Deep vein thrombosis [DVT] is a condition that can impact nearly anyone, although certain people are at higher risk. As a nurse, you’ll need to understand how this condition typically presents and which DVT nursing interventions can help you care for patients.
We’re exploring what you should know about DVT, the signs and symptoms you might see, and common nursing treatment plans that you might implement.
What is DVT [Deep Vein Thrombosis]?
Deep vein thrombosis [or DVT] is a potentially dangerous condition caused by a significant blood clot in one of the body’s major veins. This disorder can also be called venous thromboembolism.
Learn more nursing abbreviations here.
These potentially damaging clots can form anywhere in the body, but they most frequently occur in one of the legs. Once the clot forms, it can break off and travel throughout the body through the veins.
If it gets to the lungs, it can cause a potentially life-threatening condition known as a pulmonary embolism [PE].
A PE can also be called thromboembolism, post-thrombotic syndrome, or postphlebitic syndrome. If the emboli get to the lungs, they can cause obstructions in the lungs and block blood flow.
Assessing for DVT – Symptoms of Deep Vein Thrombosis
It’s important to note that while DVT often presents with recognizable symptoms, it can also occur undetected. When symptoms do occur, some patients do not identify them as symptoms of DVT, as they can coincide with other conditions.
However, as a nurse, you will need to familiarize yourself with the common characteristics to detect the condition in your patients.
Here are a few key things to keep an eye out for:
- Tenderness – Patients often find the area around the DVT feels tender. It’s because the vein wall has become inflamed. If you palpate the area on the patient, they may be able to alert you to this tenderness.
- Massive iliofemoral venous thrombosis – You can also call this symptom a phlegmasia cerulea dolens. If a patient has this symptom, the entire extremity impacted by the DVT will feel cool to the touch — as well as tension and pain. You might see considerable swelling in the area. In addition to the area feeling cooler than usual, a warm patch on an extremity [without another cause] can also potentially indicate DVT.
- Edema – If the deep vein impacted by the DVT has inhibited its outflow of blood, you’ll notice this edema or swelling in the limb.
- Pulmonary embolism – Sometimes, the first symptom you see with a patient is the presence of an actual pulmonary embolism, which restricts airflow in the lungs. For example, if your patient has a PE, you might notice them sweating or having a rapid heartbeat known as tachycardia. They might also indicate that they feel dizzy or have chest pain that worsens after taking deep breaths or coughing. They might also have shortness of breath.
- Discoloration in the skin around the DVT – You might also notice that the skin around the DVT looks odd, such as reddish, bluish, or pale in response to the lack of oxygen-rich blood being able to move through the area easily.
- Pain – In some patients, the DVT will cause direct pain, including pain in the foot or ankle that does not appear to have a logical cause. Other patients might note a strong cramp forming in their calf.
Homan’s Sign – The DVT Calf Squeeze Test
Homan’s sign is a type of test for assessing DVT, and it’s pretty easy to do.
It’s a clinical test used to assess the integrity of the venous valves in the lower limbs. Homan’s sign is also called the “squeeze test” because it requires the patient to squeeze their calf muscles against the examiner’s hands, which puts pressure on those valves.
If you press on a patient’s calf and they feel discomfort in their foot, they might be experiencing symptoms of DVT.
How to do the Homan’s sign calf squeeze test:
- Have the patient sit down and elevate their feet above heart level by at least 30 degrees.
- Push down their leg on the top of their foot while also applying pressure to the top of their leg.
- If they feel any swelling in the vein that runs along the top of your foot [the popliteal vein], this could be a sign of DVT.
Who is Most at Risk for DVT?
Although theoretically anyone can get a DVT, there are certain risk factors and members of the population with a higher risk than others.
For example: those receiving medical treatment, people who have had strokes, and critically ill patients all have an increased risk of DVT.
Let’s review more factors that could put someone at risk for DVT:
- DVT occurs in about 10% – 20% of the general population receiving medical treatment. [1]
- The rate of DVT increases between 20% and 50% for people who have had a stroke. [2]
- The rate of DVT increases to 80% for critically ill people. [3]
Other risk factors of DVT include:
- People who are overweight or have obesity.
- People who experience heart failure.
- Those who have a family history of developing DVT.
- Patients with a catheter in a vein or an injury to the vein.
- Patients with general injuries to the lower extremities [including the pelvis and hips].
