Arterial v Venous Insufficiency

Question 1

Arterial Insufficiency Overview

Answer 1

• Lack of adequate blood flow to regions of the body
• Caused by (1) smoking, (2) obesity, (3) diabetes, (4) HTN

Question 2

Arterial Insufficiency Signs & Symptoms

Answer 2

• Pale and cool skin
• Abnormal nail growth — due to lack of blood flow
• Little to no leg or foot hair — due to lack of blood flow
• Lateral malleolar wounds
• Overly dry and shiny skin
• Rest pain or intermittent claudication
• ^^^ “PALLOR”
• Decreased pulses, pale leg on elevation, and leg becomes rubor (red) when dropping leg down from elevation

Question 3

Arterial Insufficiency Wound Presentation

Answer 3

• Lateral malleoli, dorsum of feet, and toes
• Wound base is necrotic and pale, lacks granulation
• Dry gangrene (wet gangrene = infection)
• Deep, dry, painful, and well defined borders

Question 4

Atherosclerosis

Answer 4

• Damage to lining of vessels and formation of liquid deposits

Question 5

Arteriosclerosis

Answer 5

• Thickening, hardening, and loss of elasticity of walls (cannot vasodilate very well)

Question 6

Arteriosclerosis Obliterans

Answer 6

• Form of atherosclerosis (damage to lining of vessels and formation of liquid deposits) characterized by occlusion of arteries that cause rest pain, intermittent claudication, and trophic changes

Question 7

Intermittent Claudication

Answer 7

• Pain with walking that occurs when exercising muscles are not receiving blood perfusion needed for normal function

Question 8

Purpose of ABI Test

Answer 8

• Determine if there is PVD and how severe it is

Question 9

ABI Values Scoring

Answer 9

• > 1.2 = arterial disease, arteriosclerosis, falsely elevated, or diabetes
• 1.19-0.95 = normal value
• 0.94-0.75 = mild arterial disease, intermittent claudication
• 0.74-0.50 = moderate arterial disease, pain at rest
• <0.50 = severe arterial disease (no compression allowed to be used at this stage)

Question 10

Burgers Test

Answer 10

• Used to assess for arterial insufficiency
• Patient supine, flex hip and raise entire leg, see when leg becomes pale
• Normal = sole of foot remains pink up to 90 degrees
• Ischemic leg = sole of foot becomes pale from 15-30 degrees for 30-60 seconds
• Severe ischemic leg = sole of foot becomes pale with leg <20 degrees

Question 11

Rubor Dependency Test

Answer 11

• Used to assess for arterial insufficiency
• Assesses for color of sole of foot during elevation
• Patient supine, tested leg brought into 60 degrees of hip flexion and held for 1 minute
• Normal = sole should remain pink during both elevation and dependency
• PAD = color changes from pale to pink then progresses to purple-red or bright red

Question 12

Capillary Refill Test

Answer 12

• Push on thumbnail and it becomes pale
• Within 2 seconds, it should become pink again (normal), and if it doesn’t then its abnormal (arterial insufficiency)

Question 13

Arterial Insufficiency Compression

Answer 13

• No compression of leg when ABI is below 0.50
• Very light compression (12-25mmHg) is okay between 0.5-0.8 ABI — with close involvement of referring practitioner

Question 14

Arterial Insufficiency Interventions

Answer 14

• Smoking cessation and weight control
• Weight bearing exercises
• Frequency =3-5 days/week and 2 days/week for resistance
• Intensity = moderate (40-60% HRR) up to point of moderate pain
• 15 minutes per day, progressing up 5 minutes biweekly

Question 15

Arterial Insufficiency Wound Dressings

Answer 15

• Hydrogels (moistens dry wound)
• Foam with hydrogels

Question 16

Venous Insufficiency Overview

Answer 16

• Definition = inadequate drainage of venous blood from body part, usually resulting in edema and/or skin abnormalities and ulceration
• Chronic Venous Insuff = persists over long period of time, valves become damaged over time so blood leaks back down since valves dont work so blood pools in LEs

Question 17

Venous Insufficiency Causes

Answer 17

• Aging
• Lack of exercise
• Pregnancy
• Long hours of standing
• Restrictive clothing

Question 18

Venous Insufficiency Signs & Symptoms

Answer 18

• Edema
• Heaviness
• Fatigue
• Fibrosis
• Increased skin temperature
• Hemosiderin Staining — causes blood back up and it leaks out of vein so it is free floating, so the body breaks down RBCs and iron within cells comes out which causes the purple-brown staining

Question 19

Venous Insufficiency Wound Presentation

Answer 19

• Medial malleoli, medial lower leg
• Edematous
• Heavy drainage
• Mildly painful
• Shallow
• Hemosiderin staining
• Unevenly shaped borders

Question 20

Venous Insufficiency Interventions

Answer 20

• Compression Therapy! — pneumatic pumps or short stretch bandaging
• Short stretch bandaging (with high working pressure and low resting pressure) — lowest recommended pressure (20mmHg) and highest recommended pressure (40mmHg)
• Mobility exercise
• Positioning — leg elevated above heart whenever possible
• Avoid aggravating positions or activities
• Walking program (without prolonged standing)

Question 21

Venous Insufficiency Wound Dressings

Answer 21

• Calcium alginate (soak up wound first)
• Foams (soak up wound)
• Hydrogels (soak up wound, even though these can also provide moisture when needed)
• Silver impregnated gauze — if patient has infection