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Integumentary > arterial insufficiency > Flashcards

arterial insufficiency Flashcards

1
Q

most common type of ulcers

A

venous

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2
Q

% of LE ulcerations due to arterial insufficiency

A

5-10%

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3
Q

% of blockage that vasodilation can compete with

A

50%

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4
Q

three types of arteries

A

elastic
muscular
arterioles

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5
Q

elastic arteries

A

aorta and branches
maintain BP

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6
Q

muscular arteries (distributing)

A

femoral and brachial
average lumen diameter= 4mm

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7
Q

arterioles

A

sympathetic vasoconstriction
average lumen diameter of 37 micrometer

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8
Q

capillaries

A

single layer of endothelial cells on thin basement membrane
1 mm log, 9 micrometer wide
oxygen and nutrients in blood diffuse along capillary concentration gradients into the tissue

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9
Q

thixotropic fluid definition

A

changes viscosity, thicker with less water, problems in small capillaries because blood is this way

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10
Q

with less movement blood becomes more or less viscous

A

more

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11
Q

primary determinant of blood viscosity

A

hematocrit

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12
Q

blood sludging results from

A

dehydration and polycythemia
(internet says severe burns and crush injuries)

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13
Q

blood sludging

A

RBCs clump together in blood vessels
aka intravascular agglutination

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14
Q

muscles are more efficient in aerobic or anaerobic conditions

A

aerobic, suggesting muscles can be trained to decrease symptoms of claudication over time

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15
Q

causes of arterial insufficiency

A

trauma
acute embolism
diabetes mellitus
rheumatoid arthritis
thromboangiitis (buerger’s disease)
arteriosclerosis

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16
Q

thromboangiitis (Buerger’s disease)

A

closing of small vessels
they become inflamed and swollen then narrow or get blocked by blood clots

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17
Q

arteriosclerosis

A

thickening/hardening of arterial walls

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18
Q

atherosclerosis

A

systemic, degenerative process, arterial lumen is gradually and progressively encroached upon

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19
Q

high LDLs

A

enhance cholesterol deposition

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20
Q

HCLs

A

serve a protective function

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21
Q

% of stenosis to have claudication

A

50%

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22
Q

intermittent claudication possible arteries blocked

A

iliofemoral and infrapopliteal

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23
Q

flow chart leading to arterial ulcers

A

arterial insufficiency -> intermittent claudication -> ischemic rest pain -> ulcer

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24
Q

ulceration and gangrene from AI result when

A

O2 requirements of local tissue exceed perfusion

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25
Q

few facts about rutherford classification system for chronic limb ischemia

A

arterial insufficiency
higher number is worse

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26
Q

risk factors contributing to arterial ulceration

A

hyperlipidemia and elevated LDL
smoking
diabetes
hypertension
trauma
advanced age

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27
Q

smoking as a risk factor for arterial ulcers

A

only modifiable risk factor
nicotine causes vasoconstriction
decreases available O2

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28
Q

diabetes as a risk factor for arterial ulcers

A

vessel walls calcify
decrease collagen synthesis, angiogenesis and fibroblast proliferation
reduces tensile strength of wounds
impairs body ability to fight infections

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29
Q

hypertension as a risk factor for arterial ulcers

A

intimal layer of arteries fragile and easily traumatized
systolic is more damaging than diastolic

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30
Q

advanced age as a risk factor for arterial ulcers

A

body less able to adapt to changes in metabolic demands of tissues by vasodilating and constricting

31
Q

PT tests and measures for AI

A

pulses
doppler ultrasound
ankle-brachial index
rubor of dependency
venous filling time

32
Q

most common sight of occlusion for AI

A

bifurcation of the common femoral artery

33
Q

main foot blood supply

A

posterior tibial artery

34
Q

dorsal foot blood supply

A

dorsalis pedis

35
Q

doppler ultrasound

A

for assessing arterial patency
audible signal over moving fluid
method of assessment when pulses are not easily palpable
can also be used for venous perfusion

36
Q

know different types of doppler?

A

color
power
spectral
duplex
continuous wave

37
Q

ankle-brachial index (ABI)

A

first line of testing for AI
sensitive and specific method to diagnose PAD
lower values correlate with increased severity of atherosclerosis and CAD
indicator of healing potential

38
Q

ABI greater than 1.1 means…

A

vessel calcification and is not a valid indicator of peripheral perfusion
may need pulse volume waveforms to identify PAD

39
Q

when is a toe-brachial index (TBI) used?

