The Cardiovascular System NRS 108 ECC Majuvy L

The Cardiovascular System NRS 108 -ECC Majuvy L. Sulse RN, MSN, CCRN Lola Oyedele RN, MSN, CTN

SITES FOR PALPATING PERIPHERAL PULSES From Monahan, F. & Neighbors, M. (1998). Medical-surgical nursing: Foundations for clinical practice, ed 2, Philadelphia: W. B. Saunders

VEINS IN THE LEG From Jarvis, C. (2000). Physical examination and health assessment, ed 3, Philadelphia: W. B. Saunders

VENOUS THROMBOSIS p DESCRIPTION n n Thrombus can be associated with an inflammatory process When a thrombus develops, inflammation occurs that thickens the vein wall leading to embolization

TYPES OF VENOUS THROMBOSIS p THROMBOPHLEBITIS n p PHLEBOTHROMBUS n p A thrombus without inflammation PHLEBITIS n p A thrombus associated with inflammation Vein inflammation associated with invasive procedures such as IVs DEEP VEIN THROMBOPHLEBITIS (DVT) n More serious than a superficial thrombophlebitis because of the risk for pulmonary embolism

RISKS FACTORS FOR VENOUS THROMBOSIS Venous stasis from varicose veins, heart failure, immobility p Hypercoagulability disorders p Injury to the venous wall from IV injections, fractures, trauma p Following surgery, particularly hip surgery and open prostate surgery p Pregnancy p Ulcerative colitis p Use of oral contraceptives p

PHLEBITIS p ASSESSMENT n n n p Red, warm area radiating up an extremity Pain and soreness Swelling IMPLEMENTATION n n n Apply warm, moist soaks as prescribed to dilate the vein and promote circulation Assess temperature of soak prior to applying Assess for signs of complications such as tissue necrosis, infection, or pulmonary embolus

DEEP VEIN THROMBOPHLEBITIS (DVT) p ASSESSMENT n n n Calf or groin tenderness or pain with or without swelling Positive Homans’ sign Warm skin that is tender to touch

DEEP VEIN THROMBOPHLEBITIS (DVT) p IMPLEMENTATION n n n Provide bed rest Elevate the affected extremity above the level of the heart as prescribed Avoid using the knee gatch or a pillow under the knees Do not massage the extremity Provide thigh-high compression or antiembolism stockings as prescribed to reduce venous stasis and to assist in the venous return of blood to the heart

DEEP VEIN THROMBOPHLEBITIS (DVT) p IMPLEMENTATION n n Administer intermittent or continuous warm, moist compresses as prescribed Palpate the site gently, monitoring for warmth and edema Measure and record the circumference of the thighs and calves Monitor for shortness of breath and chest pain, which can indicate pulmonary emboli

DEEP VEIN THROMBOPHLEBITIS (DVT) p IMPLEMENTATION n n Administer thrombolytic therapy (t-PA, tissue plasminogen activator) if prescribed, which must be initiated within 5 days after the onset of symptoms Administer heparin therapy as prescribed to prevent enlargement of the existing clot and prevent the formation of new clots Monitor APTT during heparin therapy Administer warfarin (Coumadin) therapy as prescribed when the symptoms of DVT have resolved

DEEP VEIN THROMBOPHLEBITIS (DVT) p IMPLEMENTATION n n n Monitor PT and INR during warfarin (Coumadin) therapy Monitor for the hazards and side effects associated with anticoagulant therapy Administer analgesics as prescribed to reduce pain Administer diuretics as prescribed to reduce lower extremity edema Provide client teaching

ASSESSING FOR PERIPHERAL EDEMA From Black, J. , Hawks, J, and Keene, A. (2001). Medical-surgical nursing, ed 6, Philadelphia: W. B. Saunders

DEEP VEIN THROMBOPHLEBITIS (DVT) p CLIENT EDUCATION n n n Hazards of anticoagulation therapy Signs and symptoms of bleeding Avoid prolonged sitting or standing, constrictive clothing, or crossing legs when seated Elevate the legs for 10 to 20 minutes every few hours each day Plan a progressive walking program

DEEP VEIN THROMBOPHLEBITIS (DVT) p CLIENT EDUCATION n n n Inspect the legs for edema and how to measure the circumference of the legs Antiembolism stockings (hose) as prescribed Avoid smoking Avoid any medications unless prescribed by the physician Importance of follow-up physician visits and laboratory studies Obtain and wear a Medic Alert bracelet

ANTIEMBOLISM HOSE From Elkin MF, Perry AG, Potter PA: Nursing interventions and clinical skills, ed. 2, St. Louis, 2000, Mosby.

