Fundamentals of Nursing Q 555
Thrombophlebitis typically develops in patients with which of the following conditions?
A. Increases partial thromboplastin time
B. Acute pulsus paradoxus
C. An impaired or traumatized blood vessel wall
D. Chronic Obstructive Pulmonary Disease (COPD)
Correct Answer: C. An impaired or traumatized blood vessel wall
The factors, known as Virchow’s triad, collectively predispose a patient to thrombophlebitis; impaired venous return to the heart, blood hypercoagulability, and injury to a blood vessel wall. The three factors of Virchow’s triad include intravascular vessel wall damage, stasis of flow, and the presence of a hypercoagulable state. Understanding the factors involved in the thrombus formation and subsequent thromboembolic events enables the clinician to stratify risk, direct clinical decision making regarding treatment, and establish preventative measures.
Option A: Increased partial thromboplastin time indicates a prolonged bleeding time during fibrin clot formation, commonly the result of anticoagulant (heparin) therapy. A prolonged PTT may be due to: underlying conditions that cause low levels of clotting factors, such as: liver disease—most coagulation factors are produced by the liver, thus liver disease may cause prolonged PT and PTT. However, PT is more likely to be prolonged than PTT.
Option B: Pulsus Paradoxus refers to an exaggerated fall in a patient’s blood pressure during inspiration by greater than 10 mm Hg. Pulsus Paradoxus results from alterations in the mechanical forces imposed on the chambers of the heart and pulmonary vasculature often due to pericardial disease, particularly cardiac tamponade and to a lesser degree constrictive pericarditis. However, it is important to understand that pulsus paradoxus may be seen in non-pericardial cardiac diseases such as right ventricular myocardial infarction and restrictive cardiomyopathy.
Option D: Chronic obstructive pulmonary disease (COPD) is estimated to affect 32 million persons in the United States and is the third leading cause of death in this country. Patients typically have symptoms of chronic bronchitis and emphysema, but the classic triad also includes asthma or a combination of the above.