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Integumentary > 6] Arterial Wounds > Flashcards

6] Arterial Wounds Flashcards

1
Q

Aorta divides into?

A

R and L common iliac arteries

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2
Q

Common iliac divides into

A

Internal and external iliac arteries

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3
Q

Internal iliac artery supplies

A

Pelvis

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4
Q

External iliac artery becomes ? When it crosses ?

A

Femoral artery when it crosses inguinal ligament

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5
Q

Common femoral artery divides into

A

Superficial and deep femoral artery

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6
Q

What guides treatment for ulcers?

A

ABI

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7
Q

What’s the ABI scale??

NEED TO KNOW

A

0.9 to 1 = normal
0.75 to 0.9 = moderate disease
.5 to .75 = severe disease
Less than 0.5 = rest pain
Unreliable = diabetes

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8
Q

Deep femoral artery supplies muscles of

A

Thigh

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9
Q

Superficial femoral artery becomes

A

Popliteal artery

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10
Q

Superficial femoral artery is most common site of?

A

Atherosclerotic disease in LE

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11
Q

Popliteal artery goe smedial and divides below the knee to the 1st branch…

A

Anterior tib artery and tibioperoneal trunk

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12
Q

Tibioperoneal trunk divides into

A

Peroneal and posterior tibial arteries

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13
Q

Anterior tibial artery becomes

A

Dorsalis pedis artery

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14
Q

3 layers of the arterial wall

A

Adventitia
Media
Intima

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15
Q

Outer layer that has loose connective tissue

A

Adventitia

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16
Q

Middle layer that has elastic and muscular fibers that give strength, elasticity and contractibility

A

Media

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17
Q

Innermost layer- endothelial lining

A

Intima

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18
Q

Decreased circulation leading to ischemia and oxygen and nutrient deprivation

A

Arterial insufficiency

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19
Q

What happens in arterial insufficiency?

A

Cutaneous blood supply isnt enough and it leads to tissue death

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20
Q

You need enough arterial supply and venous return to?

A

Maintain oxygen and nutrition of the skin

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21
Q

Failure of artery supply or venous return can lead to ?

A

Wounds and healing wounds will be difficult

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22
Q

Will you do compression if they have arterial disease?

A

No

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23
Q

Characteristics of arterial ulcers?

6

A
  • Even wound margins
  • Pale, deep wound bed
  • Extreme pain
  • Minimal to no drainage
  • Gangrene/necrosis
  • Diminished or absent
    pulses
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24
Q

Appearance of arterial ulcers

A

Distinct borders, pale or yellow base, surrounding skin is pale or red If in dependent position and thin and shiny

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25
Q

Not being quizzed on venous system but what should you know?

A

Theres a lot of veins goign back to the heart

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26
Q

Death of tissue in a part of body

A

Gangrene

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27
Q

Gangrene can be how big?

A

Small skin lesion or extend to entire limb

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28
Q

Gangrene initially appears how and then progresses how?

A

Initially pale then blue/grey then purple/black

29
Q

Gangrene usually requires

A

Amputation

30
Q

PVD is commonly associated with

A

Atherosclerotic disease

31
Q

Tissue ischemia leads to

A

Necrosis

32
Q

Most often, ulcers occur at?

A

Most distal sites

33
Q

Color observation of limb

A

Pale
Mottled (smears of color)
Purplish
Black

34
Q

Temperature observation of limb

A

Cool or cold may indicate arterial insufficiency

35
Q

Skin changes- when observing limb

A

Loss of hair
Shiny
Thick hair

36
Q

Risk factors of arterial ulcers

A 
HTN
High cholesterol 
Diet/obese
Exercise
DM
Family history
Age
Smoking
37
Q

When smoking, one cigarette decreases circulation

A

30% for one hour

38
Q

Rest pain is ?

A

Severe

39
Q

What’s considered moderate pain?

A

Pain after walking up a few stairs or less than 50 yards

40
Q

What’s considered mild pain?

A

Pain after walking 1-2 blocks

41
Q

Physical exam of arterial ulcers

A 
System screen 
Observe limbs
ANKLE BRACHIAL INDEX
Pulses/Doppler
Capillary refill
Rubor of dependency
42
Q
  • Calciphylaxis
  • Pyoderma gangrenosum Scleroderma
  • Venous insufficiency
  • Spider bites
  • trauma
A

Conditions that might mimic arterial leg ulcers

43
Q

Slow, progressive, incurable multisystem disorder

A

Scleroderma

44
Q

Involves skin and internal organs;

inflammatory, vascular and sclerotic changes

A

Scleroderma

45
Q

Are venous ulcers on the feet or the legs?

A

LEGS

46
Q

Scleroderma has ?

A

Proliferation of fibroblasts, excessive collagen production

47
Q

Patients with arterial ulcers you want to leave their legs ?

A

Dangling

48
Q

Patients with venous ulcers should have their legs

A

Elevated ?

49
Q

How does scleroderma skin appear

A

Shiny and hard with loss of mobility

50
Q

What lesions on the trunk with scleroderma?

A

Morphea

51
Q

How do you perform ABI?

A

Take BOTH brachial BPs in supine.
Put the cuff on the leg just above malleoli.
Put the Doppler at 45 degree angle to the dorsalis pedis or post tib artery.
Inflate cuff until Doppler is obliterated.
Slowly deflate the cuff until doppler signal comes back and record this as the ankle systolic pressure.
Divide ankle systolic by higher of the two brachial systolic pressures.

52
Q

Behind the knee when knee is semiflexed

A

Popliteal artery

53
Q

behind medial mallelolus. Supplies

posterior compartment of leg & plantar surface of foot

A

Posterior tib pulse

54
Q

lateral to extensor hallicus longus.Supplies dorsal surface of the foot

A

Dorsalis pedis pulse

55
Q

How would you describe pulses?

A

Weak
Bounding
Regular

56
Q

Scale of pulses ?

A 
0 = no pulse
1+ = barely felt
2+ = diminished
3+ = normal pulse
4+ = bounding
57
Q

Venous filling time

A

Pt in supine with foot elevated to 45-60 deg for 1 min, bring foot into dependent position and look at skin color changes

58
Q

Less than 15 sec for venous filling time is

A

Normal

59
Q

If venous filling time = 15 - 40 seconds

A

Moderate arterial insufficiency

60
Q

More than 40 seconds for venous filling time

A

Severe ischemia

61
Q

Rubor of dependency

A

Pt in supine and elevate their leg 60 degrees for 1 minute.
Normal is when the pink decreases when returning back down.
+ would be pale appearance that turns to cherry red when lowered to dependent position.

62
Q

Intervention for arterial ulcers

A 
Local wound care
Education about smoking
Limb protection
Refer to vascular surgeon 
Exercise of walking program
63
Q

Do you debride gangrene?

A

NO

64
Q

3 types of wound prognosis

A

Healable
Maintenance
Nonhealable (palliative)

65
Q

maintain moisture and bacteria balance

A

Healable wound

66
Q

(wound that could heal but ptfactors such as uncontrolled DM or smoking make healing less likely)

A

Maintenance wound

67
Q

Two surgical interventions for arterial ulcers

A

Percutneous balloon angioplasty and femoropoploteal bypass graft

68
Q

Percutaneous balloon angioplasty is used for

A

Short term segment stenosis

69
Q

Femoropopliteal bypass graft is

A

The standard treatment

Integumentary (15 decks)

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