo se siy pulmonary embolism. Estabilize vwa respiratwa a ak oksijenasyon an pandan w ap rele èd; pa kite pasyan an.

These are signs of pulmonary embolism. Stabilize the airway and oxygenation while summoning help; do not leave the client.

Ki rezilta ki sijere yon deep vein thrombosis nan janm gòch la?Which finding suggests a deep vein thrombosis in the left leg?
  1. Anfleman, chalè ak sansiblite nan molè gòch laLeft calf swelling, warmth and tenderness
  2. Angoudisman nan de pye yoNumbness in both feet
  3. Edema bilateral nan cheviy nan fen jounen anBilateral ankle edema at the end of the day
  4. Pye gòch frèt, pal ak batman absanCool, pale left foot with absent pulses

Repons: A · Anfleman, chalè ak sansiblite nan molè gòch la

Anfleman, chalè ak sansiblite nan yon sèl bò montre thrombosis venn; manm frèt, pal san batman sijere occlusion atèryèl.

Unilateral swelling, warmth and tenderness point to venous thrombosis; cool pale pulseless limbs suggest arterial occlusion.

Ki entèvansyon ki apwopriye pou anpeche DVT nan yon pasyan apre operasyon ki pa ka bouje?Which intervention is appropriate to prevent DVT in an immobile post-operative client?
  1. Kenbe jenou yo pliye ak zòrye anba yoKeeping the knees flexed with pillows under them
  2. Aplike aparèy pneumatic compressionApplying pneumatic compression devices
  3. Limite likid oral pou diminye anfleman janmRestricting oral fluids to reduce leg swelling
  4. Masaje molè yo chak 4 èdtan pou ankouraje retou vennMassaging the calves every 4 hours to promote venous return

Repons: B · Aplike aparèy pneumatic compression

Aparèy compression amelyore retou venn. Masaj ka dekole kayo, zòrye anba jenou yo lakòz stasis, epi dehydration epesi san an.

Compression devices improve venous return. Massage can dislodge clots, pillows under the knees cause stasis, and dehydration thickens the blood.

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