Master Venous Thromboembolism (DVT) Assessment with Picmonic for Nursing RN

Thrombus formation can be attributed to three factors: venous stasis, endothelial damage, and blood hypercoagulability. When valves in the veins of the leg(s) do not function properly or when muscles of the leg are inactive for extended periods of time, pooling of blood in the lower legs can occur. This is called venous stasis. Direct or indirect injury to a vessel, called endothelial damage, can stimulate the activation of platelets and clotting factors, increasing platelet aggregation and contributing to significant hypercoagulability. As clotting factors continue to make fibrin, more platelets and red and white blood cells will stick to the wall of the vein forming a clot.

Patients with a VTE may present with tenderness of the affected extremity over the area of inflammation or distal to the site.

Edema of the affected extremity can occur due to increased venous pressure and dependent pooling of fluid in circulation. If edema or swelling is present, the skin covering the extremity may appear tight, smooth, and shiny.

A patient presenting with a VTE may also notice warmth of the affected area due to inflammation.

Because a VTE typically affects one limb at a time, the patient’s extremities may present asymmetrically in appearance and condition. The affected leg may present with signs of a VTE while the other leg is unaffected.

Keep in mind that although tenderness, swelling, and warmth are common signs of a VTE, patients with this condition may be asymptomatic.

Depending on severity, the patient with a VTE may need hospitalization and monitoring of a VTE if there is a significant chance of pulmonary embolism development. This occurs when the VTE mobilizes into the pulmonary vasculature and become a pulmonary embolism (PE). At risk patients should be monitored closely for new or worsening symptoms of a PE including dyspnea, tachycardia, and chest pain.