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Nursing Papers on Thrombolytic Therapy for Deep Venous Thrombosis of Lower Extremities 1 Deep Venous Thrombosis of Lower Extremities (DVT) refers to a disease that causes abnormal coagulation of deep venous blood of lower extremities, leading to lumen obstruction and venous blood reflux disorder. If not treated in time, it will cause chronic deep venous insufficiency in different degrees, which will affect life and even disability. In the acute phase, pulmonary embolism caused by thrombus shedding can be life-threatening. From May 2008 to April 20 1 1 year, 87 patients with deep venous thrombosis of lower limbs were treated with intravenous thrombolysis and anticoagulation, supplemented by promoting blood circulation and removing blood stasis to reduce blood viscosity. After careful nursing, the curative effect is satisfactory. The nursing experience is introduced as follows.

I. Clinical data

1. General information: There were 87 cases in this group, including 56 males and 3 females, aged from 23 to 68 years, with an average age of 46 years, including 58 left lower limbs, 25 right lower limbs and 4 both lower limbs. Postoperative 27 cases, postpartum 18 cases, post-traumatic 2/kloc-0 cases, long-term bed rest 16 cases, and no obvious inducement in 5 cases. The main clinical manifestations of patients are pain, swelling, dark complexion, high skin temperature and superficial vein dilatation. All of them were diagnosed as deep venous thrombosis of lower limbs by vascular color Doppler ultrasound. All patients were treated with intravenous thrombolysis, anticoagulation combined with promoting blood circulation to remove blood stasis and reducing blood viscosity.

2. Administration method: 500,000 units of urokinase and 200ml of normal saline were infused through the superficial vein of the affected limb, lasting for 20 hours, and a tourniquet was tied at the ankle joint of the affected limb 5 ~ 10 cm [1], and it was relaxed every 2 hours 10 ~ 15 minutes; 0.4 ml of low molecular weight heparin sodium was injected subcutaneously through abdominal wall every 65438 0.2 hours for 7 days. Intravenous infusion of low molecular dextran and salvia miltiorrhiza, once a day 1 time, for 10 ~ 15 days. After stopping using low molecular weight heparin sodium, warfarin was taken orally for 3 months.

3. Results: After comprehensive treatment such as thrombolysis, anticoagulation and depolymerization, the edema of the affected limb was obviously improved and subsided, and the skin color returned to normal.

No pulmonary embolism occurred, hematuria occurred in 1 case, and the bleeding stopped after stopping using low molecular heparin sodium. Before leaving the hospital, all patients were reexamined by color Doppler ultrasound. Thrombosis disappeared and blood vessels were completely recanalized in 78 cases, thrombus partially disappeared and blood vessels partially recanalized in 9 cases. All patients were discharged from hospital wearing sequential decompression elastic socks.

Second, nursing.

1. psychological care: some patients are worried and anxious because they don't know the condition; Others are indifferent and cannot treat treatment correctly. At this time, with a high sense of responsibility, we should carefully find out the psychological characteristics of each patient, explain the relevant knowledge and treatment effect of the disease to patients, and increase their confidence. Let the patients' families know the knowledge of the etiology, treatment, prevention and nursing of the disease, so that the patients and their families can establish a new psychological environment conducive to the recovery of the disease and actively cooperate with the treatment and nursing.

2. Postural care: stay in bed 10 ~ 14 days after acute onset, including bedridden defecation. It is forbidden to apply hot compress, massage or massage the affected limb, so as to avoid thrombus falling off [2]. Raise the affected limb to 20 ~ 30cm above the heart level, slightly bend the knee joint, and put a wide soft pillow under the knee. You can get out of bed gradually after 10 ~ 14 days. It is not advisable to carry out strenuous activities or stretching exercises of the affected limb to prevent vascular injury and lead to recurrence of the disease. It is feasible to stretch and bend the dorsum of the foot dozens of times a day for 3 ~ 5 minutes each time to promote venous return of lower limbs.

3. Observation of illness:

(1) Observe the swelling, pain, superficial vein dilatation, skin temperature, color and pulse of dorsal foot artery.

(2) Measure the circumference of the affected limb at regular and fixed points every day. In our department, the upper and lower 15cm of patella midpoint was measured and recorded. Measure the circumference of both lower limbs for the first time, and mark along the measured parts. Follow-up measurements are made from the first mark to reduce errors. Record the results of each measurement to understand the swelling changes of the affected limb.

