A nurse is caring for an 83-year-old woman in a long-term-care facility who has a history of heart failure and peripheral arterial disease. The patient is unable to stand or ambulate. The nurse knows this places the patient at significant risk for:
A) Aoritis
B) Deep vein thrombosis
C) Thoracic aortic aneurysm
D) Raynaud's disease
Ans: B
Feedback: Although the exact cause of venous thrombosis remains unclear, three factors, known as Virchow's triad, are believed to play a significant role in its development. They are stasis of blood (venous stasis), vessel wall injury, and altered blood coagulation. In this woman's case, she has venous stasis from immobility, vessel wall injury from peripheral artery disease, and altered blood coagulation from heart failure. Option A is incorrect; the cause of aoritis is unknown, but there is no direct connection to heart failure, peripheral artery disease, or mobility issues. Option C is incorrect; the greatest risk factors for thoracic aortic aneurysm are atherosclerosis and hypertension. There is no direct connection to heart failure, peripheral artery disease, or mobility issues.
Option D is incorrect; Raynaud's disease is a disorder that involves spasms of blood vessels, so there is no direct connection to heart failure, peripheral artery disease, or mobility issues.
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