TY  - CHAP
M1  - Book, Section
TI  - Venous Thromboembolism
A1  - Witt, Daniel M.
A1  - Clark, Nathan P.
A1  - Vazquez, Sara R.
A2  - DiPiro, Joseph T.
A2  - Talbert, Robert L.
A2  - Yee, Gary C.
A2  - Matzke, Gary R.
A2  - Wells, Barbara G.
A2  - Posey, L. Michael
PY  - 2017
T2  - Pharmacotherapy: A Pathophysiologic Approach, 10e
AB  - Patient  Care  Process  for  the  Treatment  of  Venous  ThromboembolismCollectPatient  characteristics  (e.g.,  age,  sex,  pregnant)Patient  history  (past  medical,  family,  social  —  dietary  habits  including  intake  of  vitamin  K  containing  foods  (see  Table  19-13),  tobacco/ethanol  use)Current  medications  including  aspirin/OTC  NSAID  use  and  prior  anticoagulant  medication  useObjective  dataBP,  heart  rate  (HR),  respiratory  rate  (RR),  O2-sat,  height,  weightLabs  (e.g.  Hgb,  Scr,  platelets,  aPTT,  PT)Do  NOT  order  hypercoagulability  testsObjective  confirmation  of  VTE  (see  Fig  19-6  and  19-7)AssessHemodynamic  stability  (e.g.  SBP  110  bpm,  O2-sat  <90%,  RR),  evidence  of  limb  ischemiaPresence  of  active  bleeding  and/or  bleeding  risk  factors  (see  Figure  19-8,  Table  19-10)Presence  of  VTE  provoking  factors  (e.g.  recent  surgery,  plaster  casting  of  lower  extremity,  indwelling  catheter,  cancer,  pregnancy,  estrogen  use,  prolonged  immobility,  recent  hospitalization)Ability/willingness  to  self-inject  LMWH/fondaparinuxAbility/willingness  to  pay  for  various  anticoagulation  therapy  optionsAbility/willingness  to  obtain  appropriate  laboratory  monitoring  (e.g.  INR  for  warfarin)Emotional  status  (e.g.  presence  of  anxiety,  depression)PlanDrug  therapy  regimen  including  specific  anticoagulant(s),  dose,  route,  frequency,  and  duration;  (see  Figs  19-8,  19-9,  Tables  19-3,  19-4,  19-6,  19-8,  19-9)Monitoring  parameters  including  efficacy  (e.g.  INR  results,  pain  control,  limb  swelling,  shortness  of  breath),  safety  (bleeding,  VTE  recurrence),  and  timing  of  assessmentsPatient  education  (e.g.  purpose  of  treatment,  dietary  and  lifestyle  modification,  invasive  procedures,  drug  therapy;  see  Table  19-5)Self-monitoring  for  resolution  of  VTE  symptoms,  occurrence  of  bleeding,  when  to  seek  emergency  medical  attentionReferals  to  other  providers  when  appropriate  (e.g.  thrombosis  specialist,  behavioral  health,  dietician)ImplementProvide  patient  education  regarding  all  elements  of  treatment  planUse  motivational  interviewing  and  coaching  strategies  to  maximize  adherenceSchedule  follow-up  (e.g.  INR  tests  [warfarin],  Scr  [DOACs],  adherence  assessment,  bleeding  risk  assessment,  duration  of  therapy  assessment)Follow-up:  Monitor  and  EvaluateResolution  of  VTE  symptoms  (e.g.  shortness  of  breath,  chest  pain,  swelling,  redness,  pain)Presence  of  adverse  effects  (e.g.  bleeding,  GI  upset  [dabigatran])INR  results  (adjust  warfarin  dose  as  needed  to  keep  between  2-3)Patient  adherence  to  treatment  plan  using  multiple  sources  of  informationDuration  of  therapy  after  90  days  
SN  - 
PB  - McGraw-Hill Education
CY  - New York, NY
Y2  - 2024/04/16
UR  - accesspharmacy.mhmedical.com/content.aspx?aid=1157514777
ER  -