VENOUS INSUFFICIENCY p DESCRIPTION n n Results from prolonged venous hypertension that stretches the veins and damages the valves The resultant edema and venous stasis causes venous stasis ulcers, swelling, and cellulitis Treatment focuses on decreasing edema and promoting venous return from the affected extremity Treatment for venous stasis ulcers focuses on healing the ulcer and preventing stasis and ulcer recurrence

VENOUS INSUFFICIENCY p ASSESSMENT n n n Stasis dermatitis or discoloration along the ankles extending up to the calf Edema The presence of ulcer formation

PERIPHERAL VASCULAR DISEASE From Bryant RA (1992): Acute and chronic wounds: nursing management, St. Louis: Mosby. Courtesy of Abbott Northwestern Hospital, Minneapolis, MN.

VENOUS INSUFFICIENCY p WOUND CARE n n n Provide care to the wound as prescribed by the physician Assess the client’s ability to care for the wound, and initiate home care resources as necessary If an Unna boot (a dressing constructed of gauze moistened with zinc oxide) is prescribed, it will be changed by the physician weekly

VENOUS INSUFFICIENCY p WOUND CARE n n The wound is cleansed with normal saline prior to application of the Unna boot; providoneiodine (Betadine) or hydrogen peroxide is not used because they destroy granulation tissue The Unna boot is covered with an elastic wrap that hardens, to promote venous return and prevent stasis Monitor for signs of arterial occlusion from an Unna boot that may be too tight Keep tape off of the client’s skin

VENOUS INSUFFICIENCY p MEDICATIONS n n n Apply topical agents to wound as prescribed to debride the ulcer, eliminate necrotic tissue, and promote healing When applying topical agents, apply an oilbased agent as petroleum jelly (Vaseline) on surrounding skin, because debriding agents can injure healthy tissue Administer antibiotics as prescribed if infection or cellulitis occur

VENOUS INSUFFICIENCY p CLIENT EDUCATION n n n Wear elastic or compression stockings during the day and evening as prescribed Put on elastic stockings upon awakening before getting out of bed Put a clean pair of elastic stockings on each day and that it will probably be necessary to wear the stockings for the remainder of life

VENOUS INSUFFICIENCY p CLIENT EDUCATION n n n Avoid prolonged sitting or standing, constrictive clothing, or crossing legs when seated Elevate the legs for 10 to 20 minutes every few hours each day Elevate legs above the level of the heart when in bed

VENOUS INSUFFICIENCY p CLIENT EDUCATION n n The use of an intermittent sequential pneumatic compression system, if prescribed; instruct the client to apply the compression system twice daily for 1 hour in the morning and evening Advise the client with an open ulcer that the compression system is applied over a dressing

VARICOSE VEINS p DESCRIPTION n n p Distended protruding veins that appear darkened and tortuous Vein walls weaken and dilate, and valves become incompetent ASSESSMENT n n n Pain in the legs with dull aching after standing A feeling of fullness in the legs Ankle edema

NORMAL VEINS AND VARICOSITIES From Monahan, F. & Neighbors, M. (1998). Medical-surgical nursing: Foundations for clinical practice, ed 2, Philadelphia: W. B. Saunders

VARICOSE VEINS From Mosby’s Medical, Nursing, and Allied Health Dictionary, ed 6, (2002). St. Louis: Mosby

VARICOSE VEINS p TRENDELENBURG TEST n n Place the client in a supine position with the legs elevated When the client sits up, if varicosities are present, veins fill from the proximal end; veins normally fill from the distal end

TRENDELENBURG TEST From Jarvis, C. (2000). Physical examination and health assessment, ed 3, Philadelphia: W. B. Saunders

VARICOSE VEINS p IMPLEMENTATION n n n Assist with the Trendelenburg test Emphasize the importance of antiembolism stockings as prescribed Instruct the client to elevate the legs as much as possible Instruct the client to avoid constrictive clothing and pressure on the legs Prepare the client for sclerotherapy or vein stripping, as prescribed

SCLEROTHERAPY p DESCRIPTION n n A solution is injected into the vein followed by the application of a pressure dressing An incision and drainage of the trapped blood in the sclerosed vein is performed 14 to 21 days after the injection, followed by the application of a pressure dressing for 12 to 18 hours

