Portal Vein Thrombosis Nursing Care Plans Diagnosis and Interventions
Portal Vein Thrombosis NCLEX Review and Nursing Care Plans
Portal vein thrombosis (PVT) occurs when a blood clot blocks or narrows the portal vein, which is the blood vessel that transports blood from the intestines to the liver.
Thrombosis can occur in the portal vein’s main body or intrahepatic branches, and it can even spread to the splenic or superior mesenteric veins (SMV). PVT is usually associated with liver cirrhosis. It can also happen without any other symptoms, such as malignancy, abdominal infection, or pancreatitis.
Extrahepatic Portal Venous Obstruction (EHPVO) should be considered a distinct phenomenon that refers to the formation of portal cavernoma or collaterals around chronic portal vein thrombosis.
Pressure in the portal vein rises as the portal vein narrows or becomes obstructed. The spleen enlarges (splenomegaly) as a result of increased pressure known as portal hypertension.
It also causes dilated, twisted (varicose) veins in the esophagus (esophageal varices) and, in certain cases, the stomach (called gastric varices). These veins are prone to bleeding extensively.
Ascites (abdominal fluid accumulation) is a rare occurrence in PVT. However, it can occur when the patient has liver congestion (blood pooling in the liver) or liver damage, such as severe scarring of the liver (cirrhosis), or when large amounts of fluids are administered intravenously to treat massive bleeding from ruptured varicose veins in the esophagus or stomach.
When the patient with cirrhosis acquire portal vein thrombosis, their situation worsens.
Signs and symptoms of Portal Vein Thrombosis
The majority of people experience no symptoms. The following are some of the most common signs of PVT:
- upper abdominal discomfort
- extra abdominal fluid causes abdominal edema.
However, some people suffer from complications as a result of portal hypertension over time. Due to pressure interfering with proper blood flow, portal hypertension can lead to splenomegaly. As a result, the number of lymphocytes extensively decreases, thus elevating the risk of acquiring infection.
Varices (abnormally expanded blood vessels) in the esophagus or stomach can also be caused by portal hypertension.
Hematemesis (vomiting blood) may be observed if these varices rupture and bleed excessively. Blood can also flow through the digestive system, resulting in dark, tarry, and foul-smelling feces called melena.
The following are the symptoms of a more severe portal vein thrombosis:
- fever spikes or hyperthermia
- liver pain
- jaundice (yellowing of the skin)
Causes of Portal Vein Thrombosis
Portal vein thrombosis affects around 25% of individuals with cirrhosis, owing to the sluggish blood flow through the severely scarred liver.
Blood clots develop more easily when blood flow is slow. Portal vein thrombosis can be caused by any condition that makes blood more susceptible to clot. The most common causes of portal vein thrombosis differ by age group:
- Infection of the umbilical cord stump in newborns (at the navel)
- Appendicitis in older children (infection can spread to the portal vein and trigger the formation of blood clots)
- In adults, causes include polycythemia (excess red blood cells), some malignancies (liver, pancreatic, kidney, or adrenal gland), cirrhosis, injuries, blood clotting issues, surgery, and pregnancy
Cirrhosis is the most common cause of PVT. While in non-cirrhotic livers, PVT is caused by hereditary or acquired pro-thrombotic conditions. The most prevalent procoagulant state is primary myeloproliferative disorders (MPD).
Antiphospholipid syndrome, paroxysmal nocturnal hemoglobinuria (PNH), inherited pro-thrombotic disorders, hyperhomocysteinemia, and, less frequently, mutations in factor V Leiden, factor II, methylenetetrahydrofolate reductase (MTHFR) gene and other pro-thrombotic conditions can cause PVT.
PVT can be caused by intra-abdominal inflammatory diseases that lead to vascular endothelial damage. Pancreatitis, cholangitis, appendicitis, and liver abscess are among them. PVT can be caused by local injury to the portal venous axis after splenectomy, laparoscopic colectomy, or abdominal trauma in combination with the aforesaid acquired or hereditary pro-thrombotic factors.
Phlebosclerosis with thrombosis as a subsequent event is the etiology of EHPVO in children. EHPVO develops as a result of omphalitis, newborn umbilical sepsis, umbilical vein cannulation, recurring abdominal infections, sepsis, abdominal surgery, and trauma.
