Pathophysiology Of Dvt Formation Health And Social Care Essay

Pathophysiology Of Dvt Formation Health And Social Care Essay DVT is the result of a number of factors that include stasis of blood, endothelial injury and hypercoagulability of blood. PE is a major complication of DVT and occurs when a thrombus or blood clot detaches itself and is carried by the blood stream to the lungs. [J32] Proximal DVT carries a higher risk of PE than distal DVT. [J30, Havig] We focused on proximal DVT because it is much more reliably detected by ultrasonography and is considered to be clinically more important. [J53: 11,12, à §Ã¢â‚¬Å¾Ã‚ ¡Ãƒ ¨Ã‚ Ã‚ ½K list,à §Ã…“Å ¸Ãƒ ¤Ã‚ ¿Ã¢â‚¬Å¡Ãƒ §Ã¢â‚¬ Ã‚ ¨Ãƒ ¥Ã¢â‚¬ ¦Ã‹â€ Ãƒ ¦Ã¢â‚¬ Ã‚ ¹] DVT can occur in any veins. (near neck, etc.) However, it is not including in this literature review becauseà ¢Ã¢â€š ¬Ã‚ ¦ Upper limb DVT is being reported, particularly associated with central venous catheters. (K66, from J20:54) After a stroke, blood clots can form in the veins of the legs (deep vein thrombosis, or DVT). These clots can break off and be carried in the blood stream to the heart and lungs (causing pulmonary embolism). This can be life threatening. [J30] Deep venous thrombosis may lead to pulmonary emboli, a frequent cause of avoidable deaths. [K52, from J53:1] Virchows triad The pathophysiological mechanisms underlying DVT include venous stasis and hypercoagulability linked to an increase in thrombin formation and platelet hyperactivity (Virchow 1858). [J30] The occurrence of one or more factors of Virchows triad (stasis of blood, endothelial injury and hypercoagulability of blood) in the venous system often leads to deep vein thrombosis (DVT) (Virchow 1858). [J18] DVT = PE = (à ¥Ã‚ ¦Ã¢â‚¬Å¡Ãƒ ¨Ã‚ ¦Ã‚ Ãƒ ¦Ã¢â‚¬ °Ã‚ ¾PEà §Ã… ¡Ã¢â‚¬Å¾incidence mortality rate (acute + Rehab) J43 P263 have) Lower extremity DVT can be anatomically be divided into proximal DVT involving the popliteal vein and proximal veins or distal DVT involving the calf vein and distal veins. [J59] DVT in the paralyzed legs of patients with stroke was reported as early as 1810 by Ferriar and again by Lobstein in 1833. [J45] Pathophysiology of DVT formation According to the Medsurg, Venous return is aided by the calf muscle pump. When the legs are inactive or the pump is ineffective, blood pools by gravity in the veins. Thrombus development is a local process. It begins by platelet adherence to the endothelium. Several factors promote platelet aggregation, including thrombin, fibrin, activated factor X, and catecholamines. In addition, where the platelets adhere to collagen, adenosine diphosphate (ADP) is released. ADP is also released from the damaged tissues and disrupted platelets. ADP produces platelet aggregation that results in a platelet plug. Deep vein thrombi vary from 1mm in diameter to long tubular masses filing main veins. Small thrombi are found commonly in the pocket of deep vein valves. As thrombi become larger in diameter and length, they obstruct the veins, the resulting inflammatory process can destroy the valves of the veins; thus; venous insufficiency and postphlebitic syndrome are initiated. Newly formed thrombi may become pulmonary emboli. Probably 24 to 48 hours after formation, thrombi undergo lysis or become organized and adhere to the vessel wall. Lysis diminishes the risk of embolization. Pulmonary emboli, most of which start as thrombi in the large deep veins of the leg, are an acute and potentially lethal complication of DVT. Venous thrombosis is the process of clot (thrombus) formation within veins. Although this can occur in any venous system, the predominant clinical events occur in the vessels of the leg, giving rise to deep vein thrombosis, or in the lungs, resulting in a pulmonary embolus (PE). [J56] In fact, about 90% of DVT are of the ascending type. The potential for embolism depends on the speed and the extent of the dynamic, ascending clot growing process. Almost all clinical PE originate from distal DVT. Only the remaining 10% are derived from clots without connection to the lower leg veins (e.g. isolated iliac vein thrombosis, transfascial great or small saphenous vein thrombosis, subclavian vein thrombosis, or catheter-related thrombosis). [J58] Damage to the epithelial cell lining of the blood vessel is one of the extrinsic factors triggering the clotting cascade. The damaged endothelium attempts to maintain vascular integrity by adhesion and aggregation of platelets. As the clotting cascade continues, the final step is the formation of thrombin, which leads to the conversion of fibrinogen to fibrin and the formation of a fibrin clot. (Arcangelo Peterson, 2006) (from K84, J40: Arcangelo) Abnormal blood clots that adhere to the vessel wall are known as thrombi. These are composed of blood cells, platelets, and fibrin. Arterial thrombi are composed mainly of platelet aggregates and fibrin. Venous thrombi are composed of mainly red blood cells. The difference in composition is caused by the conditions in which the thrombus forms. In the artery, the blood flow is high in comparison with the low flow conditions in the vein. The thrombus may become large enough to interfere with blood flow within the vein or artery. (Mansen McCance, 2002) (from K85, J40: Mansen) If the thrombus detaches from the vessel wall, it becomes an embolus. This mobile clot travels thought the circulation until it lodges in a blood vessel that is smaller than the clot. Distal to this point, blood flow is blocked and tissues or organs are deprived of oxygen and nutrition. (Mansen McCance, 2002). The signs and symptoms associated with an embolus depend on the vein or artery where th clot becomes lodged. (from K85, J40: Mansen) In 1856, Virchow described the factors that predispose to venous thrombosis, including stasis, vascular damage, and hypercoagulability. These three factors are referred to as Virchows triad. Stasis of blood may occur because of immobility, age, obesity, or disease processes. Trauma (including surgery), intravenous (IV) cannulation, medications, and toxins are some of the many sources that may precipitate vascular damage. Hypercoagulability of the blood may be caused by various disease processes and medications. (Mansen McCance, 2002) (from K85, J40: Mansen) Why focus on DVT rather than PE and VTE? A high proportion of patients with DVT also