Silver Age Health丨Nursing of Elderly Patients with Deep Vein Thrombosis

What is Deep Vein Thrombosis?

Deep vein thrombosis in the elderly is a common disease in the elderly. Because the blood vessel walls of the elderly are more fragile and the blood flow rate is slower, thrombosis is easy to form. After thrombosis, it will block the blood vessels, affect blood circulation, and cause local tissue ischemia, hypoxia and even necrosis. Symptoms of deep vein thrombosis in the elderly include swelling of the lower limbs, pain, increased skin temperature, color changes, etc., and sometimes varicose veins. There are many causes of deep vein thrombosis in the elderly, the most common of which is poor blood flow caused by long-term bed rest and sedentary living habits. In addition, some chronic diseases such as diabetes and hypertension can also increase the risk of deep vein thrombosis in the elderly. Therefore, it is very important to prevent deep vein thrombosis in the elderly. There are many ways to prevent deep vein thrombosis in the elderly, the most basic of which is to maintain proper exercise and promote blood circulation. In addition, avoiding long periods of sitting or lying in bed, and doing more leg muscle contraction and relaxation exercises can also effectively prevent thrombosis. At the same time, maintaining a healthy lifestyle, such as quitting smoking, limiting alcohol, and eating a healthy diet, can also help reduce the risk. For the elderly who have already suffered from deep vein thrombosis, they should seek medical attention in time and receive professional treatment. Currently, the treatment methods for deep vein thrombosis include drug therapy, surgical thrombectomy and interventional therapy. Drug therapy is a commonly used treatment method, mainly using anticoagulants, thrombolytics and other drugs to treat thrombosis. Surgical treatment and interventional therapy are suitable for more serious cases.

▏Classification and clinical manifestations of deep vein thrombosis

1. The central type is also called iliofemoral vein thrombosis, which is common on the left side and has an acute onset. The patient will feel local pain and tenderness, the affected limb will swell significantly, the superficial veins in the groin and the affected side of the abdomen will be distended, the skin temperature will rise, and there will be tenderness in the direction of the deep veins. If the thrombus extends upward to the inferior vena cava and downward to the entire lower limb deep vein, it will become a mixed type. 2. The peripheral type is also called calf muscle venous plexus thrombosis, which is a common site for postoperative deep vein thrombosis. Patients of this type usually have mild symptoms, feel pain or swelling in the calf, tenderness in the gastrocnemius muscle, and mild swelling in the ankle. 3. The mixed type is deep vein thrombosis of the entire lower limb, and the clinical manifestations can have the characteristics of both the central type and the peripheral type. This type can be extended from the peripheral type. The symptoms are mild at first and do not attract attention, but the swelling plane will gradually rise until the whole lower limb is swollen before it is discovered. In clinical practice, we need to adopt different treatment plans according to different types of thrombosis to protect the health of patients to the greatest extent.

