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5 Postpartum Thrombophlebitis Nursing Care Plans

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By Iris Dawn Tabangcora, RN

Thrombophlebitis is inflammation with the formation of blood clots. It occurs in 1 in 1500 pregnancies. The three most common thromboembolic conditions during the postpartum period are superficial venous thrombosis (SVT), deep vein thrombosis (DVT), and pulmonary embolism (PE). The size of the clot can increase as circulating blood passes over it and deposits more platelets, fibrin, and cells. The levels of fibrinogen and other clotting factors normally increase during pregnancy, whereas levels of clot-dissolving factors are normally decreased, resulting in a state of hypercoagulability.

Superficial thrombophlebitis is more prevalent postpartum than during pregnancy and is seen more in women experiencing varices. It involves the saphenous vein of the lower leg and is characterized by a painful, hard, reddened, warm vein that is easily seen.

While approximately 50% of clients with DVT are asymptomatic, DVT is more serious in potential complications, such as pulmonary embolism, post-thrombotic syndrome, chronic venous insufficiency, and vein valve destruction. DVT can involve veins from the feet to the femoral area and is characterized by pain, calf tenderness, leg edema, color changes, pain when walking, and sometimes a positive Homan’s sign. However, the Homan’s sign is not always reliable during the postpartum period because it is not specific to blood clots postpartum.

Pulmonary embolism occurs when the pulmonary artery is obstructed by a blood clot that breaks off and lodges in the lungs. It may have dramatic signs and symptoms, such as sudden chest pain, cough, dyspnea, a decreased level of consciousness, and signs of heart failure.

Although thromboembolic disorders occur in less than 1% of all postpartum women, pulmonary embolism can be fatal if a clot obstructs the lung circulation; thus, early identification and treatment are paramount. Nursing management focuses on preventing thrombotic conditions, promoting adequate circulation if thrombosis occurs, and educating the client about preventive measures, anticoagulant therapy, and danger signs.

Table of Contents

Nursing Care Plans and Management

Nursing care plan goals for a client diagnosed with postpartum thrombophlebitis include enhancing tissue perfusion, facilitating the resolution of thrombus, promoting optimal comfort, preventing complications, and providing information and emotional support.

Nursing Problem Priorities

The following are the nursing priorities for patients with postpartum thrombophlebitis:

  • Anticoagulant therapy. Initiating and managing appropriate anticoagulant therapy to prevent the progression of blood clots and reduce the risk of complications.
  • Pain management. Implementing effective pain management strategies to alleviate discomfort associated with postpartum thrombophlebitis.
  • Monitoring for clot progression: Regularly monitoring the patient for any signs or symptoms of clot progression or worsening, such as swelling, redness, or warmth in the affected area.
  • Infection control. Implementing measures to prevent or manage infections that may complicate postpartum thrombophlebitis.
  • Ambulation and mobility. Promoting early ambulation and mobility to improve blood circulation and prevent further clot formation.
  • Education and support. Providing comprehensive education to patients about postpartum thrombophlebitis, its symptoms, and the importance of adherence to treatment and preventive measures.
  • Supportive care. Offering emotional support and counseling to patients dealing with the physical and emotional challenges of postpartum thrombophlebitis.
  • Follow-up and monitoring. Ensuring appropriate follow-up and monitoring to assess treatment response, identify potential complications, and adjust management if needed.
  • Collaboration with specialists. Coordinating with vascular specialists or hematologists to optimize care for patients with postpartum thrombophlebitis.
  • Prevention strategies. Implementing preventive measures, such as early ambulation, hydration, and appropriate use of compression stockings, to reduce the risk of postpartum thrombophlebitis in at-risk patients.

Nursing Assessment

Assess for the following subjective and objective data:

  • See nursing assessment cues under Nursing Interventions and Actions.

Nursing Diagnosis

Following a thorough assessment, a nursing diagnosis is formulated to specifically address the challenges associated with postpartum thrombophlebitis based on the nurse’s clinical judgment and understanding of the patient’s unique health condition. While nursing diagnoses serve as a framework for organizing care, their usefulness may vary in different clinical situations. In real-life clinical settings, it is important to note that the use of specific nursing diagnostic labels may not be as prominent or commonly utilized as other components of the care plan. It is ultimately the nurse’s clinical expertise and judgment that shape the care plan to meet the unique needs of each patient, prioritizing their health concerns and priorities.

