Maternity Nursing: Postpartum Q 9
A postpartum (PP) client is being treated for DVT. The nurse understands that the client’s response to treatment will be evaluated by regularly assessing the client for:
A. Dysuria, ecchymosis, and vertigo
B. Epistaxis, hematuria, and dysuria
C. Hematuria, ecchymosis, and epistaxis
D. Hematuria, ecchymosis, and vertigo
Correct Answer: C. Hematuria, ecchymosis, and epistaxis.
The treatment for DVT is anticoagulant therapy. The nurse assesses for bleeding, which is an adverse effect of anticoagulants. This includes hematuria, ecchymosis, and epistaxis. Dysuria and vertigo are not associated specifically with bleeding. The cornerstone of treatment is anticoagulation. NICE guidelines only recommend treating proximal DVT (not distal) and those with pulmonary emboli. In each patient, the risks of anticoagulation need to be weighed against the benefits.
Option A: Low-molecular-weight heparin or fondaparinux for five days or until INR is greater than 2 for 24 hours (unfractionated heparin for patients with renal failure and increased risk of bleeding). If platelet count drops to less than 75,000, switch from heparin to fondaparinux, which is not associated with heparin-induced thrombocytopenia.
Option B: The use of thrombolytic therapy can result in an intracranial bleed, and hence, careful patient selection is vital. Recently endovascular interventions like catheter-directed extraction, stenting, or mechanical thrombectomy have been tried with moderate success. The duration of treatment for DVT is for 3-6 months, but recurrent episodes may require at least 12 months of treatment. Patients with cancer need long term treatment.
Option D: Inferior vena cava filters are not recommended in acute DVT. There are both permanent and temporary inferior vena cava filters available. These devices may decrease the rate of recurrent DVT but do not affect survival. Today, only patients with contraindications to anticoagulation with an increased risk of bleeding should have these filters inserted.