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VTE

  • Dx labs

    • Spiral CT for PE (alternatives: CT-PA, V/Q scan)
    • LE doppler for DVT
  • Admission orders

    • Admit: Floor
    • Diagnosis: Deep Vein Thrombosis and Pulmonary Embolism
    • Condition: Guarded
    • Vital Signs: q 2 hours x 4, then q 4 hours
    • Allergies:
    • Nursing:
      • O2 via NC to maintain sat > 92
      • No IM injections (hematoma)
    • Diet: Regular
    • Activity: Up with Assistance, Fall Precautions
    • Labs:
      • CBC with platelets qday
      • Chem, LFTs, calcium
      • INR qday (therapeutic range: 2-3)
      • PTT qday and 6 hours s/p dose changes if on unfractionated heparin
      • UA
      • EKG
    • IV: None
    • Special:
      • Thrombolysis if massive PE (unstable, no bleeding risk)
      • IVC filter if anticoagulation is contraindicated
    • Medications:
      • heparin
        • Enoxaparin 70 mg (1 mg/kg) SQ q 12 hours x 5 days
        • if planned surgery, use unfractionated heparin 80 mg/kg bolus, then 18 mg/kg infusion x 5 days
        • d/c after at least 5 days and 2 consecutive INRs in therapeutic range
      • Warfarin 5 mg PO tonight. Check warfarin dose qd
      • Acetaminophen 650 mg PO q 6 hours prn pain
      • Oxycodone 5-10 mg PO q 6 hours prn pain
    • Call HO: HR > 100 or SBP < 100
  • Discharge

    • warfarin for 6 months (indefinitely if re-occurrence)
    • education: LMWH administration, vitamin K in diet affects INR
    • prescribe 30 mmHg graduated compression stockings
    • f/u anticoagulation clinic for INR check in 2 days

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