Running head: DEEP VEIN THROMBOSIS

DEEP VEIN THROMBOSIS

Name of the Student

Name of the University

Author note
 My clinical placement was on St George hospital Sydney in oncology ward. I was

looking after a patient named Mr X is who is suffering from deep vein thrombosis; he is 65

years of age. He is having a complain of swelling in the left leg for 30days. He was having a

right sided abdominal pain for last 20 days and having breathlessness for 4 days. He takes

mixed diet and is a chain smoker. The weight of the patient is 88 kg and he was not suffering

from any cough, altered sensorium, trauma or improper bowel habits. Two years before he

was diagnosed with arthritis which he takes NSAIDS and he is non-diabetic however, he

suffers from hypertension. He is asthmatic and not a tuberculosis or epileptic patient. He is

suffering from breathlessness for last 3 days and the abdominal pain which is dull aching

towards the right hypochondria as well as no relieving or non-aggravating. He was suffering

from fever, weakness, nose bleeding and swollen nodes. One year before Mx.X was

diagnosed with leukaemia.

1 DEEPDeep
VEINvein thrombosis (DVT) is an illness which occurs when there is a blood clot in
THROMBOSIS

the vein that is present deep inside the body. A blood clot is cluster of blood which is turned

in solid state (Watson et al. 2016). DVT clots forms in thigh or else in lower leg, however

they develop in other regions of the body. The blood clots for DVT is caused as it prevents

the blood from circulating or clotting generally, like injury in a vein, during surgery, or due to

specific medications besides restricted movement.

DVT is highly serious as blood clots in veins breaks the loose, that travel through the

bloodstream besides stays in the lungs, thereby blocking the flow of blood (pulmonary

embolism). The symptoms of DVT includes pain in leg due to swelling, discoloured or red

coloured leg or feeling of warmth in the affected leg. DVT can also occur deprived of

perceptible symptoms (Di Nisio et al. 2016). Prophylaxis helps in treating DVT.
 The pathophysiology of DVT- It is caused due to pulmonary embolism and due to

impairment in the venous return, dysfunction, hypercoagulability as well as endothelial

injury. Valves coordinates blood flow by venous circulation and DVT creates potential

location for the hypoxia and venous stasis (Othieno et al. 2018).

The risk factors for DVT includes family history of blood clotting disorder, surgery or

injury, long bed rest or paralysis, cancer, overweight, heart failure, smoking or inflammatory

bowel movement. DVT have precise risk factors which have been extensively deliberate to

progress diagnostic methods in addition to, more prominently, anticipation. The most mutual

origins are in boundaries, where lower extremity is superior in comparison to the upper

extremity, which can occur in mesentery or else pelvic veins (Streiff et al. 2016). These are

not noticeable by Doppler ultrasound investigation. The prophylaxis grounded on the risk

factors is experienced in every hospital, with use of Lovenox along with pneumatic pressure

2 devices
DEEP or otherTHROMBOSIS
VEIN anticoagulants. In this case the patient was found to be overweight as well as

smoker. Hence, both of these factors creates pressure on veins thereby reducing blood flow

and causing DVT. The most significant cause for DVT in Mr. X is leukaemia. Cancer cell

damages the tissues causing swelling and instigating clotting. They churn out chemicals

causing clots.

The care was being implemented of Mr. X was first to provide him comfort. The

nurses must make sure that the left leg is in comfortable situation, so that there is proper

blood flow. In case of Mr. X it is predicted that leukaemia is increasing the pain. After

keeping his leg in comfortable position a Doppler ultra sound treatment would be given to

him as this sound waves can identify the blood flow in the veins and blood clots can be

noticed (Ageno et al.2016). The x-ray image would also give a clear analysis blood clots. All

the test arrangement would be done by nurses. Mr. X would be taken to the X-ray unit of

oncology for analysis. I recommended that the reduced mobility is defined as a strong risk
 factor for deep vein thrombosis besides they should be considered in context of oncology. In

my nursing knowledge I have noticed that palliative patient undergoes DVT risk assessment

and patient who are in terminal stage do not require prophylaxis (Meissner 2019). However,

Mr. X needs prophylaxis for treatment. The patient care approach is fulfilled by discussing

the risk factors with the patient. I as a nurse made the patient relax and comfortable and even

ask the patient if he is comfortable enough to discuss his health issue at that moment if not I

would ask him when to come and explain him the disease. Then I shared details about VTE

(venous thromboembolism), I will share about the signs and symptoms of VTE and would

link it with leukaemia that he is already undergoing. I explained him all the risk factors for

VTE that his blood clot might lead to pulmonary or heart failure and I will also explain him

that due to leukaemia the cell damages are occurring causing inflammation and blood clots

(Friedman et al. 2018).

