Deep Vein Thrombosis (DVT) and Pulmonary Embolism (PE) Practice Questions with Answers and NCLEX® Review

Introduction to Deep Vein Thrombosis (DVT) and Pulmonary Embolism (PE)

Deep Vein Thrombosis (DVT) and Pulmonary Embolism (PE) are two potentially life-threatening conditions that blood clots can cause. 

Deep vein thrombosis (DVT) occurs when a blood clot forms in the deep veins of the body. A pulmonary embolism (PE) is a blood clot that blocks and stops blood flow to an artery in the lung. In most cases, the blood clot started in a deep vein in the leg and traveled to the lung.

As a nurse, you’ll need to understand the pathophysiology of  DVTs and PEs and initiate nursing interventions to care for clients.

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DVT Pathophysiology

DVT is a condition that can impact nearly anyone (although certain people are at higher risk), and presents with various symptoms. It’s a potentially dangerous condition caused by a blood clot in one of the body’s major veins.

Symptoms of Deep Vein Thrombosis

It’s important to remember that recognizable symptoms often accompany DVT but can also occur undetected. However, as a nurse, you will need to be aware of the signs and symptoms and complete a thorough assessment of the client.

Common signs and symptoms of a DVT include:

• Pain – In some clients, a DVT will cause direct pain in the foot or ankle that has no obvious cause. Other clients might feel a strong cramp forming in their calf.
• Discoloration in the skin around the DVT – You might notice that the skin around the DVT is swollen and red to blue in appearance, this response is a lack of adequate blood flow.
• Tenderness – When a client has a deep vein thrombosis (DVT), the client may report that the area is tender. This tenderness is related to irritation and inflammation. Palpation (vigorous touch) of the area may alert you to this tenderness.
• Massive iliofemoral venous thrombosis – A client with a deep vein thrombosis may have a condition known as phlegmasia cerulea dolens. The afflicted extremity will feel cool to the touch, with tension and pain. A warm patch on an extremity can also indicate a DVT.
• Edema – The obstruction of blood flow will result in edema or swelling of the limb. 

Memory Trick:

• Calf pain and Cramping
• One-sided swelling (Unilateral)
• Warm and red (blood pooling)
• Sob and chest pain = PE

Risk Factors of DVT

• Obesity
• Previous heart failure
• Family history 
• Catheters in a vein (or an injury to the vein)
• General injuries to the lower extremities (including the pelvis and hips)
• Recent surgery
• Taking medications that affect hormone levels 
• Pregnancy or giving birth
• Smoking
• Being seated for an extended period of time (traveling in a car or plane for hours without walking)

Pulmonary Embolism Pathophysiology

A pulmonary embolism (PE) is a deadly medical emergency that can occur when a clot forms anywhere in the body, but it most frequently occurs in one of the legs.

A PE can also be called “thromboembolism,” “post-thrombotic syndrome,” or “postphlebitic syndrome.” Once a clot breaks off and travels throughout the body through the veins, it can get to the lungs and cause PE.

It occurs when a blood clot obstructs a pulmonary vessel within the lung (typically the pulmonary artery), this blockage prevents blood flow to the alveoli, where gas exchange occurs, eventually leading to deadly hypoxemia (low oxygen). 

Signs and Symptoms of PE

• Low blood oxygen (hypoxemia)
• Transient chest pain (that comes and goes)
• Constant chest pain
• Coughing blood (hemoptysis)
• Anxiety and restlessness
• Hypotension
• Loss of consciousness

Risk Factors of PE

It’s important to note that estrogen birth control can lead to an increased risk for blood clots. Other risk factors include:

• Smoking
• Obesity
• Immobility
• Atrial Fibrillation
• Valve disorders

DVT Treatment

The main treatment for DVT is anticoagulation therapy, which involves a health care provider (HCP) prescribing a blood thinner like Warfarin or Heparin. These medications help prevent clots from growing larger and breaking loose.

Memory Tricks

During the clot:

• Don’t Walk (bed rest)
• Venous return (eleVate)

After the clot:

• Calf Exercise & Isometrics
• Hydration
• Ambulation
• NO long sitting (car, airplane, bedrest)
• Ted and SCDs (after the clot is resolved)

PE Treatment

Treatments for PE involve administering blood thinners to dissolve clots and prevent them from traveling to other parts of the body.

Clients might also require these types of surgery:

• Embolectomy: surgical removal of the clot
• Vena Cava filter: acts like a net to catch any new clots

PE and DVT Drugs

• Anticoagulants
  • Heparin
  • Warfarin
• Thrombolytics
  • tPA
  • Alteplase
  • Streptokinase

Conclusion to Deep Vein Thrombosis (DVT) and Pulmonary Embolism (PE)

When blood clots form in the veins of the legs or pelvis, they can break loose and travel to the lungs, where they will cause further damage. 

As a nurse, it is vital to recognize the signs and symptoms of DVTs and PEs. The appropriate assessment and timely nursing interventions can assist in better outcomes for clients.

Sources

https://www.merckmanuals.com/professional/cardiovascular-disorders/peripheral-venous-disorders/deep-venous-thrombosis-dvt 

https://www.mayoclinic.org/diseases-conditions/deep-vein-thrombosis/symptoms-causes/syc-20352557 

https://www.merckmanuals.com/professional/pulmonary-disorders/pulmonary-embolism-pe/pulmonary-embolism-pe 

https://www.mayoclinic.org/diseases-conditions/pulmonary-embolism/symptoms-causes/syc-20354647