NURS6521: Advanced Pharmacology Discussion

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NURS6521: Advanced Pharmacology Discussion

NURS6521: Advanced Pharmacology Discussion

Which of the following would the nurse include in a teaching plan about the signs and symptoms of thrombophlebitis and thromboembolism that should be reported by a patient taking estrogen?

NURS6521: Advanced Pharmacology

NURS6521: Advanced Pharmacology

Thrombophlebitis is caused by superficial venous thrombosis and vascular inflammatory changes affecting the lower limbs. The condition is often encountered in pregnancy and symptomatic treatment including compression and analgesia are commonly employed. The obstetrician may become involved in the management of thrombophlebitis; however the potential for embolic complications, and need for adequate assessment remain widely unrecognised. This case report highlights pitfalls in the management of thrombophlebitis, in particular the dangers of clinical assessment without the use of Doppler ultrasound and the potential for deep venous extension and embolic complications. The case also documents the use of low molecular-weight heparin in pregnancy to prevent such complications and promote thrombus resolution; a review of the available treatment options, including surgery, is included. Whilst thromboembolism remains a leading cause of maternal death, the potential dangers of symptomatic thrombophlebitis should not be overlooked.

Case report
A 29-year-old pregnant woman presented at 35 weeks gestation, complaining of minor discomfort in the medial left thigh. Clinical examination identified tenderness and erythema overlying a varicose vein in the mid thigh, with a palpable cord of thrombus within it. The abnormality was localised, and confined to a 6 cm length of the long saphenous vein, distant to the sapheno–femoral junction. No clinical features of deep vein thrombosis (DVT) or pulmonary embolism were elicited.

Doppler ultrasound (USS) identified no abnormalities in the deep venous system, however thrombus was present in the proximal long saphenous vein extending to the sapheno–femoral junction.

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