Evidence-Based Practices for Deep Vein Thrombosis Prevention

Introduction

Overview

This paper develops an in-depth analysis of the use and application of evidence-based practice in the management and prevention of deep vein thrombosis. The purpose is to analyze a patient case and determine areas that need improvement with evidence-based practice information, including the application of single study research guides. First, the paper identifies a case from the practicum area. Secondly, the paper analyzes deep vein thrombosis from a pathophysiological perspective. Thirdly, a detailed analysis of evidence-based information and its use in EBP has been used to enhance the existing knowledge and improve patient outcomes.

Background

Over the last two decades, the application of evidence-based information in nursing and other fields in medicine has become an important topic, with various institutions, organizations, and individuals researching to determine the effectiveness of evidence-based information on patient outcomes. In particular, the term ‘evidence-based practice (EBP)’ has been derived from the earlier application of evidence-based information in medicine (Murphy, Scmitz & Rosolowski, 2012). The origin of EBP in nursing can be traced back to the work of Canadian researchers at McMaster University, the show attempted to define the practice of medicine to enhance the usability of research-based information in improving patient outcomes (Courtney & McCutcheon, 2010). Currently, EBP in nursing employs focuses on three elements- clinical expertise, patient values, and best available evidence from research (Polit & Beck, 2008). Although the exact definition of EBP is lacking, it is agreed that the practice involves the process of integrating the best research evidence with both patient values and clinical/nursing expertise (Polit & Beck, 2008). In nursing, EBP emphasizes the use of research findings and guidelines to support data collection, interventions, patient evaluation, patient care, and patient advice. This practice amounts to what is generally known as “research utilization”. The goal is to provide practicing nurse professionals with evidence-based information to help them deliver effective care for their patients based on the best information obtained from the research, resolve problems and issues in a clinical setting and achieve high-quality care delivery (Murphy, Scmitz & Rosolowski, 2012). It ensures that nurses exceed quality assurance standards and improve their innovative capacity Edwards & Grinspun, (2011). In addition, EBP requires the formation of guidelines for nurses based on the best evidence from research. It aims at implementing effective regulation of nurses’ behavior, resolving problems at their working place, and helping them achieve excellence in their area of service.

The use and application of evidence-based nursing practice in deep vein thrombosis

Pathophysiology of thrombosis

Deep vein thrombosis (DVT) is a condition defined by the formation of a blood clot in the deep-seated veins, especially in the lower extremities. In advanced conditions, one or more parts of the blood clot may break off and move towards the lung cavity, which causes pulmonary embolism, one of the most life-threatening conditions associated with DVT. According to studies, more than 25% of the conditions progress towards PE, especially when early detection and management are not provided. The advanced condition involves a number of other organs, including popliteal, liliacna, and femoral veins.

Recent studies have shown that the progress of the condition begins with a development of DVT in the calf veins before growing progressively to the direction of the venous blood flow. According to Heit, Silverstein, Mohr, Petterson, et al (2006), the growth of the DVT takes the direction of the heart, which means that the clot will always move towards the heart. Studies by Saha, Humpries, and Modarai (2011) have shown that DVT may develop but fail to grow and can be cleared by dissolving into the blood in a process known as fibrinolysis. The condition mostly affects the deeply seated veins in the calf and thighs, resulting in symptoms that represent those of May-Tuner Syndrome.

The primary mechanism of DVT is relatively complicated than the mechanism that contributes to DVT begins with a tissue factor that enhances the process of converting prothrombin to thrombin. This process is followed by the deposition of fibrin. Erythrocytes and fibrin form the main component of thrombi in the veins. Fibrin attaches to the endothelium of the vein.

Case study: The case of Dave Hawkins

Dave Hawkins is a 59-year old Caucasoid male from Vermont. He was once a mechanical engineer at one of the local civil contracting companies. He retired from the position 3 years ago to start his own business, specializing in Information Technology services, laying fiber cables, and other related activities. At the age of 58, Hawkins, whose parents originally came from Britain, presented at a local clinic with signs of swelling, redness, and excessive warmth. Upon investigation, the nurses found that his veins had distention on the surface. Due to the presence of distension of the surface veins, the nurses carried out an ultrasound diagnosis. The results were positive for DVT. Thus, the nurses held a team meeting to decide the best way to provide an intervention program in dealing with Hawkins’ situation.

Areas of weakness

Drugs were provided, but the condition did not heal within the expected time. First, apart from the drugs, the proper care was not given based on recent findings in research. Secondly, Hawkins was not given the right information to help develop the personal healing process. For instance, he was not advised to adopt a better lifestyle. In addition, Advice on the proper diet was not provided. Arguably, the best way is to apply evidence-based practice to provide the patient with the best care.

Applying evidence-based care in managing deep vein thrombosis: The case of Dave Hawkins

Major medical issue

John Hawkins has an advanced state of DVT, given that his condition has advanced towards ‘phlegmasia cerulean doesn’t. In addition, he has some pains in his lower extremities due to the presence of blood clots in the femoral vein. His situation needs advanced intervention, which is most likely achievable through.