VEIN STRIPPING p DESCRIPTION n p Varicose veins are removed if they are larger than 4 mm in diameter or if they are in clusters PREOPERATIVE n n Assist the physician with vein marking Evaluate pulses as a baseline for comparison postoperatively

VEIN STRIPPING p POSTOPERATIVE n n Maintain elastic (Ace) bandages on the client’s legs Monitor the groin and leg for bleeding through the elastic bandages Monitor the extremity for edema, warmth, color, and pulses Elevate the legs above the level of the heart

VEIN STRIPPING p POSTOPERATIVE n n Encourage range-of-motion exercises of the legs Instruct the client to avoid leg dangling or chair sitting Instruct the client to elevate the legs when sitting Emphasize the importance of wearing elastic stockings after bandage removal

PERIPHERAL ARTERIAL DISEASE (PAD) p DESCRIPTION n n n A chronic disorder in which partial or total arterial occlusion deprives the lower extremities of oxygen and nutrients Tissue damage occurs below the level of the arterial occlusion Atherosclerosis is the most common cause of PAD

ARTERIES IN THE LEG From Jarvis, C. (2000). Physical examination and health assessment, ed 3, Philadelphia: W. B. Saunders

PERIPHERAL ARTERIAL DISEASE (PAD) p ASSESSMENT n n n Intermittent claudication (pain in the muscles resulting from an inadequate blood supply) Rest pain, characterized by numbness, burning or aching in the distal portion of the lower extremities, that awakens the client at night and is relieved by placing the extremity in a dependent position Lower back or buttock discomfort

PERIPHERAL ARTERIAL DISEASE (PAD) p ASSESSMENT n n n Loss of hair and dry scaly skin on the lower extremities Thickened toenails Cold and gray-blue color of skin in the lower extremities Elevational pallor and dependent rubor in the lower extremities Decreased or absent peripheral pulses

PERIPHERAL ARTERIAL DISEASE (PAD) p ASSESSMENT n n Signs of arterial ulcer formation occurring on or between the toes, or on the upper aspect of the foot, that are characterized as painful Blood pressure measurements at the thigh, calf, and ankle are lower than the brachial pressure (normally BP readings in the thigh and calf are higher than those in the upper extremities)

ARTERIAL OBSTRUCTIONS AND CORRESPONDING AREAS OF CLAUDICATION From Monahan, F. & Neighbors, M. (1998). Medical-surgical nursing: Foundations for clinical practice, ed 2, Philadelphia: W. B. Saunders

ARTERIAL INSUFFICIENCY From Lemmi FO, Lemmi CAE: Physical assessment findings CD-ROM, Philadelphia, 2000, W. B. Saunders.

GANGRENE From Auerbach PS: Wilderness Medicine: Management of wilderness and environmental emergencies, ed. 3, St. Louis, 1995, Mosby.

PERIPHERAL ARTERIAL DISEASE (PAD) p IMPLEMENTATION n n n Assess pain Monitor the extremities for color, motion and sensation, and pulses Obtain BP measurements Assess for signs of ulcer formation or signs of gangrene Assist in developing an individualized exercise program that is initiated gradually and slowly increased

PERIPHERAL ARTERIAL DISEASE (PAD) p IMPLEMENTATION n n Encourage prescribed exercise, which will improve arterial flow through the development of collateral circulation Instruct the client to walk to the point of claudication, stop and rest, then walk a little further

PERIPHERAL ARTERIAL DISEASE (PAD) p IMPLEMENTATION n n As swelling in the extremities prevents arterial blood flow, instruct the client to elevate his or her feet at rest, but to refrain from elevating them above the level of the heart, because extreme elevation slows arterial blood flow to the feet In severe cases of PAD, clients with edema may sleep with the affected limb hanging from the bed or they may sit upright in a chair for comfort

PERIPHERAL ARTERIAL DISEASE (PAD) p CLIENT EDUCATION n n n Avoid crossing the legs, which interferes with blood flow Avoid exposure to cold (causes vasoconstriction) to the extremities and to wear socks or insulated shoes for warmth at all times Never to apply direct heat to the limb such as with a heating pad or hot water, because the decreased sensitivity in the limb may result in burning