Nursing Goals

Goals and expected outcomes may include:

  • The client will demonstrate improved perfusion as evidenced by palpable and equal peripheral pulses, good capillary refill, reduced edema, and erythema.
  • The client will engage in behaviors or actions to enhance peripheral tissue perfusion.
  • The client will display increased tolerance to activity.
  • The client will demonstrate adequate ventilation and oxygenation by ABGs within the normal range.
  • The client will report a reduction or absence of symptoms of respiratory distress. 
  • The client will report pain is relieved/controlled.
  • The client will participate in behaviors/techniques to promote comfort.
  • The client will demonstrate a relaxed manner and engage in the desired activity.
  • The client will verbalize awareness of feelings of anxiety.
  • The client will report anxiety reduced to a manageable level.
  • The client will exhibit decreased behavioral signs, such as restlessness and irritability.
  • The client will verbalize understanding of the condition, treatment, and restrictions.
  • The client will correctly perform therapeutic actions and explain the reasons for them.
  • The client will initiate necessary behavioral changes/correctly perform therapeutic procedures.
  • The client will identify signs/symptoms requiring medical evaluation.

Nursing Interventions and Actions

Therapeutic interventions and nursing actions for patients with postpartum thrombophlebitis may include:

1. Preventing Thrombus Formation

The pregnant woman is at increased risk for venous thrombosis because of the venous stasis from compression of the blood vessels by the heavy uterus or by pressure behind the knees when the legs are placed in stirrup leg supports episiotomy repair. If the client has varicose veins or remains on bed rest, her hypercoagulability state increases her risk of thrombus formation. Pulmonary embolism occurs when the pulmonary artery is obstructed by a blood clot that embolizes and lodges in the lungs, causing sudden chest pain, dyspnea, and a decreased level of consciousness. When the clot is large enough to block one or more of the pulmonary vessel that supplies the lungs, it can result in sudden death. Pulmonary embolism is the leading cause of pregnancy-related death in the United States, occurring in 2 out of 100,000 live births.

Assess the client’s vital signs closely.
It is important to closely monitor the client’s vital signs for slight elevations in temperature, possibly to 101℉ (38.3℃), and report this finding. Because the client diagnosed with DVT is at risk of developing a pulmonary embolism, be alert and immediately report any sudden onset of breathing difficulties.

Monitor capillary refill time.
Diminished capillary refill usually presents in DVT. A positive Homan’s sign is not a definitive diagnostic sign anymore. Several studies have been conducted to ascertain the predictive value of Homan’s sign for DVT. One study showed that all clinical signs were inconsistent, and Homan’s sign was seen in only 1/3rd of controlled subjects with actual thrombosis (Ambesh et al., 2017). It is no longer recommended to indicate deep vein thrombosis because a strained muscle or contusion can also cause calf pain. Homan’s sign is of more value if used in addition to more accurate diagnostic procedures (e.g., ultrasonography and venography).

Assess the client closely for risk factors and signs and symptoms of thrombophlebitis.
Look for risk factors in the client’s history such as the use of oral contraceptives before pregnancy, smoking, employment that necessitates prolonged standing, history of thrombosis, thrombophlebitis, or endometritis, or evidence of current varicosities. Also, look for other factors that can increase a client’s risk, such as prolonged bed rest, diabetes, obesity, cesarean birth, progesterone-induced distensibility of the veins of the lower legs during pregnancy, severe anemia, varicose veins, advanced maternal age (older than 35), and multiparity.

Identify symptoms that differentiate SVT from DVT.
Symptoms help differentiate between superficial thrombophlebitis and DVT. Localized edema, redness, warmth, and tenderness indicate 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 iliofemoral vein thrombosis.

Assess respiration and auscultate for lung sounds, noting crackles or friction rub. Investigate reports of chest pain or feelings of anxiety.
Be alert for signs and symptoms of pulmonary embolism, including unexplained sudden onset of shortness of breath and severe chest pain. The client may be apprehensive and diaphoretic. Additional manifestations may include tachypnea, decreased oxygen saturation by pulse oximetry, and a sudden change in mental status due to hypoxemia.

Assess for pain or tenderness in the lower extremities.
Suspect superficial thrombosis in a client diagnosed with varicose veins who reported tenderness and discomfort over the site of the thrombosis, most commonly in the calf area. The area appears reddened along the vein and is warm to the touch. The client will report increased pain in the affected leg when she ambulates and bears weight.

