Evidence in Practice NURS90120 - Assesment answer

Summary

Deep vein thrombosis (DVT) is one such medical condition in which there is a blood clot that forms a deep vein. The clots occur in the lower part of the body, like thighs, legs and pelvis. The clot is not formed in the arms. DVT comes under venous thromboembolism (Centres for Disease Control and Prevention, 2023). The major surgeries in the orthopaedic or neurovascular areas are likely to be the most risky, especially in individuals of 50 years and above. The tedious surgery process and post-surgical restriction increase the chance of DVT. In older people, a medical condition like hemiplegia for any reason also enhances the risk for DVT. (McLendon et al., 2017). Medication management is a type of strategy that is used to get involved with the caregivers and the patients to develop an authentic and complete list of medications by adopting the brown bag method. This will also help to analyse the patient's behaviour, who can be at risk of overdose, missing medication or underdose (Agency for Healthcare Research and Quality, 2023). Compression stockings are notably made to impose pressure to lower legs, which helps to maintain the blood flow and also decreases the swelling and trouble due to clotting (NHS, 2022). Compression stockings are of four types. First is class 1 stockings which apply pressure below 20mmHg. Second is class 2, which applies pressure between 20-30mmHg. Class 3 applies pressure between 30-40mmHg, and class 4 applies pressure above 40mmHg (Dahm et al., 2019).

The study was conducted by Sachdeva et al. (2018), in which he and his colleagues conducted 20 randomised control trials, among which nine trials were compared with wearing stockings and no stockings. The patients were given medication like heparin, dextran and aspirin. The compression stockings were practised on the patients before the cardiac, orthopaedic and neurosurgery. It was found that compression stockings proved to be more effective in decreasing the overall danger of growing DVT. Patients who have undergone major or minor surgeries have more probability of developing DVT. Another study conducted by Yang et al. (2022) consisted of 232 patients, among which 113 patients were given compression stockings, and it was found that compression stockings helped the patients to prevent or decrease the incidents of DVT. After comparing medication management and the application of compression stockings, it was found that compression stockings were more beneficial in preventing DVT patients post-surgery. As a result, compression stockings are the intervention for DVT prevention in post-surgical old patients.

PICO Question

In post-surgical elderly patients, does medication management or the application of compressed stockings lead to better outcomes in preventing DVT?

P- Post-surgical old patients

I-Compressed stockings

C- application of medical management

O-Prevention of DVT

Elderly patients who have undergone surgery for lower limb fractures have problems with mobility as they have to take complete bed rest. Patients who are 50 years and above already have less immunity and are weak physically. The medications also have side effects. Post-surgery, there is swelling, redness and tenderness in the lower part of the leg, including the foot region. If not taken care of at the time, this may lead to the risk of symptomatic DVT, leading to increased redness and swelling (Han et al., 2023). DVT occurs in approximately 1 in 1000 people every year, and it has increased to 5 in 1000 persons aged 50 and above. In the case of DVT, elderly patients who have undergone surgery take compression stockings, which helps them to decrease their DVT (Gross & Chan., 2021).

Inclusion and Exclusion Criteria

The study is conducted on post-surgical old patients comparing the medication management and application of compression stockings. The study also includes peer-reviewed articles from the past five years and has excluded all other peer-reviewed articles. Furthermore, articles were only considered for selection if presented in English, from peer-reviewed journals, in full-text, involved an adult population and contained adequate discussion relevant to the stated Population Intervention Control Outcome (PICO) question.

Search Strategy

In order to search for peer reviewed articles and papers related to the topic online search was attended. A search strategy is a form of well organised structure of the key term used in order to search the database. The search strategy associates the concept of the question to fetch the correct outcome. The search strategy details about all the phrases and keywords. In addition to this the possible search term and subject headings are also included. The databases used in different cases have different search strategies and hence need to be analysed well. The search strategy includes the use of boolean operators. The boolean operators are OR, NOT, AND where the boolean operator OR is used to search for articles which indicate either. Moreover AND is used to search for articles which mention both for the topics to be searched (University of Leeds, 2023).

