Cardiac Flashcards
1
Q
Normal blood flow thru ♡
A
superior and inferior vena cava (deoxygenate blood) → RA → tricuspid valve → RV → pulmonary artery → lungs → pulmonary veins (oxygenated blood) → LA → mitral/bicuspid valve → LV → aorta → body systems
2
Q
Preload
A
amount of blood returning to right side of heart and muscle stretch that the volume causes — (ANP released during stretch)
3
Q
Afterload
• what is it?
• w/ HTN = more ____ = lead to what? because HIGH afterload = ↓ CO and ↓ forward flow (wears your heart out)
A
- pressure/”resistance” in aorta and peripheral arteries that LV has to pump against to get blood out
- HTN = more RESISTANCE = lead to HF and pulmonary edema (HIGH afterload = ↓ CO and ↓ forward flow — wears your heart out)
4
Q
Stroke Volume
A
amount of blood pumped out of ventricles w/ each beat
5
Q
Cardiac Output
• formula?
• ____ is dependent on adequate CO
• Cardiac output changes according to body’s ____
A
- CO = HR x SV
- Tissue perfusion
- body’s needs
6
Q
Factors that affect Cardiac Output
• what 3 things? examples?
A
- HR and certain arrhythmias
- Blood volume
- -less volume = ↓ CO
- -more volume = ↑ CO - Decreased contractility
- -MI, meds, cardiac muscle disease
7
Q
Patho of ↓ CO • will you perfuse properly? a. Brain: LOC? b. heart? c. lungs? d. skin? e. kidneys? f. peripheral pulses?
• ____ are no big deal UNTIL they affect your Cardiac Output
A
• NO
a. LOC ↓
b. chest pain
c. wet lung sounds; SOB
d. cold and clammy
e. UO ↓
f. weaker pulses
• Arrhythmias
8
Q
3 Arrhythmias that are always a big deal
A
- V-fib
- Pulseless V-tach
- Asystole
9
Q
Medications Effects on CO
Preload - vasodilate/diurese to ↓ preload
A
- Diuretics (furosemide)
2. Nitrates (nitroglycerin)
10
Q
Medications Effects on CO
Afterload - vasodilate to ↓ afterload
A
- ACE inhibitors (enalapril, fosinopril, captopril)
- ARBs (losartan, irbesartan)
- Hydralazine
- Nitrates
11
Q
Medications Effects on CO
Improve Contractility
A
- Inotropes (dopamine, dobutamine, milrinone)
12
Q
Medications Effects on CO
Rate control
A
- Beta blockers (propranolol, metoprolol, atenolol, carvedilol)
- Calcium Channel Blockers (diltiazem, verapamil, amlodipine)
- Digoxin
13
Q
Medications Effects on CO
Rhythm control
A
- Antiarrhythmics (Amiodarone)
14
Q
Coronary Artery Disease (CAD)
• most common type of cardiovascular disease: broad term for _____ and _____
A
• chronic stable angina and acute coronary syndrome
15
Q
Chronic Stable Angina Patho
- Intermittent ↓ blood flow to myocardium leads to? and then can lead to temporary what?
- what brings this pain? ____ O2 usually d/t ____
- What relieves the pain?
A
- ISCHEMIA; pain/pressure in chest
- LOW O2 d/t EXERTION
- rest and/or nitroglycerin SL
16
Q
Nitroglycerin (Nitrostat): Sublingual • causes what? then causes ↓ \_\_\_\_ and \_\_\_\_; also causes what to increase blood flow to myocardium? • take 1 every \_\_\_\_ min x \_\_\_\_ doses • okay to swallow? • keep inside what? in what environment? • burn or fizz? • will get a what? • renew how often? spray? • after taking nitro, what to expect for BP to do?
A
- venous and arterial DILATION; ↓ PRELOAD and AFTERLOAD; also causes DILATION of CORONARY ARTERIES
- take 1 every 5 MINUTES x 3 DOSES
- DO NOT SWALLOW –needs to dissolve
- keep in DARK, GLASS BOTTLE; dry, cool
- burn or fizz –MAY OR MAY NOT HAPPEN
- will get a HEADACHE
- renew EVERY 6 MONTHS —-spray: 2 YEARS
- BP ↓
17
Q
Algorithm for NItroglycerin
A
take 1 NTG SL –after 5 mins if chest pain/discomfort is unimproved/worsened – CALL 911!
