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QUESTION
Title: two responses
Paper Details
Deep Vein Thrombosis
Deep vein thrombosis (DVT) or blood clot refers to the development of thrombosis resulting from platelet adherence to the venous walls as the thrombus becomes larger and then obstruct the vein (Ibrahim, Azza, Warda and Somaya, 2015). DVT mostly occurs in the deep veins of the leg, arm or pelvis (National Institute for Health and Care Excellence (NICE) 2012). According to Bonner and Johnson (2014), though most DVTs start distally in the veins of the calf, they can extend proximally into the veins at knee level and above the knee and from here, the thrombus can break off and travel to the lungs, causing a pulmonary embolism (PE). The collective term of venous thromboembolism (VTE) refers to both DVT and PE (NICE 2012). VTE is associated with significant morbidity and mortality. Upper extremities DVT can occur in any of the veins of the upper extremity or thoracic inlet which include the jugular, brachiocephalic, subclavian, axillary, distal brachial, ulnar and radial veins. Lower extremity DVT includes; femoral and popliteal veins (Bonner and Johnson, 2014).
Risks of Developing Deep Vein Thrombosis
According to Ibrahim, Azza, Warda and Somaya (2015) research study, trauma is one of the major risk factor of DVT which is the leading cause of death in Americans up to 44years old. More than 180, 000 people lose their lives due to trauma costing the Government approximately $406 billion a year on health care and lost productivity. Trauma causes direct injury to blood vessels which can cause intimal damage leading to the exposition of tissue factor at the sites of injury. This may cause extensive activation of the coagulation cascade with consumption of clotting factors and platelets. The result is that clotting factors and platelets are depleted because of the body’s attempts to form multiple clots. Risk factors for DVT in trauma patients include aging, prolonged immobility, lower-extremity and pelvic fractures, spinal cord injuries, head injuries, and ventilator timeframe. The research study also highlight that recognized risk factors for DVT are related to Virchow’s triad (stasis, vessel injury, and hypercoagulability) which trauma patients often suffer from (Ibrahim, Azza, Warda and Somaya, 2015).
Other risk factor includes; central venous catheters (CVC), peripherally inserted central catheters (PICC), and cardiac pacemakers. Up to 49% of patients with Upper limb (UE) DVT have a tumor or underlying malignant disease which increases the risk by a factor. Foreign bodies in the vascular system represent the most important independent risk factor for UE DVT. Surgical intervention is the third principal risk factor for DVT-UE. Prolonged immobility and being in a static position cause a reduction in venous blood returns and decrease in the supply of oxygen and nutrients to endothelial cells. Also, use of pharmacological sedations, intubation, catheterization, and neuromuscular block may decrease the velocity of limb venous blood flow (Heil et al., 2017).
Signs and Symptoms
DVT can occur without the patient showing any signs or symptoms. Several factors determine presentation of a DVT including the size of the thrombus, which can extend to occlude both proximal and distal veins. A DVT is more likely to cause symptoms when it obstructs venous outflow, resulting in inflammation of the vein wall and surrounding tissue. Common symptoms of a DVT include; warmth, redness, pain and swelling in the affected limb. When a patient reports these symptoms, as clinician, we need to perform physical examination of the whole limb to observe for signs that are suggestive of DVT which include; tenderness on palpation, warmth, erythema, cyanosis, edema and superficial venous dilation that can present as prominent collateral veins (Goolsby, Grubbs and Laurie, 2014).
Complications of Deep Vein Thrombosis
The most common complication of DVT is post-thrombotic syndrome (PTS). It can occur in more than one third of patients with DVT and can significantly affect the patient’s quality of life by causing pain, and heaviness and swelling in the leg, Other complication includes; chronic venous insufficiency, thrombophlebitis, loss of venous access, and recurrence. Serious but rare events are superior vena cava syndrome (SVC syndrome) and pulmonary embolism. (Bonner and Johnson, 2014).
Diagnostic Investigations and Treatment
Clinical diagnosis of DVT is non-specific and subjective, therefore objective diagnostic tests must be used to reduce the chances of a missed diagnosis to prevent complication. According to Bonner and Johnson (2014), if the clinical probability of a DVT is likely (two or more points on the two-level DVT Wells score), then the patient should be offered diagnostic testing without delay. NICE (2012) recommends the use of a D-dimer test and ultrasound scanning for the diagnosis of DVT. The NICE (2012) guideline also recommends that if a patient has to wait more than four hours for a diagnostic ultrasound scan, he or she should receive an interim 24-hour dose of a parenteral anticoagulant such as low-molecular-weight heparin. Venous ultrasonography is also recommended because it has a mean sensitivity and specificity of 97% and 94%, respectively, for the diagnosis of symptomatic proximal DVT. CT pulmonary angiogram is very reliable and recommended (NICE, 2012).
The goals of the primary treatment of DVT-UE by means of anticoagulation measures are to dissolve the thrombus, alleviate the symptoms, and prevent pulmonary embolism and post-thrombotic syndrome (PTS). Secondary preventive treatment must ensure there is no recurrence of DVT. Treatment of DVT consists of both pharmacological and mechanical interventions which is the use of anticoagulation (low-molecular weight heparins (LMWH); Patients are usually offered dual therapy with a parenteral and an oral anticoagulant such as Warfarin (the most commonly used vitamin K antagonist) and graduated compression stockings (NICE 2012).