Research databases searched included cumulative indexes to PubMed centre and PubMed central. PubMed is a search engine which is free to access the MEDLINE databases in the area of biomedicine and health. In addition to this it also includes the scientific field related to medicine (National Library of Medicine, 2023). PubMed central has access to all the life sciences and biomedical journal literature for free. The journals in PubMed central include the articles and papers related to health and medicine (National Library of Medicine, 2023). The key search terms applied included post surgery, stocking use, compression therapy,surgical patients, aged surgical patients, DVT, medication management, Prevention of DVT, post operative, prevention control DVT, stocking use, DVT control, and compression stockings. In addition, corresponding Medical Subject Headings (MeSH) and booleans searches were conducted using ‘AND’ and ‘OR’, alongside key search terms to allow for alternative terms and/or spelling. Advanced search settings were implemented to include articles with a publication date range from 2017 – present due to the continuous release of newly published peer reviewed articles and evolving research.

Table1: Search strategy

References

Agency for Healthcare Research and Quality. (2023). Medication Management Strategy: Intervention. https://www.ahrq.gov/patient-safety/reports/engage/interventions/medmanage.html#:~:text=Medication%20management%20is%20a%20strategy,reconciliation%20and%20medication%20management%20issues.

Centres for Disease Control and Prevention. (2023). What is VTE?. https://www.cdc.gov/ncbddd/dvt/facts.html#:~:text=Deep%20vein%20thrombosis%20(DVT)%20is,also%20occur%20in%20the%20arm.

Dahm, K. T., Myrhaug, H. T., Strømme, H., Fure, B., & Brurberg, K. G. (2019). Effects of preventive use of compression stockings for elderly with chronic venous insufficiency and swollen legs: a systematic review and meta-analysis. BMC geriatrics, 19, 1-8. https://doi.org/10.1186%2Fs12877-019-1087-1

Gross, P. L., & Chan, N. C. (2021). Thromboembolism in older adults. Frontiers in Medicine, 7, 470016. https://doi.org/10.3389%2Ffmed.2020.470016

Han, S., Bai, Y., Jiao, K., Qiu, Y., Ding, J., Zhang, J., & Li, K. (2023). Development and validation of a newly developed nomogram for predicting the risk of deep vein thrombosis after surgery for lower limb fractures in elderly patients. Frontiers in Surgery, 10, 1095505. https://doi.org/10.3389/fsurg.2023.1095505

McLendon, K., Goyal, A., & Attia, M. (2017). Deep venous thrombosis risk factors. https://www.ncbi.nlm.nih.gov/books/NBK470215/

National Library of Medicine. (2023). PubMed. https://pubmed.ncbi.nlm.nih.gov/

National Library of Medicine. (2023). PubMed. https://www.ncbi.nlm.nih.gov/pmc/

NHS. (2022). How long should I wear compression stockings to improve my circulation?. https://www.nhs.uk/common-health-questions/accidents-first-aid-and-treatments/how-long-should-i-wear-compression-stockings-to-improve-my-circulation/

Sachdeva, A., Dalton, M., & Lees, T. (2018). Graduated compression stockings for prevention of deep vein thrombosis. Cochrane Database of Systematic Reviews, (11). 10.1002/14651858.CD001484.pub4

University of Leeds. (2023). Develop a search strategy. https://library.leeds.ac.uk/info/1404/literature_searching/14/literature_searching_explained/4#:~:text=A%20search%20strategy%20is%20an,keywords%20and%20phrases

Yang, X., Zhang, X., Yin, M., Wang, R., Lu, X., & Ye, K. (2022). Elastic compression stockings to prevent post-thrombotic syndrome in proximal deep venous thrombosis patients without thrombus removal. Journal of Vascular Surgery: Venous and Lymphatic Disorders, 10(2), 293-299. https://doi.org/10.1016/j.jvsv.2021.06.023

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