18
Q
Beta-Blockers for Prevention of Angina • examples? • what BBs do to BP, Pulse, myocardial contractility? • what BBs do to workload of heart? • what BBs block? • what happens to CO?
A
- propranolol (Inderal), metoprolol (Lopressor/Toprol XL), atenolol (Tenormin), carvedilol (Coreg)
- DECREASE BP, Pulse, myocardial contractility
- ↓ workload of heart
- block beta cells (receptor sites for catecholamines – epi, norepi)
- ↓ CO
19
Q
Calcium Channel Blockers for Prevention of Angina • examples? • what CCB do to BP? • cause what in arterial system? • dilate \_\_\_\_ \_\_\_\_ • 2 benefits of CCB?
A
- nifedipine (Procardia XL), verapamil (Calan), amlodipine (Norvasc), diltiazem (Cardizem)
- ↓ BP
- vasodilation
- coronary arteries
- ↓ afterload and ↑ O2 to heart muscle
20
Q
Acetylsalicylic acid (Aspirin) typical dose?
A
81 mg - 325 mg
21
Q
Chronic Stable Angina Education • rest? • nutrition: avoid \_\_\_\_, eat what? • what to avoid that ↑ HR? • wait how long after eating to exercise? • what to wear in cold weather? why? • take \_\_\_\_ prophylactically • \_\_\_\_ cessation • lose \_\_\_\_ • avoid \_\_\_\_ exercise • reduce \_\_\_\_
A
- rest FREQUENTLY
- nutrition: avoid OVEREATING, eat LOW-FAT, HIGH FIBER
- EXCESS CAFFEINE OR ANY DRUGS that ↑ HR
- wait 2 HOURS after eating to exercise?
- DRESS WARMLY in cold weather? TEMP EXTREMES PRECIPITATE ATTACK
- take NITROGLYCERIN prophylactically
- SMOKING cessation
- lose WEIGHT
- avoid ISOMETRIC exercise (NO LIFTING WEIGHTS)
- reduce STRESS
22
Q
Cardiac Catheterization Pre-procedure • ask if allergic to what? why? • check kidney function why? • what do PHP prescribe if client has kidney problems? why? what should the client expect when getting this?
A
- shellfish or iodine — iodine-based dye is used
- b/c dye is excreted thru kidneys
- acetylcysteine (Mucomyst) —helps protect kidneys — hot shot and palpitations
23
Q
Cardiac Catheterization Post-procedure • monitor \_\_\_\_ • watch puncture site for what? • assess 5 Ps? • bed rest, flat, extremity straight for how many hours? • report \_\_\_\_ ASAP • IF client is on metformin (Glucophage) -- what to do with this med post procedure? we are worried of what?
A
- monitor VS
- bleeding and hematoma formation
- Pulselessness, Pallor, Pain, Paresthesia, Paralysis
- 4-6 hours
- Pain
- hold metformin for 48 hours post procedure — worried about kidneys
24
Q
Unstable chronic angina = Impending ______
A
MI
25
Acute Coronary Syndrome/MI/Unstable Angina
PATHO
• Decreased blood flow to ____ → ____ and ____
• does the client have to be doing anything to bring this pain on?
• will rest or nitroglycerin (Nitrostat) relieve this pain?
* Decreased blood flow to MYOCARDIUM → ISCHEMIA and NECROSIS
* no
* no
26
```
Acute Coronary Syndrome/MI/Unstable Angina
S/SX
• pain described as?
• women present with what s/sx?
• #1 sign of MI in elderly?
• skin? BP?
• CO?
• ECG changes?
• Vomiting?
```
* pain as CRUSHING, elephant sitting on chest, pressure radiating to left arm and left jaw, N/V, pain between shoulder blades
* women - GI s/sx -- epigastric discomfort, pain between shoulders, aching jaw or choking sensation
* SOB
* cold and clammy; BP ↓
* CO ↓
* ECG changes --lots of PVCs
* Yes, stimulation of vagus nerve
27
Triad of Symptoms in Women
1. indigestion or feeling of fullness
2. unsual fatigue
3. inability to catch one's breath
28
STEMI?
NSTEMI?
***WORRY ABOUT WHICH CLIENT?
STEMI
-- ST-segment elevation MI -- client is having a HEART ATTACK -- goal is to get client to cath lab for PCI in <90 minutes!!
