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arterial/venous Flashcards

management

1
Q

arterial system

A

pump; the heart
high pressure, thick walled
gravity assisted

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2
Q

venous system

A

no pump at rest
low pressure, thin walled

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3
Q

chronic venous insufficiency

A

inadequate venous return over a prolonged period of time - calf pump failure, prolong stand

associated with trauma, tumor, DVT, varicose veins, previous ulcer, DM, aging

damaged valves in the veins prevent venous return, leading to venous stasis in the lower extremities

blood pools in the veins decreasing oxygen supply to the cells, leading to venous stasis ulcers

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4
Q

signs of venous disease

A

pain, heaviness, fatigue

pitting edema round the ankle toward end of day

atrophic blanche- smooth white ivory

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5
Q

venous disorders

A

can be acute or chronic in nature

therapeutic exercise is used to manage

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6
Q

venous insufficiency ulcers

A

anything that results in venous HTN has the potential to cause venous insufficiency-related tissue damage

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7
Q

assessment of venous insufficiency

A

girth measurements
homans sign vs wells criteria
doppler

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8
Q

ABI norms

A

> /= 1 normal: adequate blood flow for healinng

</=0.9 LE arterial disease

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9
Q

wells DVT criteria of > or = 2

A

indicated that probability of DVT is likely

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10
Q

clinical manifestations of venous disorders

A

dependent, peripheral edema that occurs with long period of sitting or standing

edema decreases with elevation

dull aching pain and fatigue in LE

brownish pigmentation to the skin

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11
Q

characteristics of venous ulcers position

A

position
- medial aspect of LE
- medial mallelous
- areas exposed to trauma
- not on Plantar aspect of foot
- rarely above knee

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12
Q

characteristics of venous ulcers presentation

A

superficial
irregular shaped
mod to high amounts of drainage
edges white due to maceration

beefy red granulation wound bed

yellow fibrin

undermining

epithelialization at wound margins - does not progrss due to edema

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13
Q

venous ulcers - periwounds and structural changes

A

edema
- pitting
- indurated
erythema
hemosiderin staining
lipodermatosclerosis
skin more fibrotic and less elastic

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14
Q

management of chronic venous insufficienct and varicose veins

A

patient education
- decrease/prevent edema
- prevent skin infections and ulcers

COMPRESSION and CLEANSE
- measure and fit support stocking/bandages and teach pt
- skin care - moisture
- walking
- elevation of LE avoid prolonged sitting

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15
Q

types of arterial disorders

A

acute arterial occlusions
arteriosclerosis obliterans (ASO)
BUERGERS disease
Raynoauds

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16
Q

acute arterial occlusions

A

a thrombus, embolism or truama that causes loss of circulation to arteries

most common location is femoral popliteal bifurcation

immediated medical or surgical intervention is required

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17
Q

Acute arterial occlusion contraindications

A

THERAPEUTIC EXERCISE: Active or Passive
Use of support hose
Use of direct heat over painful areas
Restrictive clothing
Prolonged positioning could cause breakdown of the skin

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18
Q

arteriosclerosis obliterans (ASO)

A

Accounts for 95% of all the arterial disorders affecting the lower extremity
Chronic progressive occlusion of med/large arteries of the LE caused by plaque formation
Chronic, seen in elderly patients
Associated with smoking, HBP, Obesity, diabetes mellitus

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19
Q

raynauds diseas

A

Abnormal sympathetic nervous system leads to digital vasospasm, affect the small arteries of the fingers and toes
Vasospasm is brought on by exposure to cold, vibration or stress
Characterized by fingers, looking pale, f/b cyanosis, then pain, f/b numbness and ending with a cold sensation
Symptoms decreased by warmth

20
Q

integumentary changs in arterial disorders

A

Skin discoloration
- Pallor at rest, with exercise & with elevation
- Reactive hyperemia: LE turns bright red when moved to a dependent position
Trophic changes
- Shiny, waxy skin appearance
- Skin appears dry, loss of hair
Ulcerations develop
- Over bony prominences & WB areas

21
Q

sensory disturbances in arterial

A

Intolerance to heat or cold
Paresthesia: tingling and then numbness

22
Q

pain at rest in arterial

A

Gradual burning, tingling in the distal LEs at rest or with elevation indicates severe ischemia
Pain at night due to HR and blood flow decreases with rest
Elevation of LE increases the pain, and placing the LE in a dependent position decreases the pain

23
Q

clinical manifestations of peripheral arterial disorders

A

Diminished/Absent Peripheral Pulses
Integumentary Changes
Cool to touch
Sensory Disturbances
Exercise Pain & Resting Pain
Muscle Weakness

