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Postpartum Thrombophlebitis - Coggle Diagram
Postpartum Thrombophlebitis
Nursing care
Monitor capillary refill time; Assess for positive Homans’ sign (calf pain at dorsiflexion of the foot).
Assess circulation, asymmetry, sensory and motor function of extremity; Observe edema from groin to foot; Measure and record calf/thigh circumference of both legs as appropriate. Report proximal progression of inflammation, traveling pain.
Assess respiration and auscultate for lung sounds, noting crackles or friction rub. Investigate reports of chest pain or feelings of anxiety.
Instruct client to avoid massaging or rubbing the affected extremity.
Maintain bed rest with elevation of feet and lower legs in above heart level during the acute phase.
Pathophysiology
The three major causes of thrombus formation and inflammation are venous stasis, hypercoagulable blood, and injury to the innermost layer of the blood vessel.
Both venous stasis (in pelvis and lower extremities) and hypercoagulable blood are present during pregnancy.
The level of most coagulation factors (especially fibrinogen, and factors III, VII, and X) are increased during pregnancy. This increase is accompanied by a decrease in plasminogen and antithrombin III, which cause clots to disintegrate.
Injury to the innermost layer of the vessel is probably not contributory, in general, during pregnancy. However, the possibility exists if the birth is by cesarean section.
Rick factors
History of thrombophlebitis
Obesity
History of cesarean delivery
History of forceps delivery
Maternal age older than 35
Multiparity
Lactation suppression with estrogens
Varicosities
Anemia and blood dyscrasias
Diagnosis
Venography accurately diagnoses DVT. There are risks associated with the radiopaque dye that is used.
Real-time and color Doppler ultrasound will diagnose deep venous thrombosis.
Impedance plethysmography measures changes in venous blood volume and flow.
Symptoms
Superficial thrombophlebitis signs and symptoms include:
Warmth, tenderness and pain in the affected area
Redness and swelling
Deep vein thrombosis signs and symptoms include
Pain
Swelling