Several factors frequently combine to induce a blockage. In around a third of cases, the cause is unknown.
Risk Factors to Portal Vein Thrombosis
When blood flows unevenly in the body, blood clots are more likely to form. While doctors aren’t sure what causes portal vein thrombosis, there are a few things that can increase the individual’s chances of getting it.
The following are the most common risk factors of portal vein thrombosis:
- pancreatitis is inflammation of the pancreas.
- Infants with a naval infection caused by the umbilical cord stump
- extra red blood cells, or polycythemia
- contraceptive pills
- the liver cirrhosis
- liver problems
- injury or trauma
Pregnancy and surgery are two other risk factors that might cause PVT. Blood is more prone to clot in both circumstances, reducing blood flow to other extremities. These factors can have life-threatening consequences in more extreme circumstances.
Diagnosis of Portal Vein Thrombosis
People who have a combination of the following symptoms may have portal vein thrombosis, according to doctors:
- Varicose veins in the esophagus or stomach cause bleeding.
- Spleen enlargement
- Conditions that put you at risk for a portal vein thrombosis (for example, umbilical cord infection in newborns or acute appendicitis in older children)
Liver tests are performed to examine how well the liver is functioning and whether it is damaged, however, the results are frequently normal. The diagnosis is usually confirmed by Doppler ultrasonography. It indicates that blood flow through the portal vein has been decreased or stopped entirely. Magnetic resonance imaging (MRI) or computed tomography (CT) may be required in specific cases.
A variety of tests are available to determine the extent and severity of the patient’s portal vein thrombosis.
- Ultrasonography with Doppler. This is a noninvasive test that involves sound waves being bounced off of healthy red blood cells. Regular ultrasounds produce images by using sound waves, but they cannot show blood flow. Doppler ultrasounds, on the other hand, may depict blood circulation within vessels using imaging. This can be used to diagnose and assess the severity of the patient’s portal vein thrombosis.
- CT Scan. CT scans, or computerized tomography scans, provide images of bones and blood vessels using X-ray imaging and processing. Doctors will inject a dye into the veins that will show up on CT imaging in order to detect blood clots.
- Abdominal MRI. Radio waves and magnets are used in magnetic resonance imaging (MRI) to identify:
- blood flow irregularities
- abdominal swelling
- Other organs, such as the liver, may have lumps.
This test can also aid in the detection of cancers that look like other body tissues. An MRI is commonly used to clarify the results of other imaging procedures like CT scans.
- Angiography. An X-ray test is utilized to create images of blood flow within an artery or vein in this more intrusive treatment. The doctor will inject a specific dye into a vein and use a fluoroscopy imaging test to examine blood circulation within the damaged organ and look for blood clots.
Treatment for Portal Vein Thrombosis
The treatment for a blood clot is highly dependent on the primary cause. Treatment options for portal vein thrombosis will focus on dissolving the blood clot or preventing it from growing over time.
Doctors frequently prescribe medicine as a thrombolytic therapy for acute PVT. These prescription medications have the ability to dissolve blood clots. A medicine that dissolves clots (such as a tissue plasminogen activator) is sometimes utilized when a blood clot abruptly blocks a vein.
Anticoagulant medicines, such as heparin, may be recommended to patients with slow clot growth to assist avoid repeated clots and any excess growth. The efficacy of this treatment (known as thrombolysis) is unknown.
The cause (typically an infected umbilical cord or acute appendicitis) is addressed in babies and children. Portal hypertension-related issues are also addressed. Several treatments can be used to stop bleeding from esophageal varicose veins:
- Rubber bands are typically placed through the mouth into the esophagus using a flexible viewing tube (endoscope). The bands are used to secure the items.
- Antihypertensive medicines like beta-blockers and nitrates lower blood pressure in the portal vein, preventing esophageal hemorrhage.
- Intravenously administered octreotide, a medication that inhibits blood flow to the liver and hence lowers blood pressure in the abdomen, can help halt bleeding.
Depending on the amount of PVT injury, surgical procedures may be recommended. Shunt surgery may be recommended as a last resort by the doctor. The operation entails inserting a tube between the portal vein and the hepatic vein in the liver to prevent excessive bleeding and lower vein pressures. The doctor may need to conduct a liver transplant in some cases of severe liver disease.
