Text A: Deep vein thrombosis is a part of a condition called venous thromboembolism. Deep vein thrombosis occurs when a blood clot (thrombus) forms in one or more of the deep veins in the body, usually in the legs. Deep vein thrombosis can cause leg pain or swelling, but may occur without any symptoms. Deep vein thrombosis is a serious condition because blood clots in the veins can break loose, travel through the bloodstream, and obstruct the lungs, blocking blood flow.

Text B Clinical Manifestations A major problem associated with recognizing DVT is that the signs and symptoms are nonspecific.
Edema: With obstruction of the deep veins comes edema and swelling of the extremity because the outflow of venous blood is inhibited
Phlegmasiaceruleadolens: Also called massive iliofemoral venous thrombosis, the entire extremity becomes massively swollen, tense, painful, and cool to the touch.
Tenderness: Tenderness, which usually occurs later, is produced by inflammation of the vein wall and can be detected by gently palpating the affected extremity.
Pulmonary embolus: In some cases, signs and symptoms of a pulmonary embolus are the first indication of DVT
Medical Management The objectives for treatment of DVT are to prevent thrombus from growing and fragmenting, recurrent thromboemboli, and post thrombotic syndrome.
Endovascular management; Endovascular management is necessary for DVT when anticoagulant or thrombolytic therapy is contraindicated, the danger of pulmonary embolism is extreme, or venous drainage is so severely compromised that permanent damage to the extremity is likely.
Vena cava filter: A vena cava filter may be placed at the time of thrombectomy; this filter traps late emboli and prevents pulmonary emboli.
Discharge and Home Care Guidelines The nurse must also promote discharge and home care to the patient.

Text C Heparin (Rx)

Drug	Strength	Route of Administration	Recommended dosage	FIRST PTT CHECK
	1unit/mL 2units/mL 10units/mL 100units/mL	Sc/IV	80 units/kg IV bolus, THEN continuous infusion of 18 units/kg/hr, OR 5000 units IV bolus, THEN continuous infusion of 1300 units/hr, OR 250 units/kg (alternatively, 17,500 units) SC, THEN 250 units/kg q12hr	6 hours after starting infusion

Drug education : The nurse should teach about the prescribed anticoagulant, its purpose, and the need to take the correct amount at the specific times prescribed.
Blood tests: The patient should be aware that periodic blood tests are necessary to determine if a change in medication or dosage is required.
Avoid alcohol : A person who refuses to discontinue the use of alcohol should not receive anticoagulants because chronic alcohol intake decreases their effectiveness.
Activity: Explain the importance of elevating the legs and exercising adequately.

Text D Nursing Care Planning & Goals: The major goals for the patient include: Demonstrate increased perfusion as individually appropriate. Verbalize understanding of condition, therapy, regimen, side effects of medications, and when to contact the healthcare provider. Engage in behaviors or lifestyle changes to increase level of ease. Verbalize sense of comfort or contentment. Maintain position of function and skin integrity as evidenced by absence of contractures, foot drop, decubitus, and so forth. Maintain or increase strength and function of affected and/or compensatory body part.
Nursing Interventions: The major nursing interventions that the nurse should observe are:
Provide comfort; Elevation of the affected extremity, graduated compression stockings, warm application, and ambulation are adjuncts to the therapy that can remove or reduce discomfort.
Compression therapy: Graduated compression stockings reduce the caliber of the superficial veins in the leg and increase flow in the deep veins; external compression devices and wraps are short stretch elastic wraps that are applied from the toes to the knees in a 50% spiral overlap; intermittent pneumatic compression devices increase blood velocity beyond that produced by the stockings.
Positioning and exercise: When patient is on bed rest, the feet and lower legs should be elevated periodically above the level of the heart, and active and passive leg exercises should be performed to increase venous flow.

In which text can you find information about?

1. Endovascular management is for DVT …………………
2. Outflow of venous blood causing extreme swelling ………………….
3. The person receiving anticoagulants should avoid alcohol.……………
4. Deep vein thrombosis is asymptomatic sometimes …………………
5. Compression therapy reduces the caliber of the superficial veins in the leg …………………
6. The importance of keeping legs elevated …………………
7. The nursing interventions …………………

Questions 8-14: Answer each questions, 8-4, with a word or short phrase from one of the texts. Each answer may include words, number or the both. Your answers should be correctly spelled.

8. What is the route of administration of heparin? ……….
9. In which part of the body DVT normally occurs? ……….
10. When vena cava filler is used? ……….
11. Which management is preferred for DVT if anticoagulant or thrombolytic therapy is contraindicated?…
12. Which is the term used to describe the massive iliofemoral venous thrombosis?………
13. Which symptom usually occurs late in DVT?……..
14. DVT is a part of a condition called?

Questions 15-20. Complete each of the sentences, 15- 20, with a word or short phrase from one of the texts. Each answer may include words, number or both. Your answers should be correctly spelled
15. A major problem is associated with recognizing DVT is that the signs and symptoms are….
16. Tenderness which usually occurs later is produced by………………. of the vein wall
17. In some cases, signs and symptoms of a …………are the first indication.
18. First PPT check is ……………… hours after starting infusion.
19. 5000 units IV bolus, then continued infusion of ………units/hr.
20. The patient should be aware of periodic blood tests which are necessary to determine if a change in.… or dosage is required.

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