A

assess for arterial disease in patients with diabetes or with abnormally high ABI’s due to vessel calcification

40
Q

artery used in an ABI

A

posterior tibial artery

41
Q

ABI equation

A

systolic pressure of LE/ systolic pressure of UE

42
Q

ABI score of 1.1-1.3 and intervention

A

vessel calcification
ABI not valid measure of tissue perfusion

43
Q

ABI score of 0.9-1.1

A

normal

44
Q

ABI score of 0.7-0.9 and intervention

A

mild to moderate AI
conservative interventions normally provide satisfactory wound healing

45
Q

ABI score of 0.5-0.7 and intervention

A

moderate AI, intermittent claudication
may perform trial of conservative care, physician may consider revascularization

46
Q

ABI score of <0.5 and intervention

A

severe AI, rest pain
wound unlikely to heal without revascularization, limb-threatening AI

47
Q

ABI score of <0.3 and intervention

A

rest pain and gangrene
revascularization or amputation

48
Q

pressure indicator of arterial occlusion

A

drop of >20 mmHg in adjacent segments

49
Q

capillary refill is an indicator of

A

surface arterial blood flow
pts with AI have delayed capillary refill

50
Q

normal capillary refill

A

<3 seconds

51
Q

rubor of dependency assesses

A

LE arterial flow indirectly
aka hunter’s reaction

52
Q

how to perform rubor of dependency

A

elevate LE 60 degrees for one minute
note foot color
return leg to surface and note time to return to original color

53
Q

rubor of dependency meaning with pallor after 45-60 sec of elevation

A

mild AI

54
Q

rubor of dependency meaning with pallor after 30-45 sec of elevation

A

moderate AI

55
Q

rubor of dependency result of pallor within 25 sec of elevation, dependent rubor

A

severe AI

56
Q

venous filling time test

A

predictor of AI
pt supine, check superficial veins on dorsal foot, elevate limb 60 degrees for 1 min or until veins drain by gravity, lower limb and note time for refill

57
Q

venous filling time >25 sec meaning

A

severe AI

58
Q

venous filling time <5 sec

A

venous insufficiency

59
Q

venous filling time 5-15 secs meaning

A

normal

60
Q

venous filling time >20 secs meaning

A

arterial insufficiency

61
Q

indication for pulse examination

A

all open wounds located on the extremities

62
Q

indication for doppler ultrasound and ABI

A

decreased or absent pulses
signs and symptoms of AI
history of PAD

63
Q

indications for segmental pressure measurements

A

suspected AI in an ulcer proximal to the ankle
decreased or absent proximal pulses

64
Q

when to consider using a toe-brachial index

A

pt with diabetes
ABI>1.1

65
Q

indications for capillary refill test

A

digital ulcer
abnormal doppler ultrasound or ABI

66
Q

indications for rubor of dependency

A

unable to tolerate ABI
ABI >1.1
history of diabetes or vessel calcification
suspect concomitant venous insufficiency

67
Q

5PT method of characterizations of arterial ulcers

A

pain
position
presentation
periwound
pulses
temperature

68
Q

cause of pain in an arterial ulcer

A

tissue ischemia
leg elevation may increase pain because less blood is getting to ulcer area

69
Q

typical presentation of arterial ulcers

A

begin small and shallow
round and regular or conform to trauma
any granulation tissue will be pale or gray
necrotic tissue desiccated with black eschar (or yellow)
minimal or no drainage

70
Q

periwound and extrinsic tissue of arterial ulcers

A

epidermis thin, shiny, anhydrous, loss of hair growth
dependent rubor
edema is unusual without venous insufficiency or CHF

71
Q

therapeutic exercises for AI

A

gait and mobility
positioning
aerobic
resistive
flexibility

72
Q

medical testing for AI

A

plethysmography
duplex scanning
transcutaneous oxygen monitoring
toe pressures
arteriography

73
Q

risk factors of AI

A

cholesterol, LDL/HDL, triglycerides
BP
blood sugar
smoking cessation

74
Q

surgical interventions for AI

A

debridement
revascularization
percutaneous balloon angioplasty
amputation

Integumentary (1 decks)

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