Prevention of Portal Vein Thrombosis
In clinical practice, portal vein thrombosis is a rather typical occurrence. Because the ailment has such high morbidity and mortality rates if left untreated, it is best addressed by a multidisciplinary healthcare team. Early and prompt diagnosis and treatment are pivotal to reduce morbidity. Patients who receive early anticoagulation have an 85 percent 5-year survival rate. Acute portal vein thrombosis has a substantially better prognosis than chronic portal vein thrombosis, which often compromises liver function. Because percutaneous treatments are associated with far fewer problems, TIPS and open surgical procedures are far less common today.
Nursing Diagnosis for Portal Vein Thrombosis
Portal Vein Thrombosis Nursing Care Plan 1
Nursing Diagnosis: Acute Abdominal Pain related to intestinal congestion and ischemia secondary to portal vein thrombosis as possibly evidenced by abdominal distension, diarrhea, rectal bleeding, nausea, vomiting, anorexia, fever, lactacidosis, splenomegaly, and sepsis.
- The patient will use appropriate diversional activities and relaxation techniques.
- The patient will describe pain control as satisfactory (for example, less than 3 to 4 on a rating scale of 0 to 10)
- The patient will demonstrate improved well-being as evidenced by baseline levels for pulse, blood pressure, respirations, and relaxed muscle tone or body posture.
- The patient will employ both pharmaceutical and nonpharmacological pain management techniques.
- The patient will demonstrate improved mood and coping abilities.
|Nursing Interventions for Portal Vein Thrombosis||Rationale|
|Make a thorough examination of the patient’s pain. Assess pain to determine its location, features, onset, duration, frequency, quality, and intensity.||The most accurate source of information about pain is the patient who is experiencing it. Because individuals can explain the location, intensity, and duration of pain, their self-report is the gold standard in pain evaluation. As a result, having an interview to measure pain assists the nurse in designing appropriate pain treatment strategies.|
|Ask the patient experiencing the pain to point to the area that is bothering them||The patient can benefit from charts or drawings of the body, and the nurse can pinpoint specific pain spots. When working with clients who have limited vocabulary, asking them to localize the location can help you explain the pain assessment — this is especially crucial when working with children.|
|Perform a pain history evaluation.||During the pain evaluation, the nurse should also inquire about the following: (1) effectiveness of previous pain therapy or management; (2) what medications were taken and when; (3) additional medications being taken; and (4) allergies or known pharmaceutical adverse effects.|
|Determine the patient’s pain perception.||Allow the client to articulate how they view the pain and the circumstance in their own words when taking a pain history to acquire a better grasp of what the pain means to them. “What does having this suffering mean to you?” you can inquire. “, “Could you tell me more about how this discomfort is affecting you?” ”.|
|Every time vital signs are checked, pain should be assessed.||Pain evaluation is often referred to as the “fifth vital sign,” and it should be included in routine vital sign assessments.|
|The nurse must initiate pain assessments.||Suffering reactions are individual, and some clients may be hesitant to report or speak their pain until specifically requested.|
|To determine pain intensity, use the Wong-Baker FACES Rating Scale.||Some patients (e.g., children with language barriers) may need to utilize the Wong-Baker Faces Rating Scale instead of numerical pain measures. Pain assessment tools aid in the conversion of a patient’s subjective pain experience into numerical or descriptive descriptors.|
|Look into the indications and symptoms of pain.||In order to provide a tailored plan of care, an accurate assessment of pain is required. Bringing attention to additional signs and symptoms can help the nurse figure out what is causing the pain.. The existence of pain is sometimes overlooked by the sufferer.|
|Determine the patient’s pain relief expectations.||Some patients may be content if their pain is no longer severe, while others would desire complete pain relief. This has an impact on their evaluations of the treatment modality’s success and their willingness to participate in more therapies.|
|Examine the patient’s pain response and therapy options.||It’s critical to help patients convey the effects of pain treatment measures as objectively as possible (i.e., without regard for mood, emotion, or worry). Inconsistencies between the patient’s conduct or appearance and what he or she says regarding pain relief (or lack thereof) may reflect alternative coping mechanisms the patient is employing rather than pain relief itself.|
Portal Vein Thrombosis Nursing Care Plan 2
Nursing Diagnosis: Hyperthermia related to inflammatory process secondary to portal vein thrombosis as evidenced by increased body temperature, tachypnea tachycardia, flushed warm skin, malaise, and loss of appetite.