24
Q

5PT method of arterial ulcer classification

A

pain
position
presentation
periwound
pulses
temp

25
Q

arterial ulcers pain

A

Usually severe
Increases with anything that increases metabolism
I.E. ambulation
Difficulty sleeping due to pain
Hang foot over side of bed
May be masked with diabetic sensory neuropathy

26
Q

arterial ulcers position

A

Almost always in LEs
Below Knee
Common on toes
Any ulcer on distal, non-plantar aspect of foot s/b considered ischemic in nature
Lateral malleolus or anterior leg (less blood supply in these areas)

27
Q

arterial ulcers presentation

A

Start as small shallow ulcers and progress
Usually round and regular in appearance or conform to precipitating trauma
Pale or gray wound bed
Dry, desiccated tissue in wound bed
Minimal drainage
Minimal evidence of progression through healing stages

28
Q

arterial ulcers periwound

A

Trophic changes
- Epidermis thin, shiny, anhydrous, loss of hair
Increased risk of fungal infections
- Nails thickened, yellow, fragile
Muscle atrophy
Color changes
- Pale, dusky, cyanotic
- Dependent rubor
Minimal edema (unless mixed etiology)

29
Q

arterial ulcers causes

A

Arteriosclerosis (thickening,
hardening and loss of elasticity of arterial walls)
Main cause
Trauma
Acute embolism
Thromboangitis (Beurger’s disease)
Seen in young adults who smoke heavily

30
Q

clinical guideline for PT tests and measures for arterial insufficiency

A

test: pulse exam, doppler US and ABI

indications: all open wounds on extremities
decreased or absent pulses
S&sx of arterial insufficienct
H/O PVD

31
Q

assessment of arterial insufficiency

A

PALPATION OF PULSES
PALPATION OF SKIN TEMPERATURE
CHECKING SKIN INTEGRITY & PIGMENTATION
RUBOR/REACTIVE HYPEREMIA
CLAUDICATION TIME
DOPPLER US & TRANSCUTANEOUS OXIMETRY
ARTERIOGRAPHY

32
Q

assessment: palpation of pulses

A

Normal, diminished or absent?
Rate pulse 0 – 3+
Pulselessness is not a good sign!
Pulses may be difficult to assess, may need a Doppler US for a more accurate assessment

33
Q

assessment: skin temp

A

Palpation:
Skin will feel cool to the touch with decreased arterial blood flow
Skin temp should feel consistent between extremities
May need an electronic thermometer to get a quantitative measurement

34
Q

assessment skin integrity

A

Look for:
Dry skin
Pale skin (Pallor)
Hair loss
Shiny appearance
Ulcerations present

35
Q

assessment: rubor dependency for reactive hyperemia

A

Elevate legs for several minutes above the level of the heart while patient is supine
Pallor will occur in the feet within one minute or less if arterial circulation is compromised
The legs are placed in a dependent position and within 30 seconds the feet become bright red, this indicates decreased blood flow in the capillaries

36
Q

assessment pulse ox

A

Oxygen saturation in the blood
Infrared beam of light only responds to pulsating objects
It will not detect non-pulsating objects such as venous blood or skin
Can not get a pulse ox reading if there is an occlusion

37
Q

management of chronic arterial insufficienct

A

Patient Education:
Stop smoking!!!!!!
Begin healthy diet!!! (nutritional counseling)
Sleep with legs in dependent position
Medical Management:
Treat HBP and DM
PT: Begin a Graded Exercise Program
Walking or bicycling
PT: Wound Management: HYDRATION
Active ROM exercises to maintain joint mobility
Wound management: ES, sterile dressing
Reconstructive vascular surgery may be indicated for some patients with pain at rest

38
Q

exercise contraindications arterial

A

Discontinue ambulation or biking if:
Leg pain increases over time
Resting pain increases
Ulcerations, fungal infections or wounds are present on the feet
Patients with a cardiac history should be monitored closely

39
Q

exercise guidelines arterial

A

Walk or Bike as far as possible without causing Intermittent Claudication
3-5 days/week
Warm up prior to exercise and cool down afterward
Establish a target heart rate
Avoid exercising outdoors when very cold
Avoid blisters

40
Q

True or False:
Management of Chronic Arterial Insufficiency constitutes elevating the patients legs

A

False: this decreases blood flow to the extremities

41
Q

The patient requires complete bed rest:
Acute arterial occlusion or chronic arterial insufficiency?

A

acute arterial occlusion
wont get any blood supply

42
Q

Ther Ex is used to manage patients with

A

venous insufficeny

43
Q

use of support hose is contraindicated for

A

acute arterial occlusions

44
Q

obesity, pregnancy, age and cancer are risk factors for

A

venous insufficieny

45
Q

elevation of LE increases the pain with

A

arterial disorders

integ (4 decks)

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