STEMI
Non-ST segment elevation MI -- less worrisome
***WORRY ABOUT STEMI CLIENT***
29
```
MI Lab work
- CPK-MB
• Cardiac specific ____
• ____ w/ damage to cardiac cells
• elevates within ____ hours; peaks in ____ hours
```
- TROPONIN
• ____ specificity to myocardial damage
• elevates within ____ hours; remains elevated up to ____ weeks
- MYOGLOBIN
• Increases within ____ hour; peaks in ____ hours
• ____ results are a good thing
* which cardiac biomarker is the most sensitive indicator for an MI?
* which enzymes or biomarkers are most helpful when the client delays seeking care?
* biomarker
* INCREASE
* elevates within 3-6 HOURS ---- peak: 12-24 HOURS
* HIGHLY specific cardiac biomarker
* elevates within 3-4 HOURS --- elevates up to 3 WEEKS
* 1 HOUR; peak: 12 HOURS
* negative
* troponin
* troponin
30
MAJOR ARRHYTHMIAS
• what untreated arrhythmias will put client at risk for SUDDEN DEATH?
* tx for V-Fib?
* if defib doesn't work, what's 1 st med or vasopressor to give?
* what's an antiarrhythmic and is used when V-fib and pulseless VT are resistant to treatment, also for fast arrhythmias
* antiarrhythmic drugs given to prevent a second episode of V-fib?
* Lidocaine toxicity: any ____ changes
* 1sst antiarrhythmic of choice? important SE? why?
• Pulseless V-tach, V-Fib, Asystole
* Defibrillation "Defib the V-fib!"
* EPI
* amiodarone (Cordarone)
* Amiodarone or Lidocaine
* NEURO changes
* amiodarone (Cordarone); hypotension; lead to further arrhythmias
31
MI Treatment
• MONA?
• postition? why?
* oxygen, chewable aspirin, nitro, morphine (2mg at a time)
| * head up --- ↓ workload on heart and ↑ CO
32
Thrombolytics
• goal?
* medications examples?
* how soon after onset of myocardial pain should these drugs be administered? within ____ HOURS
* Stroke: _____ IS BRAIN
* major complication?
* obtain what history?
* contraindications?
* during and after administration we take _____ precautions
* draw blood when starting IV's to decrease what?
* what about ABGs? why?
• DISSOLVE CLOT that's blocking blood flow to heart muscle = ↓ size of infarction
* alteplase (t-PA), tenecteplase (TNKase, one time push), reteplase (Retavase), streptokinase
* within 6 - 8 HOURS
* TIME IS BRAIN
* BLEEDING
* bleeding hx
* intracranial neoplasm, intracranial bleed, suspected aortic dissection, internal bleeding (= CAUSE MASSIVE HEMORRHAGE)
* bleeding precautions
* number of puncture sites
* no; artery is going to BLEED
33
Bleeding Precautions
• watch for?
• use what?
* Watch for bleeding gums, hematuria, black stools
| * use electric razor, soft toothbrush, no IMs
34
MEDS REQUIRING BLEEDING PRECAUTIONS
ALL ANTICOAGULANTS!!!
abciximab, acetaminophen, acetylsalicylic acid, apixaban, clopidrogel, dabigatran, enoxaparin sodium, eptifibatide, heparin rivaroxaban, warfarin
35
PCI (PERCUTANEOUS CORONARY INTERVENTIONS)
• including interventions such as?
• major complication of angioplasty?
• if any problems occur → go to ____
• chest pain after procedure--what to do?
• anti-platelet meds?
```
• PTCA (percutaneous transluminal coronary angioplasty)
and stents
• MI
• go to SURGERY
• call PHP bc REOCCLUDING!
```
```
• acetylsalicylic acid (Aspirin);
clopidogrel (Plavix);
prasugrel (Effient);
abciximab (ReoPro IV);
eptifibatide (Integrilin IV)
```
36
```
CABG (Coronary Artery Bypass Graft)
• what is it?
• scheduled or emergency procedure?
• used for?
• the ____ main coronary artery supplies the entire left ventricle
• ____main coronary artery occlusion...
Think: ____ or Widow Maker
```
* open heart surgery
* both
* multiple vessel disease or left main coronary artery occlusion
* left
* left; sudden death
37
```
Cardiac Rehab
• ____ cessation
• activity?
• diet changes?
• exercises to avoid?
• valsalva? straining? suppository? docusate (Colace)?
• when can sex be resumed?
• safest time of day for sex?
• best exercise for MI client?
• teach s/sx of HF, which are?