- People who have had surgery recently.
- Patients who take oral contraceptives or
- Patients who use medications that can influence hormone levels and cause hypercoagulability.
- Women who are pregnant or who recently gave birth.
- Smokers.
- Those who have recently remained seated for an extended period of time [being trapped in a car or plane for hours on end].
Patients who experience certain conditions, such as venous stasis [reduced blood flow] or damage to the vessel wall, will also be more likely to develop this disorder.
Over a hundred years ago, Rudolf Virchow proposed Virchow’s Triad, which identified vein damage, venous stasis, and the activation of blood coagulation as the three factors critical in developing this dangerous clot formation.
As a nurse, you should recognize that patients who fit these risk factors will have a greater chance of developing this potentially life-threatening condition.
Therefore, you should encourage them to take steps to try and reduce their risk, such as:
- Moving around as often as possible — even getting up to move around the aisles of a plane or taking breaks on long car trips.
- Stretching their legs and feet as often as possible when sitting.
- Maintain a healthy weight or take steps to achieve a healthy weight.
- Exercise for patients with risk factors, such as pregnancy.
- Wearing compression stockings for people who have a high risk of DVT.
As a nurse, if you discover that your patient has symptoms of a DVT, you will want to take action right away. You’ll need to take a general medical history and do a physical examination to get a complete picture of the patient’s medical state.
You can also use Well’s diagnostic algorithm to classify whether your patient has a high, moderate, or low probability of developing this particular condition.
This will help guide your nursing diagnosis. Doctors may also order a D-Dimer, a blood test, or a venography to further test for the presence of DVT.
Based on your assessment, you’ll need to use your nursing interventions to treat patients and provide care to improve their health outcomes. Your nursing care plan, along with the rest of the medical treatment, will work to prevent the growth of thrombus and recurrence of the disorder.
The types of interventions used as a part of your nursing management may include:
- Compression therapy. Using compression stockings and other compression devices helps to increase the blood flow to the deep veins, such as the femoral vein. These interventions help to reduce the caliber of superficial veins and can be done on the affected extremity.
- Guiding patients through particular positioning and exercises. This can be particularly important for those who are on bed rest. For example, suppose you have a patient confined to a bed. In that case, you will need to raise the lower legs and feet above the heart occasionally. Help the patient perform some leg exercises to improve blood flow despite their immobility. You will likely do this with both the unaffected and affected legs.
- Helping patients feel more comfortable. Your treatment of DVT will also aim to help patients alleviate their discomfort through such approaches as warm compresses, ambulation, or help to find more comfortable positions.
In addition to these nursing interventions, you will also help provide care in other ways. For example, some patients will be prescribed anticoagulant therapy.
Some common options include the administration of unfractionated Heparin [which is administered subcutaneously to prevent clots] or Warfarin [which is a vitamin K antagonist used to prolong coagulant therapy]. Thrombolytic therapy may also be used.
Registered nurses may help administer medication or educate patients about how to take their medications after they are discharged properly.
Learn more about pharmacology for DVT and other vein-related disorders here.
For example, patients and their medical team will need to watch for complications related to certain drug therapies, such as a sudden drop in platelet counts. Many oral anticoagulants used in DVT treatment can also interact with other medications and need to be ingested carefully, under supervision.
While treating the patient, you may also help monitor the patient’s blood coagulation. This can help the medical team better understand the patient’s blood clot risk.
Is DVT Included in the NCLEX Exam?
As you prepare to take the NCLEX, note that questions could relate to any number of conditions that your nursing patients might face — including questions on DVT. Therefore, you may need to answer questions on this condition during your NCLEX-RN exam.
While you study for your upcoming exam, you will want to thoroughly understand what DVT is and what types of nursing interventions you can take to help patients reduce their risk of the condition or treat it should it occur.
Make Studying for the NCLEX Easy
As nursing students like you prepare for their future careers, they’ll need to take important exams demonstrating a mastery of essential nursing principles. You need to show that you are fully prepared to provide your patients with this vital nursing care.
To study for this future career in healthcare, you want to find resources that will help you prioritize the critical topics and fully understand the material.
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Sources:
[1] //www.ncbi.nlm.nih.gov/pmc/articles/PMC4624530/
[2] //www.ahajournals.org/doi/10.1161/01.STR.32.1.262
[3] //www.ncbi.nlm.nih.gov/pmc/articles/PMC6493054/