Conclusion
The signs and symptoms mentioned are not always specific to DVT and can be present in numerous other conditions. Therefore, clinical judgement about the likelihood of DVT should also take into account, the patient’s individual risk factors for DVT, concurrent illnesses and medication, medical and surgical history as well as demographic characteristics (Bonner and Johnson, 2014). By taking this information into account, we future clinicians will be able to improve accuracy in predicting whether a DVT is present or not.this is the second on
Some risk factors for DVT include: having a history of DVT, conditions that make your blood thicker or more likely to clot than normal. Some inherited blood disorders such as factor V Leiden will do this. Hormone therapy or birth control pills also increase the risk of clotting. Other factors include: injury to a deep vein from surgery, a broken bone, trauma, slow blood flow in a deep vein due to lack of movement (Yoshimura, 2012). This may occur after surgery, if you're ill and in bed for a long time, or if you're traveling for a long time. Pregnancy and the first 6 weeks after giving birth is a critical time for DVT. Also, recent or ongoing treatment for cancer, having a central venous catheter, being older than 60 years old, being obese and smoking (Yoshimura, 2012). Some of the common symptoms that may occur when you have a DVT are, swelling in the leg, red, discolored, or white skin, a cord in a leg vein that can be felt, tachycardia, slight fever, warm skin, more visible surface veins, dull ache, tightness, and tenderness or pain in the leg. This pain may only occur while walking or standing (Yoshimura, 2012).
Most DVTS occur in the lower leg or thigh. They also can occur in other parts of the body. A blood clot in a deep vein can break off and travel through the bloodstream. If the clot gets loose the clot can travel to an artery in the lungs and block blood flow resulting in a pulmonary embolism(PE).PE is a very serious condition and it can damage the lungs and other organs in the body and cause death (Thomas, 2014). Blood clots in the thighs are more likely to break off and cause PE than blood clots in the lower legs or other parts of the body. Blood clots also can form in veins closer to the skin's surface (Thomas, 2014).
There are a couple different tests that can be ordered to rule out a DVT. A venography is a special X-ray where the doctor injects a radioactive dye into a vein on the top of your foot before it's taken to help see your veins and the clot. It's more accurate than an ultrasound, but there's a slight chance it will cause more blood clots (Thomas, 2014). Another test is a duplex ultrasound is where the doctor spreads warm gel on your skin and then rubs a wand over the area where he thinks the clot could be. The wand sends sound waves into your body and relays the echoes to a computer, which makes pictures of your blood vessels and sometimes the blood clots (Thomas, 2014). One other test is a MRI. This test sends radio waves and a strong magnetic field make detailed pictures of the inside of your body on a computer. This can find DVT in your pelvis and thigh (Thomas, 2014).I ONLY NEED ONE PG OF TWO RESPONSES AND ONE REFERENCE EACH. TO BE READY TOMORROW
| Subject | Nursing | Pages | 3 | Style | APA |
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Answer
Response to the First Paper
The author skilfully begin the writing by defining the topic of discussion. The definition of deep vein thrombosis (DVT) given by the author closely relate to the one given by Yamada, Tomita, Murakami, and Nakane (2016). They defined DVT as a form of blood clot that occur within the deep veins inside the body. The author’s coverage of the risk factors of developing DVT is explicit. The author covers the subtopic in a professional manner by relating the writing to past studies. The author outlines some of the risk factors as aging, lower extremity, head injuries, immobility.
The author then briefly gives additional risk factors and complications that arises from DVT. This approach is important as it gives the reader a deeper understanding of the risks of the disease. The author’s broad coverage of treatment and diagnostic investigation of DVT is impressive as it effectively captures the readers’ attention. In overall, the author used an organized outline of presenting the condition. As such, the work is highly informative thus, it can be used for educational purpose.
Response to the Second Paper
The author failed to introduce the topic of discussion. Jumping directly to the risk factors of DVT does not provide the reader with overview or basic knowledge of the topic of discussion. However, the coverage on risk factors of DVT as outlined by the author is really captivating. This is because the author has extensively discussed each risk factor indicating specifics such as being older than 60 years, pregnancy, and first six weeks after giving birth being the major risk factors (Yoshimura, 2012). The author’s coverage of the diagnostic investigation of DVT was shallowly covered. This is because it lacks a clear indication of the subtopic thus making it difficult for the reader to grasp the information being presented. Lastly, the work lacks proper organization of the entire work.(2017) study employed, there are very little room for generalizing the study’s findings.
References
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Yamada, S. M., Tomita, Y., Murakami, H., & Nakane, M. (2016). Deep Vein Thrombosis in the Lower Extremities in Comatose Elderly Patients with Acute Neurological Diseases. Yonsei medical journal, 57(2), 388-392. Yoshimura, N., Hori, Y., Horii, Y., Takano, T., Ishikawa, H., & Aoyama, H. (2012). Where is the most common site of DVT? Evaluation by CT venography. Japanese journal of radiology, 30(5), 393-397.
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