All increase the chances of deep vein thrombosis except?

NHM UP Staff Nurse - 2016

Medical & Surgical Nursing

Hard

Appeared in: NHM UP Staff Nurse - 2016

Explanation

Hypertension is a condition of high pressure in the arteries, not the veins. It is a primary risk factor for arterial diseases like stroke and heart attack.
The development of Deep Vein Thrombosis (DVT) is explained by Virchow's triad: venous stasis, hypercoagulability, and endothelial injury.
Hypertension is not recognized as a direct cause for any of the three components of Virchow's triad and is therefore not a primary risk factor for DVT.

Option A: Oral contraceptive pills, especially those containing estrogen, are a well-established risk factor for DVT because they increase the concentration of clotting factors in the blood, leading to a state of hypercoagulability.
Option C: Superficial thrombophlebitis, which is inflammation and clotting in a superficial vein, is a risk factor for DVT. The inflammation can extend to the deep venous system, or the clot can propagate into a deep vein.
Option D: Myocardial infarction (MI) increases the risk of DVT. Post-MI, patients often have reduced mobility and may have decreased cardiac function, both leading to venous stasis. Additionally, the systemic inflammation following an MI can contribute to a hypercoagulable state.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Risk factors for Deep Vein Thrombosis (DVT) as background academic context rather than a clinical decision trigger.
Nurses play a crucial role in preventing DVT in at-risk patients by implementing measures like early ambulation, leg exercises, applying compression stockings, and administering prophylactic anticoagulants as prescribed.
A key nursing responsibility is to assess patients for DVT risk factors upon admission and throughout their hospital stay. This includes reviewing their history for conditions like cancer, recent surgery, immobility, and use of oral contraceptives.
What if the patient had obesity instead of hypertension? Obesity is a recognized risk factor for DVT. It increases intra-abdominal pressure, which can compress the iliac veins, leading to venous stasis. It is also associated with a chronic inflammatory and prothrombotic state. In that case, all options would be risk factors, and the question would be flawed.

How to Approach the Question

First, identify the core concept of the question, which is risk factors for deep vein thrombosis (DVT).
Note the keyword 'EXCEPT'. This means you need to find the option that is NOT a risk factor for DVT.
Recall or deduce the main causes of DVT, often summarized by Virchow's Triad (stasis, hypercoagulability, endothelial injury).
Evaluate each option against Virchow's Triad: Oral contraceptives cause hypercoagulability; Myocardial infarction leads to stasis; Superficial thrombophlebitis involves inflammation/endothelial injury.
Identify the option that does not fit. Hypertension is primarily an arterial disease and is not a direct cause of venous thrombosis.
Select hypertension as the correct answer because it is the exception among the given choices.

Concept Tested & Keywords

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E6 Nursing Brunner Adult Health 3SA Vol 1 Part 3 p. 76-78

E6 Medicine Macleod Clinical Examination 15e p. 87-89