Dural Venous Sinus Thrombosis Student Nurses Hannah Dugger

Dural Venous Sinus Thrombosis Student Nurses: Hannah Dugger, Diana Dugrot, Taylor Godfrey, Yetta Johnson, & Rowena Parnell Objectives • Provide a case overview of the patient diagnosed with dural venous sinus thrombosis(DVST), whom was seen by the student nurse. • Identify the pathophysiology, risk factors, clinical manifestations, laboratory findings, and plan of care per guidelines for a patient diagnosed with DVST. • Apply appropriate nursing diagnoses, interventions, and goals for the treatment process for a patient with DVST. • Discuss the education and discharge planning necessary for the patients condition. • Summarize the presentation by relating the attained research and guidelines to the treatment provided to the actual patient. Pathophysiology • Spontaneous or precipitated thrombosis of the dural (cerebral) sinuses • Commonly caused by an underlying condition identified following the acute phase • Rare, under diagnosed (0. 5 – 1%) cause of stroke • 78% of cases occur in women, children, and patient’s <50 years of age • 10% to 15% mortality rate Risk Factors • Hypercoagulable state • Metabolic or hematological disorders • Malignancies • Collagenosis • Vasculitis • Traumatic brain injury/ concussion • Surgical interventions • Medication poisoning • Gastrointestinal disorders • Heart disease • Infection Diagnostics • Magnetic resonance Imaging (MRI) with venography Nursing Diagnoses • Ineffective cerebral tissue perfusion related to obstruction of blood flow as evidenced by speech, motor, and sensory deficits secondary to DVST • Risk for bleeding related to anticoagulant therapy • Risk for falls related to right side weakness Fig. 2 • Acute confusion related to cognitive disturbances as evidenced by decreased level of consciousness and disorientation secondary to DVST Fig. 1 a • D-dimer levels 500 ng/ml • Rehabilitative support, provider follow -up, and caregiver encouragement may prevent long-term deficits • Heparin ★ • Thrombolysis • Urokinase, alteplase • Long-term: warfarin • Normal CT and MRI are not recommended to definitively diagnose the condition • Anticoagulant therapy is the gold standard for treatment Treatment • Low molecular weight heparin • Enoxaparin, deltaparin, tinzaparin • Dural venous sinuses surround the brain and provide channels of transfer for blood and cerebrospinal fluid • Most of the risk factors for the condition are non-modifiable; however, some factors are modifiable if eliminated prior to progression of exacerbating condition • Magnetic resonance Imaging (MRI) with angiography • Computed tomography (CT) with angiograhy Conclusion Fig. 1 & Fig. 1 a: [Cerebral veins]. (n. d. ). Electronic illustration. Retrieved from https: //lh 3. googleusercontent. com/sx. RJLb. Aj 8 Dx 2 COI 3 i. Eux 2 yaice 2 c 1 kh. Ow TKv. Qv. L 3 Tl. REFg_go. Lj. HFDGj. I 6 Y 4 k. TCNZtqe. Zw=s 111 Fig. 2: [Untitled image of brain]. (n. d. ). Electronic illustration. Retrieved from https: //lh 3. googleusercontent. com/w. XGh. T 2 z 3 w 2 rca. IJ 3 N 6 j 9 HCj. Pq. QLlwlr. Prgx. SELn. Gvxj. Lg. Xc_-1 Et. SGRCGFJulfo. XSK 8 A=s 128 References Herdman, T. & Kamitsuru, S. (2014). NANDA International nursing diagnoses: Definitions and classifications, 2015 -2017 (10 th ed. ). Oxford: Wiley Blackwell. Weimar, C. (2014). Diagnosis and treatment of cerebral venous and sinus thrombosis. Current Neurology and Neuroscience Report, 14(1).