▏Precautions before deep vein thrombosis surgery <br /> For patients who are preparing for deep vein thrombosis surgery, the following are matters that need attention: 1. Rest in bed Patients should rest in bed and keep the affected limb still so that the thrombus adheres closely to the venous endothelium. Avoid coughing hard, turning over in a large range, sneezing hard, and defecation hard, which may cause the lower limb venous thrombosis to fall off and increase the risk of pulmonary embolism. Patients generally need to stay in bed for 10 to 14 days. 2. Raise the affected limb to 20 to 30 cm above the level of the heart to promote venous return and reduce edema and pain. 3. Do not massage. It is forbidden to massage the affected limb to prevent the thrombus from falling off. At the same time, keep the affected limb warm and avoid using hot compresses to prevent vasodilation and aggravate limb swelling. 4. Adjust the diet. The diet should be based on high-calorie, high-protein, low-fat, and high-fiber foods. Eat more fresh vegetables and fruits, and use vegetable oils. Avoid eating fatty meat, egg yolk, animal brain and other foods. The daily fat content should not exceed 40g to avoid increased blood viscosity and aggravate thrombosis. At the same time, spicy foods should be avoided, and foods rich in fiber, such as leeks, mustard greens, fresh fruits, beans and whole grains, should be chosen. 5. Quit smoking as much as possible. Respiratory preparation is very important. Patients need to quit smoking to avoid nicotine affecting venous contraction and causing peripheral circulation spasm. At the same time, deep breathing function training, effective coughing and sputum removal should be performed. 6. Practice bed rest. During bed rest, patients need to undergo adaptive training for urination and defecation in bed. A bed bath should be performed the day before surgery, and the hair in the surgical area should be cut off. Fasting should be done 4 hours before surgery, and water should be prohibited 2 hours before surgery. Hypertensive patients need to drink a sip of water and take antihypertensive drugs on the morning of surgery. Patients should change into hospital gowns or bring their own loose clothes and pants on the morning of surgery, and remove all metal and precious ornaments on their bodies. The above precautions are intended to ensure the safe and smooth progress of the operation and reduce the risk of postoperative complications.

▏Precautions after deep vein thrombosis surgery 1. Position to ensure the safety of the patient, place in a suitable supine position, and raise the affected limb 20~30° to facilitate venous return and reduce swelling. 2. Nutrition and diet After returning to the ward, you can drink water and give a high-protein, low-fat, high-fiber, easily digestible diet. Due to the use of contrast agents during surgery, the amount of water consumed on the day after surgery must not be less than 2000ml, and care should be taken to avoid aspiration when eating. 3. Care of the affected limb Keep the skin around the puncture site clean and dry, and pay attention to observe whether there is bleeding, oozing, or hematoma formation. At the same time, pay attention to the blood circulation of the affected limb, observe the skin temperature, skin color, and whether the dorsalis pedis artery pulsation has improved. 4. Pain care Waist pain is usually caused by the implantation of filters in the lower limb veins. The pain usually lasts for 1~2 days, and most of them are tolerable and do not require special treatment. If necessary, analgesics can be used as prescribed by the doctor. 5. Observation of bleeding Thrombolytic therapy may prolong the coagulation time. Be careful to avoid collisions. Use a soft-bristled toothbrush to brush your teeth. Press the puncture point for 10 minutes after removing the needle and drawing blood. At the same time, pay attention to the following bleeding conditions: (1) Observation of the skin and mucous membranes: whether there is spontaneous bleeding in the mouth, gums, and nasal cavity, and whether there are bleeding spots or ecchymosis on the skin; (2) Observation of the digestive and urinary tracts: whether there is hematuria or blood in the stool; (3) Observation of the respiratory tract: whether there are symptoms such as coughing up blood and blood in sputum; (4) Observation of the abdomen: whether there is abdominal and lumbar pain; (5) Whether there are symptoms such as headache, nausea, and vomiting, be alert to the occurrence of cerebral hemorrhage. 6. Care of the thrombolytic catheter Proper fixation and maintenance of the thrombolytic catheter is the key. For patients who need repeated lower limb venography, the thrombolytic catheter can be removed according to the treatment situation. During the nursing process, pay attention to the fall off and blockage of the catheter. If you have any discomfort or concerns, you should inform the medical staff in time. These precautions will help ensure patient safety and promote recovery. In the early stages of bed rest, it is very important to wear elastic stockings, perform bedside activities, and gradually increase the amount of activity. The following are some suggestions for early exercise: (1) Ankle pump exercise is a very effective way to prevent thrombosis. It involves tightening and relaxing the foot, practicing for 5 to 10 minutes each time, 4 to 5 times a day, and gradually increasing the time. Note that it should be adjusted appropriately according to the degree of swelling and pain. In addition, you can also try flexion and extension, flexion and extension and pressure exercises, circumference exercises, and repeated flexion and extension and circumference of the ankle joint. These exercises help promote blood return and prevent new thrombosis. (2) Leg raising and abduction exercise is a method of passive lower limb muscle contraction that can promote venous return and prevent muscle disuse atrophy. The patient lies flat on his back, raises both legs to 10 cm above the bed surface, holds for at least 15 seconds, and then alternates parallel abduction and adduction. Start with 1 to 2 minutes each time, and gradually extend to more than 5 minutes each time depending on the swelling and skin temperature. The healthy side is 5 minutes each time, and can be gradually increased to 15 to 20 minutes, 1 to 2 times a day. Please note that when performing these early exercises, you should follow the principle of gradual progression to avoid excessive exercise that may lead to injury.