PERIPHERAL ARTERIAL DISEASE (PAD) p CLIENT EDUCATION n n Inspect the skin on the extremities daily and to report any signs of skin breakdown Avoid tobacco and caffeine because of their vasoconstrictive effects Use of hemorrheologic and antiplatelet medications as prescribed Importance of taking all medications prescribed by the physician

PERIPHERAL ARTERIAL DISEASE (PAD) p PROCEDURES TO IMPROVE ARTERIAL BLOOD FLOW n n Percutaneous transluminal angioplasty Laser-assisted angioplasty Atherectomy Bypass surgery (aortofemoral or femoralpopliteal)

RAYNAUD’S DISEASE p DESCRIPTION n n Vasospasms of the arterioles and arteries of the upper and lower extremities Vasospasm causes constriction of the cutaneous vessels Attacks are intermittent and occur with exposure to cold or stress Affects primarily fingers, toes, ears, and cheeks

RAYNAUD’S DISEASE p ASSESSMENT n n n Blanching of the extremity, followed by cyanosis during vasoconstriction Reddened tissue when the vasospasm is relieved Numbness, tingling, swelling, and a cold temperature at the affected body part

RAYNAUD’S PHENOMENON From Barkauskas VH et al (1998) Health and physical assessment (2 nd ed. ). St. Louis: Mosby.

RAYNAUD’S DISEASE p IMPLEMENTATION n n n p Monitor pulses Administer vasodilators as prescribed Assist the client to identify and avoid precipitating factors such as cold and stress CLIENT EDUCATION n n Medication therapy Avoid smoking Wear warm clothing, socks, and gloves in cold weather Avoid injuries to fingers and hands

BUERGER'S DISEASE p DESCRIPTION n n n An occlusive disease of the median and small arteries and veins The distal upper and lower limbs are most commonly affected Also known as thromboangiitis obliterans

BUERGER'S DISEASE p ASSESSMENT n n n n Intermittent claudication Ischemic pain occurring in the digits while at rest Aching pain that is more severe at night Cool, numb, or tingling sensation Diminished pulses in the distal extremities Extremities are cool and red in the dependent position Development of ulcerations in the extremities

BUERGER'S DISEASE p IMPLEMENTATION n n n Instruct the client to stop smoking Monitor pulses Instruct the client to avoid injury to the upper and lower extremities Administer vasodilators as prescribed Instruct the client regarding medication therapy

AORTIC ANEURYSMS p DESCRIPTION n n n Abnormal dilation of the arterial wall, caused by localized weakness and stretching in the medial layer or wall of an artery The aneurysm can be located anywhere along the abdominal aorta The goal of treatment is to limit the progression of the disease by modifying risk factors, controlling the BP to prevent strain on the aneurysm, recognizing symptoms early, and preventing rupture

ARTERIAL OCCLUSION AND ANEURYSMS From Monahan, F. & Neighbors, M. (1998). Medical-surgical nursing: Foundations for clinical practice, ed 2, Philadelphia: W. B. Saunders

TYPES OF ANEURYSMS p FUSIFORM n p Diffuse dilation that involves the entire circumference of the arterial segment SACCULAR n Distinct localized outpouching of the artery wall

TYPES OF ANEURYSMS p DISSECTING n p Created when blood separates the layers of the artery wall forming a cavity between them FALSE (PSEUDOANEURYSM) n n Occurs when the clot and connective tissue are outside the arterial wall Formed after complete rupture and subsequent formation of a scar sac

TYPES OF ANEURYSMS From Monahan, F. & Neighbors, M. (1998). Medical-surgical nursing: Foundations for clinical practice, ed 2, Philadelphia: W. B. Saunders

THORACIC AORTIC ANEURYSM p ASSESSMENT n n n Pain extending to neck, shoulders, lower back, or abdomen Syncope Dyspnea Increased pulse Cyanosis Weakness

ABDOMINAL AORTIC ANEURYSM p ASSESSMENT n n Prominent, pulsating mass in abdomen, at or above the umbilicus Systolic bruit over the aorta Tenderness on deep palpation Abdominal or lower back pain

RUPTURING ANEURYSM p ASSESSMENT n n n Severe abdominal or back pain Lumbar pain radiating to the flank and groin Hypotension Increased pulse rate Signs of shock

RUPTURED ABDOMINAL AORTIC ANEURYSM From Cotran RS, Kumar V, Collins T: Robbins’ pathologic basis of disease, ed. 6, Philadelphia, 1999, W. B. Saunders.