(3) Observation and nursing of complications: Pulmonary embolism is the most serious complication of deep venous thrombosis of lower limbs, with an incidence of 20-40%, and about 1 1% died within 1 hour after symptoms appeared [3]. We should be on high alert. If the patient has chest pain, chest tightness, hemoptysis, dyspnea and other symptoms, he should lie flat immediately to avoid taking a deep breath, coughing and turning over violently. Report to the doctor, continuous ECG monitoring, high concentration oxygen inhalation, closely observe the changes of vital signs and blood oxygen saturation, and actively cooperate with the rescue. Closely monitor and observe the puncture site for oozing blood, hematoma, gingival bleeding, skin purpura, hematuria and hematochezia. And monitor occult blood in stool every week to prevent gastrointestinal bleeding. Of the 87 patients in this group, 1 patient developed hematuria on the fifth day of thrombolytic and anticoagulant therapy, and the bleeding stopped after stopping using low molecular heparin sodium.

4, medication care:

(1) Take the medicine accurately and on time according to the doctor's advice, and it has been used now.

(2) Puncture urokinase with scalp needle, and press the puncture point 15 minutes after infusion.

(3) Observe the drug reaction closely, and notify the doctor in time if any abnormality is found.

(4) Monitor the coagulation function regularly every week according to the doctor's advice.

5, health guidance:

(1) A reasonable diet should be a light diet rich in vitamins and crude fiber and low in fat, so as to keep the stool unobstructed and avoid increasing abdominal pressure and affecting blood return.

(2) Exercise properly. After the acute phase, exercise properly to reduce weight, blood fat, blood sugar, blood pressure and blood viscosity, so as to avoid keeping the same posture for a long time and prevent thrombosis from recurring.

(3) Protect the affected limb from injury and cold stimulation.

(4) Quit smoking absolutely to prevent harmful substances such as nicotine from stimulating vasoconstriction and affecting venous return.

(5) Guide the correct use of sequential decompression elastic socks. Avoid wearing tights or suspenders to avoid affecting the blood circulation of lower limbs. (6) Do a good job in discharge guidance, take oral anticoagulants in strict accordance with the doctor's advice, observe the color of urine and feces, skin and mucosa during taking the medicine, and review the blood routine and coagulation time once a week. Go to the outpatient clinic for reexamination 3 ~ 6 months after discharge, and see a doctor in time if any abnormality is found.

Nursing of Thrombolytic Therapy for Deep Venous Thrombosis of Lower Limbs; Deep Venous Thrombosis of Lower Limbs is a common and serious complication after delivery, which is usually caused by the hypercoagulability of maternal blood. After venous thrombosis falls off, it reaches the maternal lung with the blood flow, which can cause acute pulmonary embolism, mainly manifested as swelling and pain of the affected limb, which poses a great threat to the life safety of patients. In recent years, with the change of people's diet structure and the increase of elderly women, the incidence of this complication has been rising. Our hospital selected 28 patients with deep venous thrombosis of lower limbs as the research object, actively gave targeted treatment and comprehensive nursing intervention, and achieved good results. The report is as follows.

1, data and methods

1. 1 general information

From June, 20 13 to June, 20 14, 28 patients with postpartum deep vein thrombosis were selected, ranging in age from 4 1 year to 24, with an average age of (28.7 4.1) year. The average onset time was (11.5 3.1) d; Among them, there were 8 cases of natural delivery and 20 cases of cesarean section. All patients had varying degrees of pain, swelling and limited walking activities in the left lower extremity, which were diagnosed by color Doppler ultrasound and venography.

1.2 method

1.2. 1 treatment methods all patients were given anticoagulation, thrombolysis and drug treatment, and patients in acute stage were required to stay in bed; Raise the affected limb of the lying-in woman, give local 50% magnesium sulfate continuous wet compress and replace it regularly. Anticoagulation therapy: patients were given low molecular weight heparin calcium 5000U, subcutaneous injection twice a day, continuous treatment 1 week; The patients took warfarin 2.5~5.0mg daily for 65438 0 ~ 6 months, and the coagulation time was closely monitored during the treatment. If the coagulation time is abnormal, the dosage can be reduced or stopped according to the doctor's advice. Thrombolytic therapy: 500,000 u urokinase was added to 250mL of 5% glucose solution, and the dosage was reduced after the condition was stable, and the treatment was continued for 10d. Oral aspirin is a commonly used therapeutic drug in clinic.

