Nursing Dx

- RISK FACTOR
- Hypercoagulability,
COMPLICATION DEEP VEIN THROMBOSIS Ineffective tissue perfusion r/t blockage of blood
- Reduce blood flow ( Venous circulation aeb legs swollen, warmth to touched, and
stasis) DVT is the formation of the blood clot inside the
pt of pf leg pain 6/10
- Damage blood vessels vein
- Hip/knee surgery Impaired physical function r/t leg swelling and pain
- Imobility aeb pt said:” I cannot stand up and walk, my legs
- Pregnancy, are so painful”
- Oral contraceptive
- Active cancer.
Risk for pulmonary ablation r/t DVT aeb pt c/o of sob,
- Heart failure Oxygen drops to 94%, lung sound has crackle when
auscultated, and pt has cough consistently.
MEDICATION : Anticoagulant .
1- Risk for injury ( bleeding) r/t adverse effect of
Procedures for Deep Vein Thrombolytics or clot dissolvers:. anticoagulant therapy aeb pt has a bruise on her arm;
Thrombosis Antiplatelets. Factor Xa inhibitor: 3cmx2cmx 1cm.

Nursing intervention
● D-Dimer test:
- Rest, elevate the extremities above the level of the heart;
avoid use the pillow under the knee - block the flow of
D blood return
- Warmth
- Assist pt for the ROM
Angiovac Clot removal Device: ,Tenderness,Painful,
- Apply assistive devices : intermittent or continuous warm
Cramping on the legs ( moist compress
calf or groin pain), - or anti-embolism stocking
increase in circumference - Educate and encourage pt consume more foods high in
of calf, edema, zinc, protein, iron,, vit A and C
Pulmonary embolism: - Do not massage the affected area
light headache, - If anticoagulant given: Monitor bleeding
GOAL SOB,chest pain, fast HR - Prepare antidote
- Pt can be able to ambulate Inferior vena cava filter and cough - Maintain healthy diet
- Lab: CBC, Hgb, Hct, PTT, PT, IRN
- Vital sign WNL, lAB vALUE - - Monitor vital sign, Monitor s/sx of pulmonary embolism,
WNL assist with elevate HOB, oxygen/breathing
- No complication such as bleeding
or infection