have subclinical PE. [K15, from J45:14] Most of the PE results from DVT (please find literature to support) Since lower limb DVT is the major origin of PE, and the characteristic of prolong bed rest of stroke, this literature review will mainly focus on the DVT at lower limbs. Approximately two thirds of these are below-knee DVTs, in contrast to unselected (nonstroke) patients presenting with symptomatic DVT, in whom the majority are proximal. [J43] Most studies show that PE seems to be much more common in patients with proximal and symptomatic DVT. [K41, from J46:1] Clinical symptoms of DVT were developed by six patients (oedema or pain of the lower extremity, no cases of PE). (out of 28, =21.4%) (J48s result) Why stroke patient easy to have DVT The general stroke population is at risk for DVT because of the following factors. First, there is an alteration in blood flow due to weakness in the lower limb and a resulting hypercoagulable state related to changes in the blood. Second, vessel wall intimal injury occurs related to changes in blood and blood flow. Stroke patients may also have similar symptoms associated with DVT, such as swelling and Homans sign, that may be misinterpreted as being related to the stroke. [J50] Stroke patients are often bed-ridden, especially during the acute phase, because of paresis. [J50] Most of the stroke patients are elderly. (age > ), while aging is a significant factors of the occurrence of DVT. Patients with stroke are at particular risk for developing deep venous thrombosis (DVT) and pulmonary embolism (PE) because of limb paralysis, prolonged bed rest, and increased prothrombotic activity. [J45 (also code at J51)] Sioson et al. [46] reported 19 DVT events in the paretic limb, nine bilateral events and four contralateral in 32 patients prospectively followed. (K49 from J46:46) Why important to prevent WHO estimates that 15 million people have a stroke every year, and this number is rising. (K91, from J39:2) Venous thromboembolism is a common but preventable complication of acute ischaemic stroke, and is associated with increased mortality and long-term morbidity and substantial health-care costs for its management. (K92, from J39:6) Without venous thromboembolism prophylaxis, up to 75% of patients with hemiplegia after stroke develop deep vein thrombosis and 20% develop pulmonary embolism, (K93, from J39:8) which is fatal in 1-2% of patients with acute ischaemic stroke and causes up to 25% of early deaths after strokes. (K94, from J39:9) low molecular weight heparin and unfractionated heparin are therefore recommended in guidelines from expert consensus groups.10-14 (K95, from J39:10-14) The best treatment for VTE is prevention. [J34] Cause preventable death [J06] Deep venous thromboembolism (DVT) is an important health issue in the hospitalized patients that leads to increased length of stay, morbidity, and mortality. [J50] Early detection of DVT is important because of the risk of pulmonary embolism and its potentially fatal consequences. However, it is well known that clinical features of DVT and PE are notoriously nonspecific. [J09] Despite improvements in prevention (SPARCL 2006), little progress has been made in treating stroke with specific interventions once it has occurred. (K72, from J44) the occurrence of venous thromboembolism was about two-fold higher in patients with an NIHSS score of 14 or more than in those with a score less than 14 (in line with previous studies25) (K99, from J39:25 + J39self) Patients with intracerebral hemorrhage (ICH) or ischemic stroke are at high risk for development of venous thromboembolism (VTE). (K103, from J29:1) In comparison to patients with ischemic stroke, the risk for VTE is higher in the hemorrhagic stroke population. (K104, from J29:2) Without preventative measures, 53% and 16% of immobilized patients develop deep venous thrombosis (DVT) or pulmonary embolism (PE), respectively, in this population. (K105, from J29:3) One study detected DVT in 40% of patients with ICH within 2 weeks and 1.9% of those patients had a PE.4 (K106, from J29:4) Development of VTE in the patient with ICH adds further detrimental complications to an already lethal disease with a 1-month case-fatality rate of 35% to 52%.5 (K107, from J29:5) DVT also prolongs the length of hospital stays, delays rehabilitation programs, and introduces a potential risk for PE. (K108, from J29:6) DVT prolongs hospitalization and increases healthcare costs. [J01] DVT is the pathophysiological precursor of pulmonary embolism (PE). However, half of the DVT cases were asymptomatic. [J01, K1 from J37:18, J37,J27]. Approximately one third of patients with symptomatic venous thromboembolism (VTE) manifest pulmonary embolism (PE), whereas two thirds manifest deep vein thrombosis (DVT) alone. Moreover, death occurs in 6% of DVT cases and 12% of PE cases within 1 month of diagnosis. [J46, J27] Clinically apparent DVT was reported in 1.7% to 5.0% of patients with stroke. Subclinical DVT occurred in 28% to 73% of patients with stroke, usually in the paralyzed limb. [J45] The frequency of asymptomatic PE in patients with DVT to be 40%. [J50] Prevention of VTE is highly effective in lowering the morbidity and mortality rate of stroke patients since PE accounts for up to 25% of post-stroke early deaths. [J43] Bounds JV, Wiebers DO, Whisnant JP, Okazaki H: Mechanisms and timing of deaths from cerebral infarction. Stroke 1981, 12:474-477.The rate of PE is likely to be underestimated because they are not routinely screened for, and autopsies are rarely performed. Fifty percent of patients who die following an acute stroke showed evidence of PE on autopsy. [K68, from J13:7] The annual incidence of DVT in the general population is estimated to be about 1 per 1000 (8), however, it should be noted that much of the published data are derived from patients who present with symptoms at medical institutions. Diagnosis of DVT has traditionally been based on clinical presentation, however, evidence from postmortem studies indicates that a substantial proportion of VTE cases are asymptomatic. [K10 from J55] Clinically apparent DVT confirmed on investigation is less common but DVTs may not be recognised and may still cause important complications. Pulmonary embolism (PE) is an important cause of preventable death after stroke [K67, from J13:4]