```
• SMOKING cessation
• activity? INCREASE GRADUALLY
• diet changes? LOW FAT, LOW SALT, LOW CHOLESTEROL
• exercises to avoid? NO ISOMETRIC EXERCISES (↑ workload of heart)
• valsalva? straining? suppository? docusate (Colace)? NO TO ALL OF IT
• when can sex be resumed? clients w/o complications -- 1 WEEK TO 10 DAYS; or can walk/go upstair w/o SOB
• safest time of day for sex? IN THE MORNING (8-9 AM)
• best exercise for MI client? WALKING
• teach s/sx of HF, which are?
--weight gain, ankle edema, SOB, confusion
38
HF causes
result from cardiomyopathy, valvular heart disease, endocarditis, acute MI, HTN
39
Left-sided HF
• blood is not moving ____ into aorta and out to body....goes backward into the ____
• s/sx
```
• forward; lungs
• pulmonary congestion
dyspnea
cough
blood tinged frothy sputum
restlessness -- hypoxia 1st sign
tachycardia
S3 (ventricular gallop, lub-dub-dub)
orthopnea
nocturnal dyspnea
```
40
Right-sided HF
• blood is not moving ____ into the ____....goes backward into the _____ system
• s/sx
```
• forward; lungs... venous system
• distended neck veins
edema
enlarged organs
weight gain
ascites
```
41
Systolic HF
heart can't contract and eject
42
Diastolic HF
ventricles can't relax and fill
43
HF Diagnosis
a. BNP
• secreted by ____ in heart when what are increased
• ____ indicator
• can be ____ for HF when CXR does not indicate a problem
• if client is on nesiritide (Natreco), what to do with before drawing a BNP?
b. CXR
enlarged ____, pulmonary ____
c. Echocardiogram
looks at what of the heart? give info about?
d. NY Heart Association Functional Classification of Persons w/ HF:
Class 1-4 --- which is the WORST?
```
a. BNP
• ventricular tissues in heart when ventricular volumes and pressure ↑
• sensitive
• positive
• turn it off 2 hours prior
```
b. CXR
enlarged HEART, pulmonary INFILTRATES
c. Echocardiogram
pumping action or ejection fraction of heart ---backflow and valve disease
d. class 4 is the worst!
44
Swan-Ganz (Pulmonary Artery) catheter
floated into the right side of heart and pulmonary artery--provides hemodynamic pressures, CO, and access to mixed venous blood sampling
45
Arterial lines
• most common site?
• provides what? allows for repeated collection of what?
* radial artery
| * provides continuous intra-arterial BP; repeated ABGs (prevent injury to client)
46
```
HF Treatment: ACE Inhibitors
• these are the ____ for HF
• suppress what?
• prevent conversion of?
• results in?
```
* drug of choice for HF
* Renin Angiotensin System (RAS)
* Angiotensin I to Angiotensin II
* arterial vasodilation and ↑ SV
47
HF Treatment: ARBs
• block what?
• cause a ______ in arterial resistance and ____ BP
* Angiotensin II receptors
| * ↓ arterial resistance, ↓ BP
48
HF Treatment: Beta Blockers
• considered as? prescribed in additon to?
• relax the? and decreases what?
• ACE inhibitors and ARBs block _____ = we lose _____ and _____ and retain ____
• why a client w/ HF will be sent home on ACE inhibitors--why?
* first-line therapy; ACE inhibitors
* vessels; ↓BP, ↓ afterload, ↓ workload on heart
* block aldosterone; lose sodium and water; retain potassium
* these drugs ↓ workload on heart by preventing vasoconstriction (↓ afterload) = ↑ CO and keep blood moving forward
49
```
HF Treatment: Digoxin (Lanoxin)
ACTIONS
• monitor for ___ in elderly
• uses?
• often given in combination with what meds?
• contraction?
• HR?
• CO?
• kidney perfusion?
```
* drug toxicity
* SINUS RHYTHM or A-Fib and has chronic HF
* ACE inhibitors, ARBs, Beta Blocker, Diuretics
* contraction IMPROVES (STRONGER)
* HR lower
* CO ↑
* kidney perfusion ↑
50
```
HF Treatment: Digoxin (Lanoxin)
NURSING CONSIDERATIONS
• would diuresis be a good thing or bad thing?
• digitalizing dose mean?
• how do you know it's working?
```
• s/sx of toxicity--early? late?
* before administering, do what? hold if?
* Monitor ____
• what electrolyte when it's low cause the most trouble? why?
* good thing!