AORTIC ANEURYSMS p DIAGNOSTIC TESTS n n Done to confirm the presence, size, and location of the aneurysm Includes abdominal ultrasound, CT scan, and arteriography

AORTIC ANEURYSMS p IMPLEMENTATION n n Monitor vital signs Obtain information regarding back or abdominal pain Question the client regarding the sensation of palpation in the abdomen Inspect the skin for the presence of vascular disease or breakdown

AORTIC ANEURYSMS p IMPLEMENTATION n n Check peripheral circulation including pulses, temperature, and color Observe for signs of rupture Note any tenderness over the abdomen Monitor for abdominal distention

AORTIC ANEURYSMS p NONSURGICAL IMPLEMENTATION n n n Modify risk factors Instruct the client regarding the procedure for monitoring BP Instruct the client on the importance of regular physician visits to follow the size of the aneurysm

AORTIC ANEURYSMS p NONSURGICAL IMPLEMENTATION n n Instruct the client that if severe back or abdominal pain or fullness, soreness over the umbilicus, sudden development of discoloration in the extremities, or a persistent elevation of BP occurs, to notify the physician immediately Instruct the client with a thoracic aneurysm to immediately report the occurrence of chest or back pain, shortness of breath, difficulty swallowing, or hoarseness

AORTIC ANEURYSMS p PHARMACOLOGICAL IMPLEMENTATION n n n Administer antihypertensives to maintain the BP within normal limits and to prevent strain on the aneurysm Instruct the client in the purpose of the medications Instruct the client about the side effects and schedule of the medication

ABDOMINAL AORTIC ANEURYSM RESECTION p DESCRIPTION n n Surgical resection or excision of the aneurysm The excised section is replaced with a graft that is sewn end-to-end

ANEURYSM RESECTION WITH GRAFT From Monahan, F. & Neighbors, M. (1998). Medical-surgical nursing: Foundations for clinical practice, ed 2, Philadelphia: W. B. Saunders

ABDOMINAL AORTIC ANEURYSM RESECTION p PREOPERATIVE n n n Assess all peripheral pulses as a baseline for postoperative comparison Instruct the client on coughing and deepbreathing exercises Administer bowel preparation as prescribed

ABDOMINAL AORTIC ANEURYSM RESECTION p POSTOPERATIVE n n Monitor vital signs Monitor peripheral pulses distal to the graft site Monitor for signs of graft occlusion, including changes in pulses, cool to cold extremities below the graft, white or blue extremities or flanks, severe pain, or abdominal distention Limit elevation of the head of the bed to 45 degrees to prevent flexion of the graft

ABDOMINAL AORTIC ANEURYSM RESECTION p POSTOPERATIVE n n Monitor for hypovolemia and renal failure due to significant blood loss during surgery Monitor urine output hourly, and notify the physician if it is less than 50 ml per hour Monitor serum creatinine and BUN daily Monitor respiratory status and auscultate breath sounds to identify respiratory complications

ABDOMINAL AORTIC ANEURYSM RESECTION p POSTOPERATIVE n n n Encourage turning, coughing and deep breathing, and splinting the incision; ambulate as prescribed Maintain nasogastric tube to low suction until bowel sounds return Assess for bowel sounds and report their return to the physician Monitor for pain and administer medication as prescribed Assess incision site for bleeding or signs of infection

ABDOMINAL AORTIC ANEURYSM RESECTION p POSTOPERATIVE n n Prepare the client for discharge by providing instructions regarding pain management, wound care, and activity restrictions Instruct the client not to lift objects greater than 15 to 20 pounds for 6 to 12 weeks Advise the client to avoid activities requiring pushing, pulling, or straining Instruct the client not to drive a vehicle until approved by the physician

THORACIC AORTIC ANEURYSM REPAIR p DESCRIPTION n n A thoracotomy or median sternotomy approach is used to enter the thoracic cavity The aneurysm is exposed, excised, and a graft or prosthesis is sewn onto the aorta Total cardiopulmonary bypass is necessary for excision of aneurysms in the ascending aorta Partial cardiopulmonary bypass is used for clients with an aneurysm in the descending aorta

THORACIC AORTIC ANEURYSM REPAIR p POSTOPERATIVE n n n Monitor vital signs Monitor for signs of hemorrhage such as a drop in BP, increased pulse rate and respirations, and report to the physician immediately Monitor chest tubes for an increase in chest drainage, which may indicate bleeding or separation at the graft site

