1.Admit to:
2. Diagnosis: Deep vein thrombosis
3. Condition:
4. Vital Signs: q shift. Call physician if BP systolic >160,<90 diastolic, >90, <60;
P >120, <50; R>25, <10; T>38.5°C.
5.Activity: Bed rest with legs elevated.
6. Nursing: Guaiac stools, warm packs to leg prn; measure calf and thigh
circumference qd; no intramuscular injections.
7. Diet: Regular
8. IV Fluids: D5W at TKO
9. Special Medications:
Anticoagulation:
-Heparin (unfractionated) IV bolus 5000-10,000 Units (100 U/kg) IVP,
then 1000-1500 U/h IV infusion (20U/kg/h) [25,000 U in 500 mL D5W (50 U/mL)].
Check PTT 6 hours after initial bolus; adjust q6h until PTT 1.5-2.0 times control
(50-80 sec).Overlap heparin and warfarin (Coumadin) for at least 4 days and
discontinue heparin when INR has been 2.0-3.0 for two consecutive days.
-Enoxaparin (Lovenox) 1 mg/kg SQ q12h or 1.5 mg/kg
SQ q24 h for DVT without pulmonary embolism.
Overlap enoxaparin and warfarin as outlined above.
-Warfarin (Coumadin) 5-10 mg PO qd x 2-3 d; maintain INR 2.0-3.0.
Coumadin is initiated on the first or second day only if the PTT is 1.5-2.0
times control[tab 1, 2, 2.5, 3, 4, 5, 6, 7.5, 10 mg].
10. Symptomatic Medications:
-Propoxyphene/acetaminophen (Darvocet N100) 1-2 tab PO q3-4h prn pain OR
-Hydrocodone/acetaminophen (Vicodin), 1-2 tab q4-6h PO prn pain.
-Docusate sodium (Colace) 100 mg PO qhs.
-Famotidine (Pepcid) 20 mg IV/PO q12h.
-Zolpidem (Ambien) 5-10 mg qhs prn insomnia.
11. Extras: CXR PA and LAT, ECG; Doppler scan of legs. V/Q scan, chest CT scan.
12. Labs: CBC, INR/PTT, SMA 7. Protein C, protein S,antithrombin III,
anticardiolipin antibody. UA with dipstick for blood. PTT 6h after bolus and
q4-6h until PTT 1.5-2.0 x control then qd. INR at initiation of warfarin and qd.