Examine extremities for obviously prominent veins. Palpate gently for local tissue tension, stretched skin, and knots or bumps along the course of the vein.
Distention of superficial veins can occur in DVT because of backflow through communicating veins. Thrombophlebitis in superficial veins may be visible or palpable.

Instruct the client to avoid massaging or rubbing the affected extremity.
Never massage the skin over the clotted area because this could loosen the clot, causing a pulmonary or cerebral embolism.

Elevate the client’s feet and lower legs above heart level when sitting or lying down.
Implement bed rest and elevation of the affected extremity for the client diagnosed with DVT. These actions help to reduce interstitial swelling and promote venous return from that leg.

Instruct the client to avoid wearing constrictive clothing and crossing her legs.
While the client is on bed rest, she should be encouraged to change positions frequently but avoid placing her knees in a sharply flexed position that could cause blood pooling in the lower extremities.

Encourage increased fluid intake of 2500 ml/day unless contraindicated
Dehydration increases blood viscosity and venous stasis, predisposing to thrombus formation.

Emphasize the importance of deep breathing exercises.
There have been few reports on the relationship between breathing exercises and venous thromboembolism. Clients admitted for acute exacerbations of chronic obstructive pulmonary disease appear to be at an increased risk of developing thrombosis. These findings suggested the potential effectiveness of regular deep breathing in postoperative clients to prevent venous thrombosis (Guo et al., 2019).

Facilitate and assist with active or passive ROM while on bedrest; Assist with the gradual resumption of ambulation as advised.
Short, frequent walks are better for extremities and prevent pulmonary complications than one long walk. If the client is confined to bed, ensure range-of-motion exercises. Initiate active or passive exercises while in bed, such as periodically flexing, extending, and rotating the feet.

Apply warm, moist compresses or heating pads to the affected extremity as ordered.
Apply warm compresses as ordered. When applying the compresses, ensure that they are at the appropriate temperature. Altered blood flow may diminish the client’s ability to sense temperature extremes, placing her at risk for a burn injury. Make sure that the weight of the compresses does not rest on the leg, compromising the blood flow. Check the client’s bed linens and change them as necessary because the linens may become damp from the moist heat applications. If possible, use a waterproof pad to protect the linens.

Apply support stockings as prescribed. Caution is advised to prevent a tourniquet effect.
If the client is diagnosed with varicose veins before or during pregnancy, wearing support stockings for the first two weeks after birth can help increase venous circulation and prevent stasis. If these are prescribed, be certain the client knows to buy medical support stockings, not pantyhose advertised as offering support and put them on before she rises in the morning. If she waits until she is up and walking, venous congestion will have already occurred, and the stockings will be less effective. Encourage her to remove the support stockings twice daily and assess her skin underneath for mottling or inflammation that would suggest inflammation of her veins.

Apply mechanical devices such as sequential compression stockings and thromboembolic (TED) stockings as indicated.
Apply anti-embolism stockings to both extremities as ordered. Fit the stockings correctly to avoid excess pressure and constriction and urge the client to wear them. Sequential compression devices can also be used for clients with varicose veins, a history of thrombophlebitis, or surgical birth.

Monitor laboratory studies such as aspartate aminotransferase (AST), lactate dehydrogenase (LDH), prothrombin time (PT), activated partial thromboplastin time  (aPTT); hemoglobin (Hb), and hematocrit (Hct)
Monitor the client’s coagulation studies closely. A therapeutic aPTT value typically ranges from 35 to 45 seconds, depending on which standard values are used. Hemoconcentration potentiates the risk of thrombus formation. The coagulation profile identifies clotting problems that may increase one’s risk of DVT.

Administer medication for postpartum thrombophlebitis as indicated.
See Pharmacologic Management

Prepare client for surgical intervention as indicated.
Thrombectomy (thrombus excision) is usually done if inflammation extends proximally or circulation is severely compromised. Recurrent thrombotic episodes that are unresponsive/ contraindicated to anticoagulant therapy may require the insertion of an inferior vena cava (IVC) filter.

Monitor the client’s vital signs and changes in cardiac rhythm.
Characteristic signs of pulmonary embolism (PE) include tachycardia (>100 beats/min) and tachypnea (>20 breaths/minute). A loud pulmonic valve closure sound (P2), the right-sided gallop rhythm, and increased central venous pressure, as assessed with vein distention, can also be signs of pulmonary hypertension caused by PE (Bauersachs, 2012).