THORACIC AORTIC ANEURYSM REPAIR p POSTOPERATIVE n n Assess sensation and motion of all extremities and notify the physician if deficits occur, which can be due to a lack of blood supply during surgery Monitor respiratory status and auscultate breath sounds to identify respiratory complications Encourage turning, coughing, and deep breathing, splinting the incision Monitor cardiac status for dysrhythmias

THORACIC AORTIC ANEURYSM REPAIR p POSTOPERATIVE n n n Monitor for pain and administer medication as prescribed Assess the incision site for bleeding or signs of infection Prepare the client for discharge by providing instructions regarding pain management, wound care, and activity restrictions

THORACIC AORTIC ANEURYSM REPAIR p POSTOPERATIVE n n n Instruct the client not to lift objects greater than 15 to 20 pounds for 6 to 12 weeks Advise the client to avoid activities requiring pushing, pulling, or straining Instruct the client not to drive a vehicle until approved by the physician

EMBOLECTOMY p DESCRIPTION n n Removal of an embolus from an artery using a catheter A patch graft may be required to close the artery

EMBOLECTOMY p PREOPERATIVE n n n Obtain a baseline vascular assessment Administer anticoagulants as prescribed Administer thrombolytics as prescribed Place a bed cradle on the bed Avoid bumping or jarring the bed Maintain the extremity in slightly dependent position

EMBOLECTOMY p POSTOPERATIVE n n n Assess cardiac, respiratory, and neurological status Monitor affected extremity for color, temperature, and pulse Assess sensory and motor function of the affected extremity Monitor for signs and symptoms of new thrombi or emboli Administer oxygen as prescribed Monitor pulse oximetry

EMBOLECTOMY p POSTOPERATIVE n n Monitor for complications caused by reperfusion of the artery, such as spasms and swelling of the skeletal muscles Monitor for signs of swollen skeletal muscles, such as edema, pain on passive movement, poor capillary refill, numbness, and muscle tenseness Maintain bed rest initially, with the client in semi-Fowler’s position Place a bed cradle on the bed

EMBOLECTOMY p POSTOPERATIVE n n n Check the incision site for bleeding or hematoma Administer anticoagulants as prescribed Monitor laboratory values related to anticoagulant therapy Instruct the client to recognize the signs and symptoms of infection and edema Instruct the client to avoid prolonged sitting or crossing the legs when sitting

EMBOLECTOMY p POSTOPERATIVE n n Instruct the client to elevate the legs when sitting Instruct the client to wear antiembolism stockings as prescribed and how to remove and reapply the stockings Instruct the client to ambulate daily Instruct the client about anticoagulant therapy and the hazards associated with anticoagulants

VENA CAVAL FILTER AND LIGATION OF INFERIOR VENA CAVA p VENA CAVAL FILTER n p Insertion of an intracaval filter (umbrella) that partially occludes the inferior vena cava and traps emboli to prevent pulmonary emboli LIGATION n Suturing or placing clips on the inferior vena cava to prevent pulmonary emboli

VENA CAVAL FILTERS From Black, J. , Hawks, J. , & Keene, A. (2001). Medical-surgical nursing: Clinical management for positive outcomes, ed 6, Philadelphia: W. B. Saunders

VENA CAVAL FILTER AND LIGATION OF INFERIOR VENA CAVA p POSTOPERATIVE n n n n Monitor vital signs Assess cardiac and respiratory status Administer oxygen as prescribed Monitor pulse oximetry Maintain semi-Fowler’s position Avoid hip flexion Maintain antiembolism stockings as prescribed

VENA CAVAL FILTER AND LIGATION OF INFERIOR VENA CAVA p PREOPERATIVE n If the client has been taking an anticoagulant, consult with the physician regarding discontinuation of the medication to prevent hemorrhage

VENA CAVAL FILTER AND LIGATION OF INFERIOR VENA CAVA p POSTOPERATIVE n n Provide activity as prescribed Check the insertion site for bleeding and hematoma Assess for peripheral edema Monitor laboratory values related to anticoagulant therapy

VENA CAVAL FILTER AND LIGATION OF INFERIOR VENA CAVA p CLIENT EDUCATION n n n Signs and symptoms of infection and edema Avoid prolonged sitting or crossing legs when sitting Elevate the legs when sitting Wear antiembolism stockings as prescribed and how to remove and reapply the stockings Ambulate daily About anticoagulant therapy and the hazards associated with anticoagulants