1.2.2 Nursing methods Comprehensive nursing intervention was given to patients during treatment, mainly including psychological nursing, anticoagulation and thrombolysis nursing, disease observation, diet nursing, rehabilitation nursing and health knowledge education.

2. Results

Twenty-eight cases of postpartum deep venous thrombosis of lower limbs were cured and discharged after symptomatic treatment and comprehensive nursing.

Step 3 discuss

Postpartum complicated with deep venous thrombosis of lower limbs is generally a serious postpartum complication with slow venous blood flow and changes in hormone level under hypercoagulability, which is affected by pregnancy factors. The main clinical manifestation is swelling and pain of the affected limb, which has great influence on the health of patients. Symptomatic treatment such as anticoagulation and thrombolysis, combined with comprehensive nursing intervention, can effectively improve the clinical symptoms of patients and promote the recovery of limb function. Comprehensive nursing intervention mainly includes psychological nursing, anticoagulation and thrombolysis nursing, condition observation, diet nursing, rehabilitation nursing and health knowledge education.

3. 1 psychological care

Patients with postpartum deep venous thrombosis of lower limbs need to stop breastfeeding their newborns during anticoagulant and thrombolytic therapy. The change of neonatal feeding mode, swelling and pain of the affected limb, limited activity, slow recovery, long treatment time and high treatment cost make patients prone to anxiety and depression. Medical staff should actively communicate with patients, explain the causes, treatment methods, precautions and prognosis of postpartum deep vein thrombosis in detail, establish a good nurse-patient relationship with patients, gain the trust of patients, give targeted psychological intervention, relieve patients' anxiety and depression, and improve treatment compliance. Relaxation therapy, such as playing music and videos, can divert patients' attention, reduce their psychological burden and ensure the therapeutic effect.

3.2 Anticoagulation and thrombolytic care

When anticoagulation and thrombolysis are given to postpartum patients complicated with deep venous thrombosis of lower limbs, traumatic treatment and examination should be reduced; When performing venipuncture, avoid tying the tourniquet too tightly, choose intravenous indwelling needle to reduce the number of venipuncture; When pulling out the needle, it should be pressed locally for 5min~ 10min. Blood samples are taken regularly for platelet count and routine blood examination, and the prothrombin time of patients is recorded in detail to ensure that the blood samples meet the relevant requirements; Observe whether the patient has hematuria, bloody stool and subcutaneous blood stasis phenomenon; When diluting urokinase, avoid violent shaking and use it immediately after dilution.

3.3 observation of illness

First of all, in the course of treatment, we should carefully observe whether the patient has bleeding tendency, pay attention to whether the patient has vomiting and pain, and report to the doctor in time if there is any abnormality, so as to treat the symptoms. Secondly, we should observe the symptoms of pulmonary embolism in patients. Pulmonary embolism is one of the serious complications of postpartum deep venous thrombosis of lower limbs, which is caused by thrombus shedding. The main clinical manifestations are cough, chest pain, dyspnea and blood pressure drop. Some severe patients may have coma and arrhythmia, so they should be given high concentration oxygen in time and reported to the doctor for symptomatic treatment.

3.4 Diet care and rehabilitation care

Make a scientific diet plan for patients, focusing on low-fat, high-protein, high-fiber and high-calorie foods to ensure adequate water intake, reduce blood viscosity and promote blood circulation. According to the specific situation of patients, guide patients to get out of bed and carry out early rehabilitation training; You can wear elastic socks when you are active, which is beneficial to deep vein reflux. After thrombus recanalization, oral anticoagulants should be continued to avoid recurrence and strengthen the warmth of the affected limb.

3.5 Health knowledge education

According to patients' information feedback and knowledge needs, a targeted health education plan was made for them, and patients were actively educated during hospitalization to improve their mastery of relevant knowledge. The nurse in charge actively explained the causes, treatment process and prognosis of postpartum complicated with deep venous thrombosis of lower limbs to help patients establish a correct view of disease; And give patients scientific discharge guidance and precautions, and ask patients to go to the hospital for review regularly. 28 cases of postpartum complicated with deep venous thrombosis of lower limbs were cured and discharged after anticoagulation, thrombolysis and comprehensive nursing intervention. To sum up, targeted treatment for postpartum patients complicated with deep venous thrombosis of lower limbs, combined with psychological care, anticoagulation and thrombolysis care, illness observation, diet care, rehabilitation care and health education, can improve the treatment effect and promote the rehabilitation of patients.

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