Auscultate the lungs for areas of decreased and absent breath sounds and the presence of adventitious sounds.
On auscultation, the typical pleural leather rub and crackles caused by the pleural friction rub and decreased breath sounds are signs of pleural infarction (Bauersachs, 2012).

Note respiratory rate and depth and work of breathing, such as using accessory muscles or nasal flaring and pursed-lip breathing.
Tachypnea and dyspnea accompany pulmonary obstruction. Dyspnea and increased work of breathing may be the first and only signs of subacute PE. Severe respiratory distress and failure accompany moderate to severe loss of functional lung units. 

Assess the level of consciousness and evaluate mentation changes.
Hypoxemia may cause a sudden change in mental status and apprehension. It is important to consider syncope as a characteristic, albeit infrequent presentation of PE, which also points towards a reduced hemodynamic reserve. Syncope is present in about 8-19% of clients with PE (Bauersachs, 2012).

Assess activity intolerance, such as reports of weakness and fatigue or increased dyspnea during exertion.
These parameters assist in determining client response to resumed activities and ability to participate in self-care. According to a study, PE survivors walk substantially shorter distances than predicted on the 6-minute walk test and have the generic quality of life scores in the 40th percentile compared to the population norms. Evidence that many more have a poor quality of life and exercise intolerance following PE, a constellation that some have termed the “post-PE syndrome” (Sista et al., 2017).

Provide measures to restore or maintain a patent airway.
Instruct in using deep-breathing exercises, coughing, and suctioning to clear an obstructed airway caused by plugged or non-functional alveoli. Arterial blood gas analysis typically shows hypoxia, hypocapnia, and respiratory alkalosis (Bauersachs, 2012).

Elevate the head of the bed as the client can tolerate and assist with frequent changes in position.
An elevated head of the bed promotes maximal chest expansion, making breathing easier and enhancing physiological and psychological comfort. Turning and ambulation enhance the aeration of different lung segments, therefore improving oxygen diffusion.

Monitor the client frequently and arrange for someone to stay with the client as indicated.
This assures that changes in condition will be noted and that assistance is readily available. A client who develops pulmonary embolism needs to have emergency measures instituted immediately.

Assist the client in dealing with the fear and anxiety present.
Encourage the expression of feelings and inform the client and family members of the normalcy of anxious feelings and sense of impending doom. Understanding the basis of feelings may help the client regain some sense of control over emotions.

Monitor serial ABGs and pulse oximetry.
Arterial blood gas analysis typically shows hypoxia (PaO₂ <80 mm Hg) and hypocapnia and respiratory alkalosis, but up to 20% of clients with PE have a normal arterial oxygen pressure and a normal alveolar-arterial oxygen gradient (Bauersachs, 2012).

Prepare the client for a lung scan and other diagnostic imaging procedures.
Physical examination is not a sensitive diagnostic indicator for thrombosis. Venous ultrasonography with or without color Doppler is the most commonly used diagnostic test. MRI and D-dimer assays also may be used. With PE, echocardiographic abnormalities may be seen in right ventricular size or function. A ventilation-perfusion scan, spiral computed tomography scan, magnetic resonance angiography, and pulmonary arteriogram may be used for diagnosis.

Administer supplemental oxygen by the appropriate method.
The client needs oxygen administered immediately and is at high risk for cardiopulmonary arrest. Her condition is extremely guarded until the clot can be lysed or adheres to the pulmonary artery wall and is reabsorbed.

8. Administer fluids, IV or by mouth, as indicated.
Increased fluids may be given to reduce hyperviscosity of the blood, which can potentiate thrombus formation or support circulating volume and tissue perfusion.

Administer medications as prescribed.
An anticoagulant such as unfractionated heparin (given intravenously) or low-molecular-weight heparin (given subcutaneously) will be prescribed to prevent further blood clotting. Thrombolytics (medications that dissolve clots) may also be prescribed; these should be initiated within the first 24 hours for best results.

Assist with chest physiotherapy, such as postural drainage and percussion of nonaffected areas, blow bottles, and incentive spirometer.
Chest physiotherapy facilitates deeper respiratory effort and promotes drainage of secretions from the lung segments into the bronchi, where they may more readily be removed by coughing or suctioning.

