Modern advanced practice nurses find it challenging to differentiate such disorders as chronic venous insufficiency (CVI) and deep venous thrombosis (DVT). The major reason for such a problem is insufficient knowledge in pathophysiology, epidemiology, and symptoms of the aforementioned conditions. Moreover, nursing practitioners have to take into account specific patient factors that may alter the process of treatment and become a barrier to quick recovery. The analysis of the pathophysiology of CVI and DVT with regard to the patients’ age allows nurses to distinguish these two illnesses, set relevant diagnoses, and effectively treat them.

The Pathophysiology of CVI and DVT

The knowledge of the pathophysiology of CVI and DVT is one of the most critical competencies required for modern nurses. Experts claim that healthcare practitioners tend to overlook or misidentify the symptoms of CVI with other venous diseases due to the lack of awareness of its clinical representation (Eberhardt & Raffetto, 2014). CVI is an inadequate venous return over a long period as a result of the process of inflammation of vessels caused by venous hypertension, circulatory stasis, or tissue hypoxia (Huether & McCance, 2015). The symptoms of this condition include the changes of the skin, pain, and edema, which a nurse can reveal during the physical assessment. Other signs of CVI are reticular and varicose veins, ulcers, and venous eczema, which are advanced vessel disorders associated with CVI (Eberhardt & Raffetto, 2014). The most negative effect of CVI on the human body is that the venous system of a person fails to return blood to the heart at its regular volume, which may lead to ischemia.

Turning to DVT, it also affects the venous system of a patient, as it manifests itself as the damage of the venous tissue. DVT is one of the critical signs of venous thromboembolism, which may resolve without complications, if diagnosed correctly, and lead to pulmonary embolism and mortality in the case of its misidentification (Patel, Brenner, & Chun, 2014). During a physical assessment, a patient is likely to have DVT in case of calf pain or warmth of one foot, presence of a palpable cordlike, tender subcutaneous venous segment, discoloration of a foot, and edema (Patel et al., 2014). In addition, a patient with DVT may have such complaints as tenderness and skin warmth as well as leg pain, which are absent in persons with CVI. In order to differentiate CVI from DVT, the advanced practice nurses are strongly advised to perform additional objective assessments, such as venograms, d-dimer, and coagulation testing (Patel et al., 2014). Finally, it is necessary for a healthcare practitioner to consider the potential impact of patient factors on the evolvement and progression of the disease.

The Role of a Patient Factor

Age is one of the factors that may affect the pathophysiology of CVI and DVT. Hence, the advanced practice nurses have to include the role of this factor in the assessment list. According to Eberhardt and Raffetto (2014), the increase of the patients’ age is directly associated with the decrease of the strength of their blood vessels. Age is an essential risk factor for vascular dysfunction as well as cardiovascular and cerebrovascular diseases since aging vessels gradually suffer from various functional impairments (Xu et al., 2017). Therefore, middle-aged adults and geriatric patient populations represent risk groups for the development of CVI and DVT since their vessels may accumulate various functional impairments. Such patients should be diagnosed using not only subjective but objective testing methods, including venograms, d-dimer, and coagulation tests.

Modern healthcare professionals should be aware of standard clinical procedures that allow to decrease the progression of CVI and DVT and advanced treatment initiatives, which eradicate the risks of the progression of the disease. In the case of CVI, standard procedures comprise bed rest and elevation of legs above the level of the heart as well as wearing of compression stockings and dressings (Bhattacharya & Stansby, 2018). Similar strategies are relevant for patients with DVT along with the use of anticoagulant medications, endovascular management, or surgery (Patel et al., 2014). At the same time, modern scientific development in the sphere of venous treatment reached such a stage that it is possible to use effective medications and avoid surgery. For instance, Bhattacharya and Stansby (2018) characterize the administration of targeted antithrombotics as an effective and safe method for treatment of DVT, as such methods are easy to use and efficiently remove the blood clot. Therefore, nowadays, it is possible to treat CVI and DVT safely and effectively without surgery, but the nurses still have to develop their competency in diagnosing both venous diseases.

Mind Maps for Advanced Practice Nurses

The following mind maps assist the advanced practice nurses consider the key issues associated with the assessment, epidemiology, pathophysiology, and treatment of CVI (see figure 1) and DVT (see figure 2).

Figure 1. The mind map of CVI.

Figure 2. The mind map of DVT.

The critical data indicated in both mind maps was elicited from the book by Huether and McCance (2015). Advanced practice nurses are strongly advised to consider the suggested mind maps in order to increase their competency in the sphere of assessment and treatment of CVI and DVT.

Conclusion

All in all, the assessment and treatment of CVI and DVT are demanding tasks for advanced practice nurses who often fail to distinguish between their symptoms, as they are associated with vascular damage. At the same time, the analysis of both diseases revealed that in the case of CVI, the patients experience pain, changes in the skin color of extremities, and edema. In contrast, people with DVT have leg pain, skin discoloration, edema, and warmth of the skin on one leg. The risk for both diseases directly elevates with the increase of the age of a person. A standard treatment procedure in both cases is bandaging and compressive clothing or endovascular management and surgery in the case of an adverse stage of the condition. However, the administration of modern medications, such as targeted antithrombotics, is an effective and safe alternative to surgery.

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