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The Cardiovascular System
NRS 108-ECCMajuvy 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 DESCRIPTION
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
THROMBOPHLEBITIS A thrombus associated with inflammation
PHLEBOTHROMBUS A thrombus without inflammation
PHLEBITIS Vein inflammation associated with invasive
procedures such as IVs DEEP VEIN THROMBOPHLEBITIS (DVT)
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
Hypercoagulability disorders Injury to the venous wall from IV
injections, fractures, trauma Following surgery, particularly hip surgery
and open prostate surgery Pregnancy Ulcerative colitis Use of oral contraceptives
PHLEBITIS ASSESSMENT
Red, warm area radiating up an extremity Pain and soreness Swelling
IMPLEMENTATION 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)
ASSESSMENT Calf or groin tenderness or pain with or without
swelling Positive Homans’ sign Warm skin that is tender to touch
DEEP VEIN THROMBOPHLEBITIS (DVT)
IMPLEMENTATION 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)
IMPLEMENTATION 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)
IMPLEMENTATION 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)
IMPLEMENTATION 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)
CLIENT EDUCATION 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)
CLIENT EDUCATION 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
DESCRIPTION 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
ASSESSMENT 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
WOUND CARE 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
WOUND CARE The wound is cleansed with normal saline prior
to application of the Unna boot; providone-iodine (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
MEDICATIONS Apply topical agents to wound as prescribed to
debride the ulcer, eliminate necrotic tissue, and promote healing
When applying topical agents, apply an oil-based 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
CLIENT EDUCATION 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 CLIENT EDUCATION
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 CLIENT EDUCATION
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 DESCRIPTION
Distended protruding veins that appear darkened and tortuous
Vein walls weaken and dilate, and valves become incompetent
ASSESSMENT 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 TRENDELENBURG TEST
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 IMPLEMENTATION
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 DESCRIPTION
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 DESCRIPTION
Varicose veins are removed if they are larger than 4 mm in diameter or if they are in clusters
PREOPERATIVE Assist the physician with vein marking Evaluate pulses as a baseline for comparison
postoperatively
VEIN STRIPPING
POSTOPERATIVE 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 POSTOPERATIVE
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)
DESCRIPTION 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)
ASSESSMENT 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)
ASSESSMENT 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)
ASSESSMENT 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)
IMPLEMENTATION 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)
IMPLEMENTATION 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)
IMPLEMENTATION 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)
CLIENT EDUCATION 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)
CLIENT EDUCATION 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)
PROCEDURES TO IMPROVE ARTERIAL BLOOD FLOW Percutaneous transluminal angioplasty Laser-assisted angioplasty Atherectomy Bypass surgery (aortofemoral or femoral-
popliteal)
RAYNAUD’S DISEASE DESCRIPTION
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 ASSESSMENT
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 (2nd ed.). St. Louis: Mosby.
RAYNAUD’S DISEASE IMPLEMENTATION
Monitor pulses Administer vasodilators as prescribed Assist the client to identify and avoid
precipitating factors such as cold and stress CLIENT EDUCATION
Medication therapy Avoid smoking Wear warm clothing, socks, and gloves in cold
weather Avoid injuries to fingers and hands
BUERGER'S DISEASE DESCRIPTION
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 ASSESSMENT
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 IMPLEMENTATION
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 DESCRIPTION
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 FUSIFORM
Diffuse dilation that involves the entire circumference of the arterial segment
SACCULAR Distinct localized outpouching of the artery
wall
TYPES OF ANEURYSMS DISSECTING
Created when blood separates the layers of the artery wall forming a cavity between them
FALSE (PSEUDOANEURYSM) 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 ASSESSMENT
Pain extending to neck, shoulders, lower back, or abdomen
Syncope Dyspnea Increased pulse Cyanosis Weakness
ABDOMINAL AORTIC ANEURYSM ASSESSMENT
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 ASSESSMENT
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 DIAGNOSTIC TESTS
Done to confirm the presence, size, and location of the aneurysm
Includes abdominal ultrasound, CT scan, and arteriography
AORTIC ANEURYSMS IMPLEMENTATION
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 IMPLEMENTATION
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 NONSURGICAL IMPLEMENTATION
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 NONSURGICAL IMPLEMENTATION
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 PHARMACOLOGICAL IMPLEMENTATION
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
DESCRIPTION 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
PREOPERATIVE Assess all peripheral pulses as a baseline for
postoperative comparison Instruct the client on coughing and deep-
breathing exercises Administer bowel preparation as prescribed
ABDOMINAL AORTIC ANEURYSM RESECTION POSTOPERATIVE
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 POSTOPERATIVE
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 POSTOPERATIVE
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 POSTOPERATIVE
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
DESCRIPTION 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 POSTOPERATIVE
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 POSTOPERATIVE
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
POSTOPERATIVE 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 POSTOPERATIVE
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 DESCRIPTION
Removal of an embolus from an artery using a catheter
A patch graft may be required to close the artery
EMBOLECTOMY PREOPERATIVE
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 POSTOPERATIVE
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 POSTOPERATIVE
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 POSTOPERATIVE
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 POSTOPERATIVE
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 VENA CAVAL FILTER
Insertion of an intracaval filter (umbrella) that partially occludes the inferior vena cava and traps emboli to prevent pulmonary emboli
LIGATION 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 POSTOPERATIVE
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 PREOPERATIVE
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 POSTOPERATIVE
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 CLIENT EDUCATION
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