Management and Leadership Skills Essay -- Business, Conflicts, Leaders

Introduction Management and leadership skills in nursing and other healthcare professions are becoming a more and more widely spoken of subject, as they are essential skills for everyday practice in delivering care (Gopee and Galloway, 2009). Effective management requires the nurse to be able to draw on evidence based knowledge and experience to develop the ability to manage competently during practice. Skills without knowledge, appropriate attitude and understanding will not equate to competency (Watson, 2002). This piece of work will critically explore the theories about management and leadership in health care. At the beginning it will provide a base understanding of both topics and accountability importance. It will then concentrate on management of conflict, which could be seen in the clinical setting scenario from my current placement area. It will demonstrate how the use of conflict management theories can be helpful and how I behaved in the role of a manager. Also different leadership styles involved during this conflict situation will be analysed with use of evidence-based literature. To address the subject of confidentiality as per the Nursing & Midwifery Council guidelines (NMC, 2008), no names or exact location of the hospital placement will be mentioned. Conflict management and leadership Murray and Dicroce (2003) suggest that management is a process that uses resources to achieve specific goals effectively; basic management functions including planning, organising, coordinating, directing and controlling. The term of manager can be appointed to the person to plan, organise, coordinate, supervise, negotiate, evaluate and use resources available in the best way possible to achieve the best service. Alternativ... ...ively, nurses should not only have sufficient evidence-based knowledge and skills, but also a caring and compassionate attitude. This essay presented a scenario, which at first, may have seemed to be trivial. However, it offered a clear presentation of conflict between two members of staff, manager and staff nurse, with me being a learner manager trying to resolve the issue. I have developed knowledge about conflict management theory, especially the importance of trying to achieve a win-win situation between the two different leadership styles, to be precise, autocratic and democratic. It was not an easy task to manage a conflict situation as a learner, but acquiring this new knowledge and experience has helped me to build my confidence and identify not only my strengths, but also weaknesses, which I am going to work on in the future as a newly qualified nurse.