▏Things to note when being discharged from hospital after deep vein thrombosis surgery
1. Daily activities After discharge, patients can work and do general housework normally, and can also exercise appropriately, such as walking. When you are active, please wear professional medical elastic stockings. Avoid long-term walking, standing or sitting. When the affected limb is swollen and uncomfortable, you should rest in bed and raise the affected limb to a position above the heart level. If there is no obvious subsidence after lying flat or raising the affected limb, you should seek medical attention in time. 2. Maintain good living habits Good living habits are very important for the rehabilitation of deep vein thrombosis after surgery. Quit smoking and limit alcohol, maintain a regular work and rest time, and ensure adequate sleep. Eat a reasonable diet, eat more fresh vegetables and fruits, and keep your bowels open. Exercise appropriately to enhance physical fitness and improve resistance. 3. Drug guidance After discharge, please take medicine on time as prescribed by the doctor. For patients with filters, doctors will prescribe corresponding prescription drugs, such as oral antiplatelet drugs (such as aspirin, clopidogrel bisulfate, etc.) and/or anticoagulants (such as warfarin/rivaroxaban tablets, etc.). During the medication process, you should strictly follow the doctor's instructions to take the medicine on time and in the prescribed amount. You should not stop taking the medicine or change the dosage at will. At the same time, you should pay attention to whether there is bleeding from the gums and mucosa; wound healing; whether there are bleeding spots on the skin; subcutaneous hematoma; female patients should also pay attention to whether the menstrual volume is normal. Regularly monitor the four coagulation items and adjust the dosage according to the doctor's instructions. If there is a tendency to bleed, you should see a doctor in time. 4. Follow-up guidance After discharge, you should go to the outpatient clinic for a follow-up examination within one week, one month, three months and half a year. If there is no obvious subsidence when lying flat or raising the affected limb when swelling of the lower limbs occurs, you should see a doctor in time. If you have obvious swelling, pain, difficulty breathing, chest tightness and other discomfort symptoms in the lower limbs, you need to call 120 immediately and go to the nearest hospital for help. The above content is for reference only. You can consult a doctor for accurate information. 5. Psychological adjustment Patients may feel anxiety, depression and other negative emotions after deep vein thrombosis surgery. Please pay attention to psychological adjustment, maintain an optimistic attitude, and actively face the difficulties and challenges in the rehabilitation process. If necessary, you can seek professional psychological counseling. Deep vein thrombosis in the elderly is a common vascular disease that has a serious impact on the health and quality of life of the elderly. Through scientific care measures and prevention methods, the risk of deep vein thrombosis in the elderly can be effectively reduced. At the same time, for the elderly who have already developed symptoms of deep vein thrombosis, they should seek medical treatment in time and receive professional treatment and care. (Picture from the Internet) (Picture from the Internet)
Author | Han Mei is a practicing pharmacist who has worked in a well-known national tertiary hospital for more than 30 years and has rich medical care experience. She has represented the hospital on many occasions to go out for exchanges and study. She is an expert in food hygiene and nutrition, has a national nutritionist qualification, and is a science enthusiast.
First review | Chen Jiaqi, Li Shuhao Second review | Wei Xinghua Final review | Han Yonglin