* loading dose
* CO ↑
• early -- anorexia, N/V
late -- arrhythmias and vision changes (yellow halo
• check apical pulse (hold if <60 bpm)
* electrolytes
* POTASSIUM --- hypokalemia + digoxin = DRUG TOXICITY
51
HF Treatment: Diuretics
• med examples
• action
• when do you give diuretics?
* furosemide (Lasix), hydrochlorthiazide (HCTZ), bumetanide (Bumex), hydrochlorothiazide/triamterene (Dyazide), spironolactone (Aldactone)
* decreases preload
* morning
52
HF Treatment: IV Inotropes
| examples?
• milrinone (Primacor), dobutamine
53
HF Treatment: Vasodilators
| examples?
• nitroprusside (Nipride), neseritide (Natrecor)
54
HF Treatment: Non-med
• what diet? decreases what? helps with?
• watch for?
• what can contain a lot of sodium?
* elevate ____
* weigh daily and report a gain of ______
* Report s/sx of recurring ______
* low sodium diet; ↓ fluid retention; helps ↓ preload
* salt substitutes (has lots of potassium!)
* canned/processed foods and OTC meds
* elevate HOB
* 2-3 lbs (1-2 kgs)
* failure
55
Fluid retention - think _____ problems first
heart
56
Pacemakers
• what's your "natural" pacemaker called? it sends out what?
• if HR drops 60 or below = CO?
• what is pacemaker used for?
* SA node or sinus node; sends out impulses that makes heart contract
* ↓ CO
* increase HR w/ symptomatic bradycardia
57
Pacemaker may be temporary or permanent?
• always worry if HR drop below the _______
• what maintain a certain minimal HR depending on settings?
* a ____ pacemaker kicks in only when the client needs it
* _____ rate pacemakers fire at a ____ rate constantly
* it's okay for rate to increase but never _____
* always worry if the rate _____ below the set rate
BOTH; temporary (invasive or non-invasive) and permanent
* set rate
* set rate
* demand pacemaker
* fixed
* decrease
* drops
58
Post-procedure care (permanent pacemakers)
• monitor the?
• most common complication?
• immobilize the ____
• how to prevent frozen shoulder?
• kee the client from raising arm higher than what?
* incision and ECG for malfunction
* Electrode displacement (wires pull out)
* arm
* assisted passive ROM
* keep client from raising the arm higher than shoulder height
59
Pacemakers: S/SX of Malfunction
• is it possible that no contraction will follow the stimulus? called what?
* is it possible for pacemaker to fire at inappropriate times? called what?
* what can cause any malfunction?
- -pacemaker may not be ______ correctly
- -electrodes can _____
- -battery may be ____
• watch for any sign of what?
* loss of capture
* failure to sense
* programmed; dislodged; depleted
* ↓ CO or ↓ rate
60
```
Pacemaker Client Education/Teaching
• Check ___ daily
• wear what?
• Avoid _______ fields
• Avoid what dx procedure?
```
* pulse
* ID card or bracelet
* electromagnetic fields (cell phones, large motors)
* MRI
61
```
Pulmonary Edema Risks
Any person:
• receiving IVFs really ____
• very ___ and very ____
• history of what diseases?
```
* FAST
* young, old
* heart or kidney
62
Pulmonary Edema Patho
• fluid is backing up into ____ --- heart is unable to move the volume ____
• usually occurs when?
* lungs; forward
| * at night when client goes to bed
63
Pulmonary Edema S/SX
* sudden onset
* breathless
* restless/anxious (think hypoxia)
* SEVERE HYPOXIA
* productive cough (pink frothy sputum)
64
Pulmonary Edema Treatment:
• Non-med
• position? improves what? promotes ____ of blood in lower extremities
• prevention -- check what and avoid what?
• Oxygen (high flow O2) -- monitor O2 sat and keep
>90%
• Upright position; legs down --- improves CO ---- promotes POOLING of blood
• check lung sounds and avoid FVE
65
Pulmonary Edema Treatment: Diuretics
• furosemide: causes what? dose? to prevent?
• bumetanide: given how? dose?
* diuresis and vasodilation = reduces preload --- 40 mg IV push SLOWLY over 1-2 minutes to prevent HYPOTENSION and OTOTOXICITY
* given IV push or continuous IV infusion to provide rapid fluid removal ---- 1-2 mg IV push given over 1-2 minutes
66
Pulmonary Edema Treatment: Nitroglycerin IV
• Vasodilation = ____ afterload
• _____ afterload = ____ CO because why?
