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Fall 2023 Integumentary > C: Week 2 > Flashcards

C: Week 2 Flashcards

1
Q

Arterial Wound

A
  • Wound that results from a lack of blood flow which deprives the area of oxygen
  • 5%-10% of all LE ulcerations are because of arterial insufficiency
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2
Q

Arterial vessels outer most layer to inner most layer

A

1.)Tunica Adventita= protective layer + supportive outer layer
2. Tunica Media=
3.) Tunica Intima= delicate layer in contact with the blood cells

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3
Q

Acute Embolism (Etiology of Arterial Insufficiency)

A

A clot stops blood flow to an area + damages arteriole wall when a clot gets stuck

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4
Q

Thromboangiitis Buerger’s Disease (Etiology of Arterial Insufficiency)

A
  • Inflammation of the small vessels
  • When inflamed they can include things like swelling which makes them close off
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5
Q

Atherosclerosis (Etiology of Arterial Insufficiency)

A

Thickening or hardening of arteries
- #1 reason for Arterial Insufficiency

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6
Q

Atherosclerosis (Etiology of Arterial Insufficiency)

A

-Systemic process by which the vessels narrow
- lipids + calcium deposits + scar tissue accumulate on the inner lining of the arteries and narrow the lumen- stenosis
-High LDL’s lead to a deposition of plaques into the arteries

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7
Q

Intermittent Claudication

A
  • It is activity specific discomfort due to local ischemia
  • Pain stops within 1-5 minutes of ceasing activity
  • Pain location is usually distal to the site of occlusion
  • Demand of O2 exceeds what they can supply
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8
Q

If there is intermittent claudication in the Iliofemoral artery obstruction where would the person feel the pain?

A

Buttock, thigh, calf pain

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9
Q

If a person had a Infrapopliteal artery obstruction where would they feel the pain?

A

foot pain

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10
Q

Ischemic Rest Pain

A
  • More significant arterial disease
  • Burning pain exacerbated with elevation and relieved by dependency
  • Increasing Tissue O2 demand can fatally upset the balance between O2 supply and tissue demand causing ulceration
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11
Q

The progression of Arterial Insufficiency

A

Arterial Insufficiency–> Intermittent Claudication–> Ischemic rest pain –> Ulcer

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12
Q

Gangrene

A
  • when oxygen supply does not equal demand you have cell death
  • dead tissue typically dry, dark, cold, and contracted
    -Dry= stable its ok (good), circulation, proximal, keep it dry
  • Wet not good
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13
Q

Diabetes (Etiology of Arterial Insufficiency)

A
  • Arteries tend to accumulate calcium making them harder + narrowing the openings of the vessels -stenosis
    -prolonged hyperglycemia impairs angiogenesis, fibroblast proliferation, collagen synthesis and overall strength of scar tissue and impairs all 3 phases of healing
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14
Q

What is the A1c level of a normal person and a diabetic

A

Normal= 5.7
Diabetic= anything less than 7

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15
Q

Difference between neuropathic wound and an arterial wound

A

Neuropathic wound happens over points of pressure like a bed sore

Arterial wound happens from ischemic tissue dying and forming an ulcer

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16
Q

Characteristics of an Arterial Wound

A
  1. Pain- severe unless masked by neuropathy- pain increases with elevation
  2. Position- Primarily LE, Distal toes, Dorsal Foot, areas of trauma
  3. Presentation
    –> Regular appearance
    –> may conform to precipitating trauma
    –> pale granulation tissue if present
    –> Black eschar
    –> gangrene
    –> little to no drainage
  4. Periwound & Extrinsic Tissue
    –> thin, shiny, anhydrous skin
    –> loss of hair growth
    –> thickened yellow nails
    –> pale, dusky, or cyanotic skin
    –> dependent rubor
    –> edema unusual, may indicate VI or CHF
  5. Pulses- decreased or absent pedal pulse
  6. Temperature- cool/decreased
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17
Q

Wound Presentation Arterial Insufficent Wounds

A
  • Begin small and shallow
  • Round and regular or conform to trauma
  • Any granulation tissue will be pale or grey
  • Necrotic tissue desiccated with black eschar or yellow if bandaged for wound moisture
  • Minimal to no wound drainage even with infection
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18
Q

Physical Therapist Tests for Arterial Insufficiency

A
  1. Pulses
  2. Doppler Ultrasound
  3. ABI
  4. Rubor of Dependency
  5. Capillary Refill
  6. Venous Filling Time
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19
Q

Doppler Ultrasound

A
  • Indications: decreased or absent pulses
  • Helpful in assessing arterial Patency
  • method of assessment when pulses cannot be palpated easily
20
Q

