arterial/venous

Question 1

arterial system

Answer 1

pump; the heart
high pressure, thick walled
gravity assisted

Question 2

venous system

Answer 2

no pump at rest
low pressure, thin walled

Question 3

chronic venous insufficiency

Answer 3

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

Question 4

signs of venous disease

Answer 4

pain, heaviness, fatigue

pitting edema round the ankle toward end of day

atrophic blanche- smooth white ivory

Question 5

venous disorders

Answer 5

can be acute or chronic in nature

therapeutic exercise is used to manage

Question 6

venous insufficiency ulcers

Answer 6

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

Question 7

assessment of venous insufficiency

Answer 7

girth measurements
homans sign vs wells criteria
doppler

Question 8

ABI norms

Answer 8

> /= 1 normal: adequate blood flow for healinng

</=0.9 LE arterial disease

Question 9

wells DVT criteria of > or = 2

Answer 9

indicated that probability of DVT is likely

Question 10

clinical manifestations of venous disorders

Answer 10

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

Question 11

characteristics of venous ulcers position

Answer 11

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

Question 12

characteristics of venous ulcers presentation

Answer 12

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

Question 13

venous ulcers - periwounds and structural changes

Answer 13

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

Question 14

management of chronic venous insufficienct and varicose veins

Answer 14

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

Question 15

types of arterial disorders

Answer 15

acute arterial occlusions
arteriosclerosis obliterans (ASO)
BUERGERS disease
Raynoauds

Question 16

acute arterial occlusions

Answer 16

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

Question 17

Acute arterial occlusion contraindications

Answer 17

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

Question 18

arteriosclerosis obliterans (ASO)

Answer 18

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

Question 19

raynauds diseas

Answer 19

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

Question 20

integumentary changs in arterial disorders

Answer 20

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

Question 21

sensory disturbances in arterial

Answer 21

Intolerance to heat or cold
Paresthesia: tingling and then numbness

Question 22

pain at rest in arterial

Answer 22

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

Question 23

clinical manifestations of peripheral arterial disorders

Answer 23

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

Question 24

5PT method of arterial ulcer classification

Answer 24

pain
position
presentation
periwound
pulses
temp

Question 25

arterial ulcers pain

Answer 25

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

Question 26

arterial ulcers position

Answer 26

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)

Question 27

arterial ulcers presentation

Answer 27

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

Question 28

arterial ulcers periwound

Answer 28

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)

Question 29

arterial ulcers causes

Answer 29

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

Question 30

clinical guideline for PT tests and measures for arterial insufficiency

Answer 30

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

Question 31

assessment of arterial insufficiency

Answer 31

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

Question 32

assessment: palpation of pulses

Answer 32

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

Question 33

assessment: skin temp

Answer 33

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

Question 34

assessment skin integrity

Answer 34

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

Question 35

assessment: rubor dependency for reactive hyperemia

Answer 35

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

Question 36

assessment pulse ox

Answer 36

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

Question 37

management of chronic arterial insufficienct

Answer 37

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

Question 38

exercise contraindications arterial

Answer 38

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

Question 39

exercise guidelines arterial

Answer 39

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

Question 40

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

Answer 40

False: this decreases blood flow to the extremities

Question 41

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

Answer 41

acute arterial occlusion wont get any blood supply

Question 42

Ther Ex is used to manage patients with

Answer 42

venous insufficeny

Question 43

use of support hose is contraindicated for

Answer 43

acute arterial occlusions

Question 44

obesity, pregnancy, age and cancer are risk factors for

Answer 44

venous insufficieny

Question 45

elevation of LE increases the pain with

Answer 45

arterial disorders