Prepare and assist with bronchoscopy and surgical intervention, if indicated.
Bronchoscopy is performed to remove blood clots and clear airways. Surgical interventions recommended for PE include venalcaval ligation or insertion of an intracaval umbrella. These interventions are useful for clients who experience recurrent emboli despite adequate anticoagulation, when anticoagulation is contraindicated, or when septic emboli from below the renal veins do not respond to treatment.

2. Managing Acute Pain

Deep venous thrombosis (DVT) is a common condition with serious complications. Deep venous thrombi have a high probability of propagating and leading to pulmonary emboli, which may cause chest pain. Although DVT is often clinically silent, it may present several signs, including calf pain, edema, and venous distention. They are caused by an inflammatory process and obstruction of venous return.

Assess the degree and characteristic of discomfort or pain using a 0–10 scale; palpate the leg cautiously.
The degree of pain is directly related to the extent of arterial involvement, degree of hypoxia, and extent of edema associated with thrombus development in the inflamed venous walls. Ask the client if she has pain or tenderness in the lower extremities. Suspect superficial venous thrombosis in a client with varicose veins who reports tenderness and discomfort over the site of the thrombosis, most commonly in the calf area. The client will report increased pain in the affected leg when she ambulates and bears weight.

Assess for Homan sign.
A Homan sign or pain in the calf of the leg on dorsiflexion of the foot may be positive; however, a negative Homan sign does not rule out obstruction. Homan’s sign is usually not performed because more objective tests are needed for diagnosis. Assess for other factors such as redness, tenderness, warmth, or increased leg circumference. The clinical significance of a positive Homan sign is low because the postpartum client may have a strained muscle from delivery positioning.

Monitor vital signs, noting elevated temperature or pulse.
It is important to closely monitor the client’s vital signs for slight elevations in temperature, possibly 101℉ (38.3℃), and report this finding. Elevation of vital signs may indicate increasing pain or response to fever and the inflammatory process. Fever may contribute to general discomfort. 

Observe for reports of sudden or sharp chest pain, dyspnea, tachycardia, or apprehension.
Be alert for signs and symptoms of pulmonary embolism, including unexplained sudden onset of shortness of breath and severe chest pain. Additional manifestations may include tachypnea, decreased oxygen saturation, and a sudden change in mental status due to hypoxemia.

Encourage change of position, keeping extremity elevated.
Prevent venous stasis by encouraging activity that causes the leg muscles to contract and promotes venous return, such as leg exercises and walking. Elevate the client’s legs above the heart level to promote venous return—caution against prolonged sitting or standing in one position.

Elevate affected extremity; provide foot or bed cradle.
Elevation of the extremity encourages venous return and facilitates circulation. A bed cradle over the leg can lift the pressure of the bedclothes off the affected leg and decrease the leg’s sensitivity and improve circulation. 

Maintain bed rest during the acute phase.
Implement bed rest and elevation of the affected extremity for the client. These actions help to reduce interstitial swelling and promote venous return from that leg.

Explain procedures, treatments, and nursing interventions.
Involving the client in the nursing care increases her sense of control and decreases her level of anxiety. Interventions should include explanations and education about diagnosis and treatment. The client will need assistance with personal care as long as she is on bed rest; the family should also be encouraged to participate in the care.

Apply moist heat to the extremity.
Apply warm compresses as ordered. When applying the compresses, ensure that they are at the proper temperature. Altered blood flow may diminish the client’s ability to sense temperature extremes, placing her at risk for a burn injury. Use chemical heat packs or a pad such as an Aquathermia pad to help keep the compresses warm.

Apply compression stockings as appropriate.
For the superficial, localized, mildly tender area of thrombophlebitis that occurs in a varicose vein, the use of some elastic support is usually sufficient, together with analgesics. In the early phases of superficial thrombophlebitis in the leg, dangling the extremity without external support from stockings or elastic bandages leads to leg swelling and increased pain (Nagarsheth & Lopez, 2021).

Administer antipyretics, anti-inflammatory drugs, and analgesics as indicated.
Some anti-inflammatory drugs may be of benefit in the treatment of superficial thrombophlebitis. Salicylates, indomethacin, and ibuprofen have been reported to be effective. In addition, salicylates, ibuprofen, and dipyridamole have been used as antithrombotic agents, but their effectiveness has not been documented in this setting (Nagarsheth & Lopez, 2021).

