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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
few facts about rutherford classification system for chronic limb ischemia
arterial insufficiency higher number is worse
26
risk factors contributing to arterial ulceration
hyperlipidemia and elevated LDL smoking diabetes hypertension trauma advanced age
27
smoking as a risk factor for arterial ulcers
only modifiable risk factor nicotine causes vasoconstriction decreases available O2
28
diabetes as a risk factor for arterial ulcers
vessel walls calcify decrease collagen synthesis, angiogenesis and fibroblast proliferation reduces tensile strength of wounds impairs body ability to fight infections
29
hypertension as a risk factor for arterial ulcers
intimal layer of arteries fragile and easily traumatized systolic is more damaging than diastolic
30
advanced age as a risk factor for arterial ulcers
body less able to adapt to changes in metabolic demands of tissues by vasodilating and constricting
31
PT tests and measures for AI
pulses doppler ultrasound ankle-brachial index rubor of dependency venous filling time
32
most common sight of occlusion for AI
bifurcation of the common femoral artery
33
main foot blood supply
posterior tibial artery
34
dorsal foot blood supply
dorsalis pedis
35
doppler ultrasound
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
know different types of doppler?
color power spectral duplex continuous wave
37
ankle-brachial index (ABI)
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
ABI greater than 1.1 means...
vessel calcification and is not a valid indicator of peripheral perfusion may need pulse volume waveforms to identify PAD
39
when is a toe-brachial index (TBI) used?
assess for arterial disease in patients with diabetes or with abnormally high ABI's due to vessel calcification
40
artery used in an ABI
posterior tibial artery
41
ABI equation
systolic pressure of LE/ systolic pressure of UE
42
ABI score of 1.1-1.3 and intervention
vessel calcification ABI not valid measure of tissue perfusion
43
ABI score of 0.9-1.1
normal
44
ABI score of 0.7-0.9 and intervention
mild to moderate AI conservative interventions normally provide satisfactory wound healing
45
ABI score of 0.5-0.7 and intervention
moderate AI, intermittent claudication may perform trial of conservative care, physician may consider revascularization
46
ABI score of <0.5 and intervention
severe AI, rest pain wound unlikely to heal without revascularization, limb-threatening AI
47
ABI score of <0.3 and intervention
rest pain and gangrene revascularization or amputation
48
pressure indicator of arterial occlusion
drop of >20 mmHg in adjacent segments
49
capillary refill is an indicator of
surface arterial blood flow pts with AI have delayed capillary refill
50
normal capillary refill
<3 seconds
51
rubor of dependency assesses
LE arterial flow indirectly aka hunter's reaction
52
how to perform rubor of dependency
elevate LE 60 degrees for one minute note foot color return leg to surface and note time to return to original color
53
rubor of dependency meaning with pallor after 45-60 sec of elevation
mild AI
54
rubor of dependency meaning with pallor after 30-45 sec of elevation
moderate AI
55
rubor of dependency result of pallor within 25 sec of elevation, dependent rubor
severe AI
56
venous filling time test
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
venous filling time >25 sec meaning
severe AI
58
venous filling time <5 sec
venous insufficiency
59
venous filling time 5-15 secs meaning
normal
60
venous filling time >20 secs meaning
arterial insufficiency
61
indication for pulse examination
all open wounds located on the extremities
62
indication for doppler ultrasound and ABI
decreased or absent pulses signs and symptoms of AI history of PAD
63
indications for segmental pressure measurements
suspected AI in an ulcer proximal to the ankle decreased or absent proximal pulses
64
when to consider using a toe-brachial index
pt with diabetes ABI>1.1
65
indications for capillary refill test
digital ulcer abnormal doppler ultrasound or ABI
66
indications for rubor of dependency
unable to tolerate ABI ABI >1.1 history of diabetes or vessel calcification suspect concomitant venous insufficiency
67
5PT method of characterizations of arterial ulcers
pain position presentation periwound pulses temperature
68
cause of pain in an arterial ulcer
tissue ischemia leg elevation may increase pain because less blood is getting to ulcer area
69
typical presentation of arterial ulcers
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
periwound and extrinsic tissue of arterial ulcers
epidermis thin, shiny, anhydrous, loss of hair growth dependent rubor edema is unusual without venous insufficiency or CHF
71
therapeutic exercises for AI
gait and mobility positioning aerobic resistive flexibility
72
medical testing for AI
plethysmography duplex scanning transcutaneous oxygen monitoring toe pressures arteriography
73
risk factors of AI
cholesterol, LDL/HDL, triglycerides BP blood sugar smoking cessation
74
surgical interventions for AI
debridement revascularization percutaneous balloon angioplasty amputation

Integumentary (1 decks)

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