3 DEEPInvolvement of the multidisciplinary team would help and better collaboration of

VEIN THROMBOSIS

health professionals and practitioners in the field of health and social care to collaborate

effectively. An effective caring would help in greater satisfaction from the patient side and

efficient resources are used for enhancing the treatment measures for Mr. X. I checked if Mr.

X needs any pharmacological as well as mechanical prophylaxis required during admittance

of patient that commenced for risk assessments and care (Health.nsw.gov.au, 2020). The

pattern of mechanical and pharmacological prophylaxis need to be informed as evidence.

PHOs would be ensured about the system which are in place in order to provide clinicians to

have an access to all the evidence guidelines and protocols. Health High Risk Medicines

Management Policy Directive guidelines are to be followed for proper pharmacological

prophylaxis setting in the pattern of an anti-coagulant and that needs accordance.

DVT prevention is needed hence, the documentation for Prophylaxis would be done

by electronic prescribing system that were in use. The medical officer who is attending Mr. X
 would be in charge of this can confirm the use of prophylaxis for DVT prevention. I as a

nurse prescribe mechanical or pharmacological prophylaxis according to the protocol.

However, I should keep in mind that any prescription outside the section would be considered

as a duplication of order causing harm to patient (Safetyandquality.gov, 2020). The

mechanical prophylaxis with check associates are documented twice by the nurses and

midwives. We used mechanical prophylaxis to prevent DVT and we have received significant

result. It compresses and makes the blood flow normal however, mechanical prophylaxis

causes nausea, vomiting, tiredness and diarrhoea in patient. This further sickness scares

patient from taking the treatment.

On other hand, I noticed that there was lack in communication regarding use of PHO

VTE prevention in the hospital. There was no proper strategy to proctor VTE incidents which

would determine the mortality and mobility of the hospital. Hence, a proper effective

4 communication and planning required for this (Nursingmidwiferyboard.gov.au, 2020).

DEEP VEIN THROMBOSIS

It can be concluded by explaining that DVT patient needs proper care. DVT patient

must know in detail about their disease and they must flow some measure such as

compressed stocking and take walks every day. The patient must follow these so that there is

blood flow. I personally would follow an effective means of communication, I would see that

the legs are in proper comfortable position and even after very two hours I will turn the

patient without crossing the legs, I would make sure that the patient is doing range of motion

exercise every day and most important I will always monitor the vital signs for the DVT

patient.
 References

Ageno, W., Mantovani, L.G., Haas, S., Kreutz, R., Monje, D., Schneider, J., Van Eickels, M.,

Gebel, M., Zell, E. and Turpie, A.G., 2016. Safety and effectiveness of oral rivaroxaban

versus standard anticoagulation for the treatment of symptomatic deep-vein thrombosis

(XALIA): an international, prospective, non-interventional study. The Lancet Haematology,

3(1), pp.e12-e21.

Di Nisio, M., van Es, N. and Büller, H.R., 2016. Deep vein thrombosis and pulmonary

embolism. The Lancet, 388(10063), pp.3060-3073.

Friedman, R.J., Gallus, A.S., Cushner, F.D., Fitzgerald, G., Anderson Jr, F.A. and Global

Orthopaedic Registry Investigators, 2018. Physician compliance with guidelines for deep-

vein thrombosis prevention in total hip and knee arthroplasty. Current medical research and

opinion, 24(1), pp.87-97.

5 DEEP VEIN THROMBOSIS
Health.nsw.gov.au. 2020. Clinical Guidelines for Nursing and Midwifery Practice -

Professionals. Retrieved 26 May 2020, from

https://www.health.nsw.gov.au/aod/professionals/Pages/clinical-guidelines-nursing-and-

midwifery.aspx

Meissner, M.H., 2019. Thrombolytic therapy for acute deep vein thrombosis and the venous

registry. Reviews in cardiovascular medicine, 3(S2), pp.53-60.

Nursingmidwiferyboard.gov.au, 2020. Nursing And Midwifery Board Of Australia -

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standards.aspx> [Accessed 26 May 2020].

 Othieno, R., Okpo, E. and Forster, R., 2018. Home versus in‐patient treatment for deep vein

thrombosis. Cochrane Database of Systematic Reviews, (1).

Safetyandquality.gov. 2020. The NSQHS Standards | Australian Commission on Safety and

Quality in Health Care. Retrieved 26 May 2020, from

https://www.safetyandquality.gov.au/standards/nsqhs-standards

Streiff, M.B., Agnelli, G., Connors, J.M., Crowther, M., Eichinger, S., Lopes, R., McBane,

R.D., Moll, S. and Ansell, J., 2016. Guidance for the treatment of deep vein thrombosis and

pulmonary embolism. Journal of thrombosis and thrombolysis, 41(1), pp.32-67.

Watson, L., Broderick, C. and Armon, M.P., 2016. Thrombolysis for acute deep vein

thrombosis. Cochrane Database of Systematic Reviews, (11).

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