- The patient will keep his/her body temperature below 39 degrees Celsius (102.2 degrees Fahrenheit).
- The patient will keep his/her blood pressure and heart rate within normal ranges.
|Nursing Interventions for Portal Vein Thrombosis||Rationale|
|Check for hyperthermia signs and symptoms.||Signs and symptoms of hyperthermia include weakness, respiratory trouble, flushed face, rash, increased cardiac rate, malaise, headache, and irritability. Keep a watch out for excessive sweating, hot and dry skin, or a feeling of being too hot.|
|Examine for signs of dehydration secondary to hyperthermia.||Dehydration is indicated by thirst, a wrinkled tongue, dry lips, dry oral membranes, low skin turgor, decreased urine output, high urine concentration, and a weak, fast pulse.|
|Keep an eye on the patient’s pulse and blood pressure.||As hyperthermia advances, the heart rate and blood pressure rise.|
|Examine the patient’s history, diagnosis, and procedures to determine what causes hyperthermia.||Understanding the origin of hyperthermia and the fluctuations in temperature will aid in therapy and nursing interventions.|
|Determine the patient’s age and weight.||The danger of being unable to control body temperature increases with increasing age or weight. Because of physiologic changes associated with aging, the prevalence of chronic diseases, and the use of polypharmacy, the elderly are susceptible to hyperthermia.|
|Keep track of the patient’s fluid intake and excretion.||If the patient is unconscious, the central venous or pulmonary artery pressure should be checked to monitor fluid status.|
Portal Vein Thrombosis Nursing Care Plan 3
Nursing Diagnosis: Risk for Bleeding related to ruptured esophageal and gastric varices secondary to portal vein thrombosis.
- The patient will take steps to prevent bleeding and detects indicators of bleeding that should be reported to a medical expert right once.
- The patient will not demonstrate bleeding as evidenced by normal blood pressure, steady hematocrit and hemoglobin levels, and appropriate coagulation profile ranges.
|Nursing Interventions for Portal Vein Thrombosis||Rationale|
|Monitor the patient’s vital indicators, notably the blood pressure and heart rate. Keep an eye out for symptoms of orthostatic hypotension.||When bleeding is present, the body compensates by decreasing blood pressure and increasing heart rate. When shifting from a supine to a sitting position, orthostasis (a drop of 20 mm Hg in systolic BP or 10 mm Hg in diastolic BP) implies diminished circulating fluids.|
|Examine any drugs the patient is taking that may impact hemostasis (e.g, anticoagulants, salicylates, NSAIDs, or cancer chemotherapy).||Inhibitors of clotting processes or platelet activity raise the risk of bleeding. COX-1, an enzyme that causes platelet aggregation, is inhibited by salicylates and other NSAIDs. Warfarin, an oral anticoagulant, inhibits vitamin K production in the liver, lowering levels of many clotting factors in the process. Heparin, a parenteral anticoagulant, prevents the formation of a fibrin clot by inhibiting the activity of thrombin. Many cancer medications inhibit bone marrow activity and, as a result, platelet production.|
|As needed, review laboratory data for coagulation status: Platelet count, prothrombin time/international normalized ratio (PT/INR), activated partial thromboplastin time (aPTT), fibrinogen, bleeding time, fibrin breakdown products, vitamin K, active coagulation time (ACT).||The blood clotting cascade is a complex mechanism that requires both intrinsic and extrinsic variables to function properly. Clotting ability can be affected by a variety of variables. These laboratory tests reveal crucial information about the patient’s coagulation status and bleeding risk. The clinical status of the patient will decide the laboratory parameters that will be monitored. Increased levels of PT/INR and aPTT above therapeutic values are linked to an increased risk of bleeding in patients taking anticoagulants. Patients on heparin therapy may develop low platelet counts.|
|Examine the patient’s skin and mucous membranes for petechiae, bruising, hematoma formation, or blood seeping.||Patients with low platelet counts or poor clotting factor activity may have excessive bleeding into tissues. Coagulation irregularities are linked to prolonged spilling of blood from surgical wounds or regions of skin damage.|
|Hematocrit (Hct) and hemoglobin (Hgb) levels should be monitored.||Reduced Hgb and Hct levels may be an early sign of bleeding when bleeding is not evident.|
Portal Vein Thrombosis Nursing Care Plan 4
Nursing Diagnosis: Ineffective Tissue Perfusion related to venous stasis, vessel wall injury, and increased blood coagulability secondary to thrombophlebitis as possibly evidenced by changes in skin color and warmth across the affected area, edema, discomfort, decreased peripheral pulses, and sluggish capillary refill are all possible symptoms.