* ↓ afterload
| * ↓ afterload = ↑ CO --- heart is pumping against less pressure and more blood can move forward
67
Pulmonary Edema Treatment: Morphine
| • dose? decrease what?
• 2 mg IV push for vasodilation; ↓ preload and afterload
68
```
Pulmonary Edema Treatment: Nesiritide (Natrecor)
• synthetic version of?
• route? short or long term?
• not be given more than ____ hours
• action?
```
* synthetic BNP
* IV infusion; short term therapy
* 48 hours
* vasodilates veins and arteries and has a diuretic effect
69
Cardiac tamponade
Patho
• blood, fluid, or exudates have leaked into _____ resulting in what?
• causes?
* pericardial sac; compression of heart
| * MV collision, RV biopsy, MI, pericarditis, hemorrhage post CABG
70
```
Cardiac tamponade
S/SX
• CO
• CVP
• BP
• heart sounds
• neck veins
• pressures in all 4 chamber are ________
• shock?
• _____ pulse pressure
```
* CO ↓ (LV being squeezed)
* CVP ↑
* BP ↓ (CO is dropping)
* heart sounds -- MUFFLED/DISTANT
* neck veins DISTENDED
* pressures in all 4 chamber are THE SAME
* shock? YES
* NARROWED pulse pressure
71
Cardiac tamponade
Treatment
• To remove blood from around the heart?
• procedure? monitor what after?
* Pericardiocentesis --- insert needle into pericardial sac and remove fluid
* Surgery --- monitor UO
72
```
Arterial Disorders
Patho
• if you have _____ in one place, you have it everywhere
• medical emergency if you have what?
• client will report what?
• extremity temp?
• no _____ pulse
• more symptomatic where?
• what's the hallmark sign? what is it?
• arterial blood isn't getting to the ______ →
what sx?
• paint rest means what?
```
Treatment
• If you elevate the extremity, would pain increase or decrease?
• treated with what?
• if you have ATHEROSCLEROSIS in one place, you have it everywhere
• medical emergency - ACUTE ARTERIAL OCCLUSION
• client will report NUMBNESS and PAIN
• extremity temp? COLD
• no PALPABLE pulse
• more symptomatic where? LOWER EXTREMITIES
• what's the hallmark sign? what is it? INTERMITTENT CLAUDICATION; pain when walking
• arterial blood isn't getting to the TISSUES →
coldness, skin/nail changes, ulcerations
• paint rest means SEVERE OCCLUSION
tx
• increase --- we DANGLE ARTERIES
• angioplasty or endarterectomy
73
```
Venous Disorders
• arteries carry ____ blood; veins carry ____ blood
• what can occur?
• could develop what?
• tx?
```
* oxygenated; deoxygenated
* inflammation and chronic ulcers
* DVT
* absorbent dressing on wound; compression
74
we _____ veins
| we ____ arteries
we ELEVATE veins
| we DANGLE arteries
75
```
Chronic Arterial Insufficiency Symptoms
• Pain
• Pulses
• Color
• Temp
• Edema
• Skin changes
• Ulceration
• Gangrene
• Compression
```
* Pain --- INTERMITTENT CLAUDICATION
* Pulses --- ↓ or ABSENT
* Color --- PALE WHEN ELEVATED; RED W/ LOWERING OF LEG
* Temp --- COOL
* Edema --- ABSENT OR MILD
* Skin changes --- THIN, SHINY, LOSS OF HAIR OVER FOOT/TOES, NAIL THICKENING
* Ulceration --- IF PRESENT, WILL INVOLVE TOES OR AREAS OF TRAUMA ON FEET (PAINFUL)
* Gangrene --- MAY DEVELOP
* Compression --- NOT USED
76
```
Chronic Venous Insufficiency Symptoms
• Pain
• Pulses
• Color
• Temp
• Edema
• Skin changes
• Ulceration
• Gangrene
• Compression
```
* Pain --- NONE TO ACHING PAIN, depending on dependency of area
* Pulses --- NORMAL (may be difficult to palpate d/t edema)
* Color --- NORMAL (may see petechiae or brown pigmentation with chronic condition)
* Temp --- NORMAL
* Edema --- PRESENT
* Skin changes --- BROWN PIGMENTATION AROUND ANKLES, POSSIBLE THICKENING OF SKIN, SCARRING MAY DEVELOP
* Ulceration --- IF PRESENT, WILL BE ON SIDES OF ANKLES
* Gangrene --- DOES NOT DEVELOP
* Compression --- USED