EBP intervention

In this case, I was able to apply the evidence-based guideline provided by Assessment Technologies Institute (2013), which is based on evidence from research. I carried out DVT prevention using preventive measures such as frequent changes of positions, mobilizations, and sequential compression stockings. I trained Hawkins on how to carry out some of these tasks on his own. Within three weeks, Hawkins reported to me, providing evidence that the pains on the lower extremities as well as excessive heat had reduced significantly.

Thus, evidence-based nursing provides the best intervention methods in a number of diseases, especially life-threatening conditions such as the situation facing Hawkins. In this case, it is evident that a number of studies have been carried out in the last few decades to determine the best way of dealing with deep vein thrombosis.

Researchers have produced one of the best analyses of the evidence-based methods for intervention in DVT. In this case, the authors provide evidence that the Caprini Risk Assessment Model (RAM) is one of the most effective methods for managing DVT in the modern world (Murphy, Scmitz & Rosolowski, 2012). It was shown that the method was effective in managing the condition by addressing risk factors, including an analysis of the patient’s diet and lifestyle history to determine the possible risk factors, especially those resulting from feeding habits (Guyatt, Akl & Crowther, 2012).

According to several previous studies, it is evident that the risk stratification procedure has become one of the most effective methods of intervention in managing DVT. For instance, studies by Kakkos, Tsolakis, Katsamouris, and Nicolaides (2013) have shown that stratification of the patient into risk factors defined by VTE categories of risk should be mainly based on their risk factors. In this case, some patients should receive intensive care than others. This model argues that drugs used to provide relief should only be used in those patients whose conditions have already shown evidence of pains in the lower extremities. On the other hand, patients whose conditions are detected early, including those who have not developed pains in the lower extremities, can be provided with advice based on lifestyle. For instance, the evidence from research shows that such patients should be provided with education on how to avoid excessive fats, especially unsaturated lipids from animals and synthetic fats in their diet. Research has shown that these fats are the major cause of thrombosis of various kinds, including DVT.

The use of thromboprophylaxis is necessary for all patients, regardless of the individual stage of the condition. For instance, a study by Heit, Mohr, Petterson, et al (2008), shows that thromboprophylaxis for patients admitted to hospitals with or without advanced conditions helps in improving the existing knowledge about the patient’s possible conditions (Murphy, Scmitz & Rosolowski, 2012). This allows nurses and clinicians to develop the best possible medical intervention.

According to a study by Silverstein, Heit, Mohr, Petterson, et al (2008), the absence of contraindications to pharmaceutical conditions allows nurses and physicians to apply a number of drugs, including heparin with low molecular weighty. These studies have shown that high molecular weight heparin is likely to lead to complications such as immune reaction to the drug.

Conclusion

The evidence obtained from recent studies indicates that patients in Hawkins’ situation require more than one form of intervention. First, immediate intervention involving the use of drugs such as heparin is necessary upon the patient’s admission to the health facility. Secondly, evidence from research indicates that education on lifestyle is an important aspect of the intervention. Studies have revealed that one of the best intervention protocols is to provide patients with information on the necessity of reducing unsaturated fatty acids that result from animal products. Thus, this set of information will provide an important intervention protocol to improve patient outcomes in Hawkins’s case.

References

Assessment technologies institute. (2013). RN adult medical surgical nursing. New York: ATI Nursing Education.

Courtney, M., & McCutcheon, H. (2010). Using evidence to guide nursing practice. New York: Elsevier Health Sciences.

Edwards, N., & Grinspun, D. (2011). Understanding whole systems change in healthcare: The case of emerging evidence-informed nursing service delivery models. Ottawa, ON: Canadian Health Services Research Foundation.

Guyatt, G., Akl E., & Crowther, M. (2012). Antithrombotic therapy and prevention of thrombosis: American College of Chest Physicians evidence-based clinical practice guidelines. Chest, 2(12), 7S–47S.

Heit, J. A., Silverstein, M. D., Mohr, D. N., Petterson, T. M., et al. (2006). Risk factors for deep vein thrombosis and pulmonary embolism: a population-based case-control study. Archives of internal medicine, 160(6), 809-815.

Kakkos, S. K., Tsolakis, I. A., Katsamouris, A., & Nicolaides, A. N. (2013). Risk stratification approaches for venous thromboembolism (VTE) prophylaxis in surgical patients. Hellenic Journal of Surgery, 85(1), 18-27.

Murphy, R. X., Scmitz, D., & Rosolowski, K. (2012). Evidence-based practices for thromoboembolism prevention: A report from ASP venous thromboembolism task force approved by ASPS executive committee, July 2011. Arlington, IL: American society of plastic surgeons.

Polit, D. F., & Beck, C. T. (2008). Nursing research: Generating and assessing evidence for nursing practice. New York: Lippincott Williams & Wilkins.

Saha, P., Humphries, J., & Modarai, (2011). Leukocytes and the Natural History of Deep Vein Thrombosis Current Concepts and Future Directions. Arteriosclerosis, thrombosis, and vascular biology, 31(3), 506-512.

Silverstein, M. D., Heit, J. A., Mohr, D. N., Petterson, T. M., et al. (2008). Trends in the incidence of deep vein thrombosis and pulmonary embolism: a 25-year population-based study. Archives of internal medicine, 158(6), 585-593.

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