oxygen resulting in the failure to nourish the tissues at the capillary level.

Superficial thrombophlebitis is commonly prevalent during the postpartum period than during pregnancy and is seen more in women experiencing varices. Postpartum deep vein thrombosis (DVT) and superficial thrombophlebitis have been attributed to trauma to pelvic veins from the pressure exerted by the presenting fetal part, impaired circulation caused by mechanical edema, and changes in coagulation related to the high amount of estrogens produced during pregnancy. Thrombosis that involves only the superficial veins of the leg or thigh is unlikely to result in pulmonary emboli (PE). While approximately 50% of clients with DVT are asymptomatic, DVT is more serious in terms of potential complications, such as pulmonary embolism, post-thrombotic syndrome, chronic venous insufficiency, and vein valve destruction.
Nursing Care Plans

Nursing care plan goals for a client with postpartum thrombophlebitis include enhance tissue perfusion, facilitate resolution of thrombus, promote optimal comfort, prevent complications and provide information and emotional support.

Here are four (4) nursing care plans (NCP) and nursing diagnosis for postpartum thrombophlebitis:
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Altered Peripheral Tissue Perfusion
Acute Pain
Deficient Knowledge
Anxiety

Altered Peripheral Tissue Perfusion

Ineffective Tissue Perfusion: Decreased in the oxygen resulting in the failure to nourish the tissues at the capillary level.

May be related to

Venous blood flow interruption

Possibly evidenced by

Pallor and cyanosis (DVT)
Prolonged capillary refill time
Weak peripheral pulses
Swelling of affected extremity
Redness/erythema (superficial thrombophlebitis)
Pain

Desired Outcomes

Client will demonstrate improved circulation of affected extremity as evidenced by palpable and equal peripheral pulses, adequate capillary refill, reduced edema, and erythema.

Nursing Interventions Rationale
Monitor capillary refill time; Assess for positive Homans’ sign (calf pain at dorsiflexion of the foot). DVT may prolonged capillary refill time. Positive Homans’ sign is not a reliable indicator of DVT.
Assess circulation, asymmetry, sensory and motor function of extremity; Observe edema from groin to foot; Measure and record calf/thigh circumference of both legs as appropriate. Report proximal progression of inflammation, traveling pain. Symptoms help differentiate between superficial thrombophlebitis and DVT. Localized edema, redness, warmth, and tenderness are indicative of superficial involvement. Pallor and coolness of extremity are more characteristic of DVT. Calf vein involvement of DVT is usually associated with the absence of edema; mild to moderate edema suggests femoral vein involvement, and severe edema is characteristic of ileofemoral vein thrombosis.
Assess respiration and auscultate for lung sounds, noting crackles or friction rub. Investigate reports of chest pain or feelings of anxiety. Pulmonary congestion, sudden sharp substernal chest pain, anxiety, shortness of breath, rapid heart rate, and hemoptysis are characteristic of pulmonary emboli, especially in DVT.
Instruct client to avoid massaging or rubbing the affected extremity. Massaging the extremity increases the risk of dislodging the thrombus that can turn into emboli.
Maintain bed rest with elevation of feet and lower legs in above heart level during the acute phase. Decreases the possibility of dislodging thrombus and creating emboli. Rapidly empties superficial and tibial veins and keeps veins collapsed, thereby increasing venous return.
Elevate client’s legs when resting or sitting in a chair. Reduces tissue swelling and rapidly empties superficial and tibial veins, preventing overdistension and, thereby, increasing venous return.
Instruct client to avoid crossing the legs or wear constrictive clothing. Promotes restriction in circulation that impairs blood flow, thus increasing venous stasis, pain, and trauma.
Encourage increased fluid intake of 2500 ml/day unless contraindicated Reduces blood viscosity and minimizes the possibility of a thrombus formation.
Emphasize the importance of deep-breathing exercises. Increase negative pressure in the thorax which aids in emptying large veins.
Facilitate and assist with active or passive ROM while on bedrest; Assist with gradual resumption of ambulation as advised. Enhances increased venous return, decreases venous stasis, and maintains muscle strength.
Apply warm, moist compresses or heating pad to affected extremity as ordered. Promotes circulation, reduces swelling and improves venous return.
Apply elastic support hose. Caution is advised to prevent a tourniquet effect. Useful during the acute phase of superficial thrombosis since they exert a sustained, evenly distributed pressure over the entire surface of calves and thighs, decreasing caliber of superficial veins, enhancing blood flow to deep veins, and reducing stasis
Apply mechanical devices such as sequential compression stockings, thromboembolic (TED) stockings as indicated. Reduces venous stasis in the lower extremities and increases blood flow to the large leg veins which are prone to thrombus formation.
Monitor laboratory studies:

Aspartate aminotransferase (AST), lactate dehydrogenase (LDH).

Increased levels may indicate a thrombi formation.

PT, PTT/APTT; Hb/Hct

Measures the efficacy of the anticoagulant therapy. Hemoconcentration and dehydration increases blood viscosity and venous stasis, which promotes thrombus formation.
Administer medication as indicated:

Antimicrobial agents

Reproductive tract infection may result in septic pelvic thrombophlebitis.

Thrombolytic agents (streptokinase, urokinase)

May be used for the treatment of acute or massive DVT to prevent valvular damage and development of chronic venous insufficiency. Heparin is usually begun several hours after the completion of thrombolytic therapy.

Heparin (via continuous IV drip, intermittent administration using heparin lock, or subcutaneous administration) or coumarin derivatives

Heparin is usually preferred initially, owing to its prompt and predictable antagonistic action toward thrombin formation and prevention of further clot formation. Because of its large molecular size, heparin does not pass through to breast milk as coumarin derivatives do; however, coumarin, which blocks the formation of prothrombin from vitamin K, may be used for long-term therapy following discharge.
Prepare client for surgical intervention as indicated. Thrombectomy (excision of thrombus) is usually done if inflammation extends proximally or circulation is severely compromised. Recurrent thrombotic episodes that are unresponsive/ contraindicated to anticoagulant therapy may require insertion of an inferior vena cava (IVC) filter.
Acute Pain

Acute Pain: Unpleasant sensory and emotional experience arising from actual or potential tissue damage or described in terms of such damage; sudden or slow onset of any intensity from mild to severe with anticipated or predictable end and a duration of <6 months.

May be related to

Presence of inflammatory process
Vascular spasms
Accumulation of lactic acid

Possibly evidenced by

Verbalizations of pain, tenderness, or burning
Restlessness
Guarding behavior
Self-focus
Autonomic responses

Desired Outcomes

Client will report pain is relieved/controlled.
Client will participate in behaviors/techniques to promote comfort.

Nursing Interventions Rationale
Assess degree and characteristic of discomfort or pain using 0–10 scale; palpate leg with caution. Note guarding of extremity. Degree of pain is directly related to extent of arterial involvement, degree of hypoxia, and extent of edema associated with thrombus development in inflamed venous wall. Client may guard or immobilize affected extremity to decrease painful sensations associated with muscle movement.Changes in characteristics of pain may indicate progression of problem/development of complications
Monitor vital signs, noting elevated temperature or pulse. Elevation of vital signs may indicate increasing pain, or occur in response to fever and inflammatory process. Fever may contribute to general discomfort.
Observe for reports of sudden or sharp chest pain, dyspnea, tachycardia, or apprehension. These signs and symptoms indicate pulmonary embolism as a complication of DVT.
Encourage change of position, keeping extremity elevated. Promotes increases venous return; Decreases fatigue and muscle spasm.
Elevate affected extremity; provide foot cradle. Encourages venous return, facilitates circulation. Foot cradle keeps pressure of bedclothes off the affected leg, thereby reducing pressure discomfort
Maintain bedrest during the acute phase. Reduces discomfort associated with muscle contraction and movement. Minimizes the possibility of dislodging thrombus.
Explain procedures, treatments, and nursing interventions. Involving the client in the nursing care increases her sense of control and decreases her level of anxiety.
Apply moist heat to extremity. Causes vasodilation, which increases circulation, relaxes muscles and may stimulate the release of endorphins.

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