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Nursing Clients With Medical Surgical Conditions Comparative Analysis Of A Nursing Practice

2313 words - 9 pages

The purpose of this comparative analysis essay is to discuss the different approaches used for the prevention of postoperative Deep vein thrombosis (DVT). There are a variety of prophylactic treatments to prevent DVT, but for the purpose of this essay only thromboembolic deterrent stockings (TEDs) in relation to Sequential compression devices (SCDs) will be covered and pharmacologic prophylaxis will be covered only briefly. DVT is the formation of blood clots in the deep veins (Kesieme, 2011). The most common sites for thrombus formation are the deep veins within muscle, typically of the calf or the thigh. The clots may dislodge and travel in the blood to the lung and cause pulmonary emboli (PE) (Australian Nursing Journal, 2008). DVT and PE are important pathologies that affect apparently healthy individuals as well as medical or surgical patients (Ageno, 2010). Collectively, DVT and PE are known as venous thromboembolism (VTE) (Australian Nursing Journal, 2008).

DVT is a major postoperative complication that has been estimated to occur in up to 40% of patients without prophylaxis (Novis et al., 2009). The highest risk for thrombosis is during the immediate postoperative period which then decreases during the first week following the operation (Bergqvist, 2007). DVT will often show no signs or symptoms; however, symptoms may include pain, tenderness, swelling, warmth and discolouration of the skin (Australian Nursing Journal, 2008). Risk factors for post surgical DVT includes the nature and duration of the surgery, sepsis, hydration, immobility and type of anaesthesia administrated. The risk increases with age, obesity, smoking and malignancy (Miller, 2011). These risk factors should be identified during the preoperative assessment conducted by the preoperative RN as a requirement of the DVT prevention protocol. The information from this assessment should be used for developing the plan of care related to DVT prophylaxis (Burlingame, 2010).

Prophylaxis against DVT is an important aspect of nursing care and can be achieved using mechanical methods such as TEDs, SCDs and pharmacological methods, for example, subcutaneous injection of low molecular weight heparin (LMWH) (Walker & Lamont, 2008). The key to preventing DVT formation in any patient is to promote perfusion (Maiocco, 2008). In the surgical patient who is non ambulant, TEDs are often used as mechanical prophylaxis of DVT in the lower limb either alone or in combination with other external compression devices or medications. If used alone TEDs have been shown to reduce the relative risk of DVT in surgical patients by 60-80% (Miller, 2011). TEDs exert an even and sustained regressive pressure to the legs, with gradient pressure, decreasing from the ankle to the knee and thigh. This physiological mechanism has the double action of increasing the venous blood flow velocity and preventing venous stasis. TEDs effectively decrease the overall cross-sectional area of the venous system of...

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