A comparison of the Ideas of William James and the Teachings of Christ Essay

William James had an incisive insight about a number of intellectual and psychological dealings. He was a trained medical doctor yet he excelled in the field of philosophy and wrote enormously about his thoughts and ideas. Pragmatism, Meaning of Truth as a Sequel to Pragmatism, Pluralistic Universe, and Varieties of Religious Experiences are considered as the major philosophical premises proposed by William James. The ideas of Pragmatism demand scrupulous attention to understand. As per William James, the meaning of an idea or a proposition or a thought lies in its observable practical consequences. Hence the idea under proposition must exhibit this quality of direct practical results. He believes that a thought or an idea must always be based on the verity of faith. He writes: â€Å"A fact [may] not come at all unless a preliminary faith exists in its coming†¦ Faith in a fact can help create the fact. † (James, â€Å"The Will to Believe†, 1897) Therefore trust and idea are sometimes inter-reliant and may often cease to exist without each other. He opines that the truth or falsity of a judgment depends on the obtainment of the expectations that follow the judgment under question. For a judgment to comply with this, one needs to be pragmatic [= as a matter-of-fact] in his approach towards the events which are going to be judged. We can also see a contrast between his thoughts when he constantly vacillates between science and religion. The general credence that religious experiences involve a supernatural domain, on the whole, is somehow remote to science. However, to the individual human being these remote things are accessible as their driving force is faith and not empirical examination. James tries to bridge this gap between science and religion. The difference between the scientific principles and religious beliefs are woven to arrive at a multipart thinking procedure which we can call as the â€Å"Science of Religion†. He wrote about this as follows: Religious experience, in other words, spontaneously and inevitably engenders myths, superstitions, dogmas, creeds, and metaphysical theologies, and criticisms of one set of these by the adherents of another. Of late, impartial classifications and comparisons have become possible, alongside of the denunciations and anathemas by which the commerce between creeds used exclusively to be carried on. We have the beginnings of a â€Å"Science of Religions,† so-called; and if these lectures could ever be accounted a crumb-like contribution to such a science, I should be made very happy. (James, The Varieties of Religious Experiences, Lecture XVIII) These thoughts point towards that eternal question of can there be a God who created this universe? A pragmatist, such as James Williams, would say â€Å"Yes, there indeed must be an empirical God who made all this universe provided the consequences are proved or the relations established†. That, simply put, is another state of perplexity where the vision of identifying the ‘Cause’ and ‘Effect’ may cease to exist. Now let us examine what pure religion and religious thoughts or philosophies (sans James Williams! ) say about such perplexities of life. The Bible and the preaching of Jesus Christ and other religious foundations categorically decline the right to question. They demand absolute ‘surrender’ in order to get absolute ‘delight’. The teachings of Jesus must be quoted here: â€Å"Therefore everyone who hears these words of mine and puts them into practice is like a wise man who built his house on the rock. The rain came down, the streams rose, and the winds blew and beat against that house; yet it did not fall, because it had its foundation on the rock. But everyone who hears these words of mine and does not put them into practice is like a foolish man who built his house on sand. The rain came down, the streams rose, and the winds blew and beat against that house, and it fell with a great crash. † (Matthew 7:24-27) The teachings of Christ demands unquestionable faith in the supernatural in order to attain absolute delight. This absolute delight or state of freedom is in total contrast to what we have seen so far in the flow of William James’ ideas. However there is one similarity: That both the schools of thoughts agree to the fact that humanity is something which, neither needs to be empirically analyzed nor pragmatically accepted. The laws of both pragmatism and religion bend and tend to converge at one solitary point and this point of convergence is diligently referred to as ‘Kindness’. Historically, William James lived in the 19th Century. (January 11, 1842 – August 26, 1910) During this period of time America was witnessing the industrial revolution and started emerging as the international power. It was also that phase of the history when the country was reeling under aftereffects of the Civil War and the laborer strikes. The ideas of William James were widely accepted from both laymen and intellectuals alike. The very concepts of ‘Pragmatism’, â€Å"Will to Live’, ‘Pluralistic Universe’ and ‘A Study in Human Nature’ were regarded as the new hopes amidst turbulent times. Even though the dynamics of the contemporary society have changed immeasurably, I still feel some of James’ ideas would be contentedly accepted. Economical imbalances (Read: The Recession), and religious conflicts (Read: Fundamentalists/Extremists) have rendered a sense of cynicism. The thoughts of William James will surely be a respite if understood and implemented diligently. The astute adoption is the key as James writes: â€Å"The art of being wise is the art of knowing what to overlook. † (William James â€Å"The Principles of Psychology†, 1890) Let us hope better sense prevails upon the humanity and the thoughts of William James guide us through the testing times. References William James, â€Å"The Will to Believe†, 1897 William James, The Varieties of Religious Experiences, Lecture XVIII Bible, Matthew 7:24-27 William James â€Å"The Principles of Psychology†, 1890

The Country Of Nicaragua And The Center Of Central America

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