Administer magnesium sulfate (Epsom salt) compresses, as indicated.
Magnesium sulfate compresses may also alleviate swelling and pain, though surgery is sometimes necessary to remove the clot (Nagarsheth & Lopez, 2021). A quasi-experimental study used magnesium sulfate dressing by dipping a gauze in the magnesium sulfate glycerine solution and applying it to the affected area three times in three days. The study’s findings indicated that magnesium sulfate application was most effective in reducing the signs and symptoms of superficial thrombophlebitis (Varghese, 2018).

3. Reducing Anxiety

Anxiety is a well-known risk factor for cardiovascular disease. Alpha-adrenergic vasoconstriction, even if the stress lasts only a few minutes, results in the leakage of intravascular fluid into the interstitium, causing hemoconcentration that increases viscosity—a risk factor for arterial and venous thrombosis. Also, catecholamine-induced hypertension favors atherosclerotic plaque rupture, a substrate for arterial thrombus formation (Hoirisch-Clapauch, 2018).

Determine anticipated availability/ effectiveness of support for the following discharge. Prioritize responsibilities/ household tasks.
This helps identify specific needs and encourages problem-solving to meet the needs of the client/family before the client is discharged. The client will need assistance with personal care as long as she is on bed rest; the family should be encouraged to participate in the care if that is what she and they wish.

Assess the client’s and family members’ level of understanding.
The client and her family should be assessed for their understanding of the diagnosis and their ability to cope during the unexpected extended period of recovery.

Monitor vital signs and behavioral signs such as restlessness, irritability, and crying.
These signs may reveal a change in the level of anxiety and reflects decreasing ability to cope with events. Additionally, a client who is apprehensive, diaphoretic, and has a sudden change in mental status may be experiencing a pulmonary embolism.

Explain disease conditions, diagnostic procedures, and treatment regimens.
This promotes the client’s learning and involvement in the care; Decreases the fear of the unknown. Provide anticipatory guidance, support, and education about associated risks. Focus on eliminating modifiable factors for DVT and the danger signs and symptoms to report to the health care provider.

Involve client and family members in developing a plan of care; review instructions and restrictions.
Involvement in the care plan allows them to have a sense of control over the situation, provides information, and enables the client and significant other to understand the purpose of interventions and restrictions. Regardless of the type of thrombophlebitis, teach the client preventive measures to reduce the risk of recurrence with future pregnancies, such as wearing nonconstricting clothing on their lower extremities, resting with the feet elevated, and ambulating daily.

Assist the client in caring for herself and the infant.
The client’s anxiety may minimize when needs are met, and she can adjust and engage in self-care and infant care tasks. Allow the client to continue breastfeeding the infant if she is receiving heparin. If thrombophlebitis does not seem severe and the client wants to restart breastfeeding after warfarin, encourage her to express breast milk at the time of normal feedings manually. Hence, she maintains a good milk supply.

Encourage the use of relaxation techniques.
Relaxation prevents muscle fatigue and allows the client to rest. Assist the client in dealing with their fear and anxiety through breathing exercises. Fear and anxiety are associated with the inability to breathe and may increase oxygen consumption and demand.

Provide an opportunity to verbalize concerns.
Expression of concerns reduces emotional tension, lessening anxiety. Encouraging expressions of concerns may also help understand the basis of the client’s feelings and help the client regain some sense of control over their emotions.

Encourage frequent contact with spouse and children if the client is hospitalized in person or by telephone. Encourage regular ”rooming in” with the newborn as the condition allows.
This helps to reduce feelings of separation and isolation and facilitates the transition to home. If the infant has been discharged, the family is encouraged to bring the infant for feedings as permitted by hospital policy; the mother also can express milk to be sent home.

Refer to social services, visiting nurse, or home care agency, as appropriate.
The client may require additional support to facilitate recovery or meet the family’s needs. Home nursing visits are often prescribed to obtain blood for laboratory clotting studies and help the client cope with the therapy.

4. Initiating Patient Education and Health Teachings

Educating the client and her partner or family members about necessary information regarding their condition and treatment regimen may help boost their confidence and self-esteem in managing thrombophlebitis. Support for the postpartum client should encompass the emotional and physical aspects and enhance their mental and intellectual capacity to overcome the disorder entirely.