- The patient will recognize variables that aid circulation.
- The patient will maintain optimum tissue perfusion to vital organs as evidenced by strong peripheral pulses, warm and dry skin, vital signs within the normal range, balanced input and output, absence of edema, normal ABF, and absence of abdominal discomfort
|Nursing Interventions for Portal Vein Thrombosis||Rationale|
|Examine for symptoms of poor tissue perfusion.||Different reasons create different clusters of signs and symptoms. The defining aspects of ineffective tissue perfusion are evaluated to give a baseline for future comparison.|
|Examine possible contributory variables such as a temporary reduction in arterial blood flow. Compartment syndrome, a constricting cast, embolism, indwelling vascular catheters, placement, thrombus, and vasospasm are just a few examples.||Early diagnosis of the source allows for more efficient and effective control.|
|If anticoagulants are used for treatment, review the patient’s laboratory profile (ABGs, BUN, creatinine, electrolytes, international normalized ratio, and prothrombin time or partial thromboplastin time).||Blood clotting investigations are done to determine whether or not clotting factors are at therapeutic levels. Organ perfusion or function indicators. Coagulation irregularities may emerge as a result of therapeutic interventions.|
|Evaluate for signs of GI dysfunction such as anemia, reduced or missing bowel noises, nausea or vomiting, abdominal distension, and constipation.||Reduced blood supply to the mesentery can result in GI dysfunction, such as loss of peristalsis. Analgesic use, decreased activity, and dietary changes can all exacerbate or exacerbate problems.|
|Examine the patient’s breathing for any signs of work.||Respiratory distress can be caused by cardiac pump failure and/or ischemia pain. However, sudden or persistent dyspnea could indicate thromboembolic pulmonary consequences.|
Portal Vein Thrombosis Nursing Care Plan 5
Nursing Diagnosis: Deficient Knowledge related to unawareness of the disease, its treatment, and prevention secondary to portal vein thrombosis as evidenced by erroneous information, inconsistent follow-up, and several inquiries to the medical team.
Desired Outcome: The patient and/or significant others will communicate their awareness of the disease, its treatment, and prevention.
|Nursing Interventions for Portal Vein Thrombosis||Rationale|
|Examine the client’s knowledge of deep vein thrombosis‘ causes, treatments, and preventative strategies.||This knowledge provides a valuable educational beginning point. To limit the chance of recurrence, DVT requires proactive measures.|
|Explain the actions, dosing, and side effects of the medications to the client.||Correct information reduces future issues. Short-term symptom alleviation is best achieved with analgesics and anti-inflammatory drugs. Depending on the risks, clients may require anticoagulation for weeks or months.|
|While taking oral anticoagulation, remind the client that regular laboratory testing is required.||Coagulation monitoring is required on a regular basis to ensure a treatment response and prevent clot recurrence.|
|Discuss and provide a list of signs and symptoms of excessive anticoagulation to the client.||Clients must take charge of their own health. Early detection allows for faster treatment.|
|Provide instruction on how to stay safe while on anticoagulant medication, such as using an electric razor and a soft toothbrush.||These safety precautions serve to limit the danger of bleeding.|
|To prevent reoccurrence, inform the patient about the following measures:|
|Maintain proper hydration levels.||Hypercoagulability is prevented by adequate hydration.|
|Work on a healthy body weight.||Through compression of the principal veins in the pelvic region, obesity contributes to venous insufficiency and venous hypertension.|
|Encourage smoking cessation.||Nicotine in cigarettes acts as a vasoconstrictor, affecting blood coagulation and circulation.|
Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier. Buy on Amazon
Gulanick, M., & Myers, J. L. (2022). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon
Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2020). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier. Buy on Amazon
Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier. Buy on Amazon
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