ABI Indications

A
  • Decreased/absent pulses
  • Signs/symptoms of AI
  • History of PVD
21
Q

ABI 1.1-1.3 =

A
  • vessel Calcification
  • ABI is not a valid measure of tissue perfusion
  • Referral to vascular
22
Q

ABI 0.9-1.1=

A
  • Normal
  • Okay to debride
23
Q

ABI 0.7-0.9=

A
  • Mild to moderate Arterial Insufficiency
  • Conservative interventions normally provide satisfactory wound healing
  • 0.8-0.5: clinical judgment required for debridement
24
Q

ABI 0.5-0.7=

A
  • Moderate arterial insufficiency, intermittent claudication
  • May perform trial of conservative care, physician may consider revascularization
  • 0.8-0.5: clinical judgment required for debridement
25
Q

ABI <0.5 =

A
  • Severe arterial insufficiency, rest pain
  • Wound is unlikely to heal without revascularization, limb threatening arterial insufficiency
  • <0.5 referral to vascular surgeon
26
Q

ABI <0.3 =

A
  • Rest pain and gangrene
  • Revascularization or amputation
27
Q

Arterial Insufficiency Medical and surgical interventions

A
  • Prescription drugs
  • Revascularization
  • Percutaneous Balloon Angioplasty= procedure in which balloon tip catheter is expanded at a site of stenosis: compressing any of the plaque formation that is obstructing the blood flow against the wall and then opening the vessel
  • Amputation: earlier is better than later in terms of healing potential
28
Q

Physical Therapy Management for Arterial Insufficiency

A
  • Limb protection from trauma, chemicals, excessive heat/cold, protect open wounds, live healthy
  • Therapeutic exercises: strengthening, aerobic exercise, stretching, positioning, gait training and mobility
29
Q

Venous Insufficiency Definition

A
  • Condition where the veins particularly in the lower extremities have difficulties sending blood back to the heart
30
Q

Type of Veins: Deep

A
  • Popliteal
  • Femoral
  • Tibial
    Carry 80-90% of blood back to the heart
31
Q

Type of Veins: Superficial

A
  • Greater/Lesser Saphenous veins
  • Drain skin and subcutaneous tissues
  • ## Assist with temperature regulation
32
Q

Type of Veins: Perforating Veins

A
  • Connect deep and superficial veins
  • 60-100 perforating veins in each leg
33
Q

True false: Venous insufficiency is a low pressure system

A

True

34
Q

Calf muscle Pump

A

Main way we get blood back to the heart+ calf muscle contracts the veins get compressed blood forced up leg

35
Q

Respiratory Pump

A

Every time we inhale/exhale
- Inhale = decrease in thoracic pressure + increase in abdominal pressure which provides a pressure gradient to drive blood back to the heart

36
Q

Valves

A

present to prevent retrograde blood flow (backwash)+ preventing increase venous back pressure (venous hypertension)

37
Q

What are the common causes of Venous hypertension?

A
  • Vain dysfunction
  • incompetent superficial and perforating veins
  • Valve damage
  • Calf muscle pump failure
38
Q

White Blood Cell Trapping Theory

A
  • congestion + distention is caused by venous hypertension
  • distention encourages WBC’s to come to the area which further increases congestion
  • WBC’s adhere to the vessel walls and become trapped
  • Trapped WBCs trigger inflammatory response which encourages more cells to an already congested area
    -WBCs releasing substances that further damage the epithelial lining of the veins
  • Ulcer will ultimately develop from local hypoxia caused by the trapped WBCs
39
Q

Fibrin Cuff Theory

A

The distention caused by venous hypertension will make the veins leaky
- Leaky veins allow proteins and fluids to escape into interstitial tissue causing swelling and edema
- Fibrinogen is leaked once in the interstitial it will convert fibrin
- Which then adheres to the capillary walls forming a cuff
- Cuff then prevents O2 + nutrients exchange to the skin so the skin dies and ulcer develops

40
Q

Venous Insufficiency Ulcer: Pain

A
  • mild to moderate unless masked by neuropathy
  • decreases with elevation /compression
41
Q

Venous Insufficiency Ulcer: Position

A
  • Medial Malleolus
  • Medial Leg
  • Areas of Trauma
42
Q

Venous Insufficiency Ulcer: Presentation

A
  • irregular shape
  • Fibrous, glossy coating
  • Red, ruddy wound bed
  • Copious drainage
43
Q

Venous Insufficiency Ulcer: Peri wound and Extrinsic Tissue

A
  • Edema
  • Dermatitis and cellulitis common
    Hemosiderin staining
    Lipodermatosclerosis
44
Q

Venous Insufficiency Ulcer: Pulses

A
  • Normal or decreased due to edema or concomitant arterial insufficiency
45
Q

Venous Insufficiency Ulcer: temperature

A
  • Normal to mild warmth
46
Q
A

Fall 2023 Integumentary (10 decks)

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