Assess the client’s knowledge and understanding of the disease process of postpartum thrombophlebitis. Correct misconceptions as needed.
Baseline assumptions about the disease can help determine specific needs and clarify previous information. The client and her family are assessed for their understanding of the diagnosis and their ability to cope during the unexpected extended period of recovery.

Provide information about management and diagnostic tests for postpartum thrombophlebitis.
Interventions include explanations and education about diagnosis and treatment. Physical examination is not a sensitive diagnostic indicator for thrombosis. Venous ultrasonography with or without color Doppler is the most commonly used diagnostic test. MRI and D-dimer assays also may be used. Pregnancy limits the usefulness of arterial blood gases and oxygen saturation in diagnosis.

Identify signs and symptoms requiring notification of healthcare provider, e.g., pain, swelling, and tenderness in one of the legs.
The information provided can increase understanding and decrease anxiety associated with the condition and home management. Manifestations of deep venous thrombosis are often absent and diffuse. Calf swelling, erythema, warmth, tenderness, and pedal edema may be noted. Provide anticipatory guidance, support, and education about associated signs of complications and risks. Danger signs and symptoms like sudden onset of chest pain, dyspnea, and tachypnea must be reported to the health care provider. Progression of condition or development of bleeding requires prompt evaluation and possible changes in therapy to prevent serious complications.

Demonstrate the use of anti-embolic stocking. Encourage removal of elastic stockings for brief intervals at least twice daily.
Continuous constriction may alter or reduce surface perfusion, leading to muscle fatigue. Removal of elastic stockings allows for the detection of further vascular involvement or inflammation. Fit the stockings correctly to avoid excess pressure and constriction and urge the client to wear them. Sequential compression devices can also be used for the client with varicose veins, a history of thrombophlebitis, or surgical birth.

Explain the purpose of bedrest or activity restrictions and the need for adequate rest. Elevate the extremities when at rest.
Rest reduces compromised tissues’ oxygen and nutrient needs and decreases the risk of fragmentation of thrombosis. Balancing rest with activity prevents exhaustion and further impairment of cellular perfusion. These actions help to reduce interstitial swelling and promote venous return from that leg.

Educate on safety measures to avoid bleeding, such as using an electric razor for shaving, using a soft toothbrush, and avoiding barefoot walking.
Alterations in the coagulation process may result in an increased tendency to bleed, indicating a need to alter anticoagulant therapy. The client and her family should be given this information on safe care practices to prevent bleeding and injury while she is on anticoagulant therapy. 

Discuss the purpose and dosage of the anticoagulant. Emphasize the importance of taking the drug as prescribed.
This promotes client safety by reducing the risk of inadequate therapeutic response/harmful side effects. The client is usually discharged home on oral anticoagulants and will need an explanation of the treatment schedule and possible side effects. If subcutaneous injections are given, the client and family are taught how to administer the medication and site rotation. Be certain that the client or family members demonstrate good injection techniques before discharge.

Identify possible interactions between oral other medications (e.g., antibiotics, NSAIDs, barbiturates, diuretics, and vitamins). Stress the need to read ingredient labels of over-the-counter (OTC) drugs.
Oral anticoagulant therapy may last 3–4 months and may cause problems or require alterations in drug dosage if it is allowed to interact with other medications. Salicylates and excess alcohol decrease prothrombin activity; vitamin K in multivitamins increases prothrombin activity; antibiotics alter intestinal flora and may interfere with vitamin K synthesis; barbiturates increase the metabolism of coumarin drugs. Aspirin inhibits the synthesis of clotting factors and can lead to prolonged clotting time and increased risk for bleeding during anticoagulant therapy.

Identify untoward anticoagulant effects requiring medical attention.
Early detection of deleterious effects of therapy (prolongation of clotting time) allows for timely interventions and may prevent serious complications. Watch out for possible signs of bleeding and notify the health care provider if any occur: nosebleeds, bleeding from the gums or mouth, black tarry stools, brown “coffee grounds” vomitus, red to brown speckled mucus from a cough, increased lochia discharge, bruises, etc.

Stress the importance of medical follow-up/ laboratory testing.
Understanding that close supervision of anticoagulant/therapy is necessary (therapeutic dosage range is narrow and complications may be deadly) promotes client participation/adherence to the therapeutic regimen. The client will need information about the follow-up with her health care provider to monitor clotting times and regulate the correct dosage of anticoagulant therapy.

