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370 Textbook of Cardiovascular and Thoracic Nursing

• Other laboratory studies to monitor as ordered or if bleeding is suspected while patient is taking unfractionated
heparin:
- Platelet count
Hemoglobin and
hematocrit
- Fibrinogen
• Prothrombin time (PT) and international normalized ratio (INR) are the coagulation tests used to monitor the
anticoagulation effects of warfarin.
• Other laboratory studies to monitor as ordered or if bleeding is suspected while patient is taking warfarin:
- Platelet count
- Hemoglobin level and hematocrit.
Preventing Hazards of Immobility
• Prevent venous stasis by proper positioning in bed.
• Support full length of legs when they are to be elevated.
• Initiate active exercises unless contraindicated, in such case use passive exercises.
• Encourage adequate fluid intake, frequent changes of position, and effective coughing and deep-breathing
exercises.
• Be alert for signs of pulmonary embolism chest pain, dyspnea, anxiety, and apprehension and report immediately.
• After the acute phase (5 to 7 days), apply elastic stockings as directed.
• Remove twice daily and check for skin changes, pressure points,
and calf tenderness.
Health Education
• Teach patient signs of recurrent thrombophlebitis and pulmonary
embolism to report immediately.
• Provide thorough instructions about anticoagulant therapy.
• Teach patient to promote circulation and prevent stasis by
applying elastic hose at home.
• Advice against straining or any maneuver that increases venous
pressure in the leg. Eliminate the necessity to strain at stool by
increasing fiber and fluids in the diet.
• Advice the patient to avoid smoking since nicotine causes
constriction veins thereby decreasing the venous blood flow.
• Advice patient to avoid prolonged periods of sitting or
standing. If necessary, perform exercises to encourage venous
return.

VARICOSE VEINS
• Varicose veins are (Fig. 19.1) dilated, tortuous subcutaneous veins
Fig. 19.1: Varicose veins
most frequently found in the saphenous system.
• Primary varicose veins (idiopathic), which are more common in women and patients with a strong family
history, are probably caused by congenital weakness of the veins.
• Secondary varicose veins typically result from a previous DVT or another identifiable obstruction. Secondary
varicose veins also may occur in the esophagus (esophageal varices), in the anorectal area (hemorrhoids).

Predisposing Factors
• Age
• Sex
• Race
• Weight
• Height
• Diet
• Bowel habit