Educate the client regarding the use of contraceptives during anticoagulant therapy.
The client should use a reliable form of contraception if taking warfarin because this medication is considered teratogenic. Oral contraceptives are contraindicated because of the increased risk for thrombosis.

Inform the client that breastfeeding is still allowed while she is on anticoagulant therapy.
If the client is breastfeeding, she is informed that neither heparin nor warfarin is excreted in significant quantities in breast milk. If the infant has been discharged, the family is encouraged to bring the infant for feedings as permitted by hospital policy; the client also can express milk to be sent home.

5. Administer Medications and Provide Pharmacologic Support

Administering medications and providing pharmacologic support in patients with postpartum thrombophlebitis is crucial in managing the condition and preventing potential complications. Anticoagulant medications, such as heparin or low-molecular-weight heparin, are commonly prescribed to reduce the risk of blood clots and prevent their progression. These medications help to inhibit the formation of new blood clots and promote the dissolution of existing clots. Healthcare providers closely monitor the patient’s response to medication, including regular assessments of coagulation parameters, to ensure appropriate dosing and optimal therapeutic effect.

Antimicrobial agents
If an infection were the conditions underlying cause, an antibiotic to treat the initial infection would be prescribed. Reproductive tract infection may result in septic pelvic thrombophlebitis. The length of antibiotic therapy is still a matter of debate; according to some authors, a short course is advocated, and antibiotics should be discontinued after clinical improvement (afebrile state for at least 48-72 hours) and normalization of laboratory values. In contrast, others recommend continuing therapy until discharge from the hospital (Kozar & Savc, 2021).

Thrombolytic agents (streptokinase, urokinase)
Thrombolytic agents may be used to treat acute or massive DVT to prevent valvular damage and the 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
A heparin regimen should be restarted 12 hours after a cesarean delivery or six hours after vaginal birth, assuming significant bleeding has not occurred (Malhotra & Weinberger, 2021). 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, coumadin, which blocks the formation of prothrombin from vitamin K, may be used for long-term therapy following discharge.

Recommended nursing diagnosis and nursing care plan books and resources.

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Ackley and Ladwig’s Nursing Diagnosis Handbook: An Evidence-Based Guide to Planning Care
We love this book because of its evidence-based approach to nursing interventions. This care plan handbook uses an easy, three-step system to guide you through client assessment, nursing diagnosis, and care planning. Includes step-by-step instructions showing how to implement care and evaluate outcomes, and help you build skills in diagnostic reasoning and critical thinking.

Nursing Care Plans – Nursing Diagnosis & Intervention (10th Edition)
Includes over two hundred care plans that reflect the most recent evidence-based guidelines. New to this edition are ICNP diagnoses, care plans on LGBTQ health issues, and on electrolytes and acid-base balance.

Nurse’s Pocket Guide: Diagnoses, Prioritized Interventions, and Rationales
Quick-reference tool includes all you need to identify the correct diagnoses for efficient patient care planning. The sixteenth edition includes the most recent nursing diagnoses and interventions and an alphabetized listing of nursing diagnoses covering more than 400 disorders.

Nursing Diagnosis Manual: Planning, Individualizing, and Documenting Client Care 
Identify interventions to plan, individualize, and document care for more than 800 diseases and disorders. Only in the Nursing Diagnosis Manual will you find for each diagnosis subjectively and objectively – sample clinical applications, prioritized action/interventions with rationales – a documentation section, and much more!

All-in-One Nursing Care Planning Resource – E-Book: Medical-Surgical, Pediatric, Maternity, and Psychiatric-Mental Health 
Includes over 100 care plans for medical-surgical, maternity/OB, pediatrics, and psychiatric and mental health. Interprofessional “patient problems” focus familiarizes you with how to speak to patients.

See also

Other recommended site resources for this nursing care plan:

Other care plans related to the care of the pregnant mother and her baby:

References and Sources

Recommended journals, books, and other interesting materials to help you learn more about postpartum thrombophlebitis nursing care plans and nursing diagnosis:

Reviewed and updated by M. Belleza, R.N.

Iris Dawn is a nurse writer in her 20s who is on the constant lookout for latest stories about Science. Her interests include Research and Medical-Surgical Nursing. She is currently furthering her studies and is seriously considering being a student as her profession. Life is spoiling her with spaghetti, acoustic playlists, libraries, and the beach.

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