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Integumentary Systems > Exam 2: Week 8, Arterial/Venous > Flashcards

Exam 2: Week 8, Arterial/Venous Flashcards

1
Q

List the different types of ulcers

A
  • Arterial
  • Venous
  • Diabetic/neuropathic
  • Mixed
  • Other
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2
Q

What do the abbreviations PAD, PVD, CVI, and CAD mean?

A
  • Peripheral artery disease
  • Peripheral vascular disease
  • Chronic venous insufficiency
  • Coronary artery disease
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3
Q

What are the risk factors for arterial disease?

A

Arteriosclerosis, HTN, Smoking, Diabetes, Hyperlipidemia, CVD/CAD, Sedentary lifestyle, Advanced age, Family history, Obesity, Trauma

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4
Q

What are some clinical symptoms of arterial disease?

A
  • Decreased skin temp
  • Cyanosis
  • Intermittent claudication
  • Dry, scaly, or shiny skin
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5
Q

List and describe the 3 types of arterial insufficiency

A

Arterial Insufficiency Ulcer
- Ulceration and gangrene result when oxygen requirements of local tissue exceed perfusion
- Most common due to trauma
- Can be spontaneous

Intermittent Claudication
- Pain occurs during activity, but feels better at rest
- Activity specific discomfort due to local ischemia (lack of blood)
- Pain is typically described as cramping, burning, fatigue

Ischemic Rest Pain
- “Burning” pain
- Becomes worse with elevation, but relieved by dependency
- If the patient’s arteries are 70% narrowed (stenotic), he/she will typically have ischemic rest pain

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6
Q

Differentiate between arterial and venous ulcers

A

Arterial Ulcers:
- Location: Lower leg, foot/ankle
- Appearance: Small, deep hole (sometimes w/necrotic base)
- Peri wound: Dry, pale, shiny, hairless
- Risk Factors: Atherosclerosis, smoking, diabetes, high BP

Venous Ulcers:
- Location: Lower leg, foot/ankle
- Appearance: Irregularly shaped, shallow w/granulation tissue
- Peri wound: Dark, swollen, warm
- Risk Factors: Usually linked to poor varicose veins. Pregnancy, obesity, history of blood clots

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7
Q

List and describe the stages of Rutherford’s classification of peripheral artery disease

A

Stage 0: Patient is asymptomatic
Stage 1: Mild intermittent claudication is present
Stage 2: Moderate intermittent claudication is present
Stage 3: Severe intermittent claudication
Stage 4: Ischemic rest pain is present
Stage 5: Patient has minor tissue loss
Stage 6: Patient has major tissue ulceration/gangrene

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8
Q

List and describe the pulse scale

A

0: Absent pulse
1+: Thready pulse
2+: Weak pulse
3+: Normal pulse
4+: Strong/Pounding pulse

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9
Q

Describe the capillary refill test

A

Compress fleshy part of big toe until it blanches (turns white)

  • Should return within 3 seconds for capillary refill
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10
Q

Describe the rubor of dependency test

A

Elevate legs while supine for 45-60 seconds, then return to a normal position

Check plantar surface of foot to observe how long it takes for it to become pink again
- Normal: 15-20 secs
- Severe Arterial Insufficiency: >30 seconds or dark red

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11
Q

Describe the “elevation pallor” part of the rubor of dependency test

A

Limb is elevated 45-60 degrees for 60 seconds, then observe the color change

Normal: No change in color
Mild Occlusive Disease: Pallor within 45-60 seconds
Moderate Disease: Pallor within 30-45 seconds
Severe Disease: Pallor within 25 seconds [anticipate rubor (redness) when foot is not elevated]

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12
Q

Describe the ABI test

A

A test that measures the blood pressure difference between the arm and ankle

(use posterior tibial artery or dorsal pedis artery when checking pulse)

To get the number, divide the ankle systolic pressure by brachial systolic pressure

1.1 to 1.3: Vessel calcification
.9 to 1.1: Normal
.7 to .9: Mild to moderate arterial insufficiency
.5 to .7: Moderate arterial insufficiency, intermittent claudication
<.5: Severe arterial insufficiency, rest pain
<.3: Rest pain and gangrene

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13
Q

Describe the appearance of an arterial wound

A

Will look like a small hole

  • “Punched out”
  • Well defined wound edges
  • Wound bed is often necrotic, dry, pale
  • Very painful
  • Peri wound may have edema
  • Pallor with elevation
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14
Q

What are some precautions and contraindications of arterial ulcers

A
  • SHARP DEBRIDEMENT
  • Compression
  • Adhesive dressings
  • NPWT (because it is dry)
  • Non healing ulcer (referral will be needed)
  • Risk of infection (can be subtle or silent)
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15
Q

A classification system that can be used to classify arterial and diabetic ulcers is called

A

Wagner scale

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16
Q

What is the Marion scale used for?

A

To assess the color

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17
Q

How should you treat an arterial wound?

A
  • Enhance blood flow by exercise, walking, referring patient to surgeon if ABI is <.5
  • Enzymatic/autolytic debridement, pulse lavage (NO SHARP)
  • HBOT
  • Proper footwear
  • Patient positioning
  • Flexibility exercise
  • BuergerAllen exercises
    (always monitor vitals)
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18
Q

How would you educate a patient with an arterial wound?

A
  • Modify risk factors (smoking, health habits, etc.)
  • Protect against external trauma
  • Head of bed (HOB) elevated 5-7 degrees (helps blood reach the lower extremities)
  • Heat to femoral triangle
  • Lubricate skin to avoid cracks and fissures
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19
Q

How is a prognosis determined with an arterial ulcer?

A
  • Consider wound size/depth
  • Consider local tissue perfusion
  • Whether or not physical therapy is needed
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20
Q

What are the 4 types of surgical intervention with arterial wounds? (DON’T SPEND TOO MUCH TIME ON THIS)

A
  • Debridement
  • Revascularization
  • Angioplasty
  • Amputation
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21
Q

T or F? Arterial ulcers are less prevalent, but more severe compared to venous ulcers

A

True

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22
Q

T or F? 10 to 15% of adults in the US have chronic venous insufficiency (CVI)

A

True

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23
Q

T or F? 25% of leg ulcers are due to venous insufficiency

A

False, 70-90%

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24
Q

What do AI and VI stand for?

A

Arterial insufficiency, Venous Insufficiency

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25
Q

T or F? Women have a greater risk of venous insufficiency due to pregnancy

A

True

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26
Q

What are the common causes (etiology) of venous insufficiency (VI)?

A
  • Venous hypertension
  • Vein dysfunction
  • White blood cell (WBC) trapping theory
  • Fibrin cuff theory
27
Q

List some risk factors for developing a venous ulcer

A
  • History (Hx) of varicose veins
  • Venous hypertension
  • DVT
  • Pregnancy
  • Diabetes mellitus (DM)
  • Family history (Hx) of clotting disorders
  • Obesity
  • Lower extremity trauma
28
Q

List some clinical features of venous ulcers

A
  • Hemosiderin pigmentation
  • Shallow with flat, jagged wound edges
  • Proximal to medial malleolus
  • Lipodermatosclerosis
  • Edema
  • Dermatitis of periwound area
  • Localized pain
  • Large amount of exudate
  • Palpable pulses
  • Abnormal venous refill time
  • Increased time
29
Q

Which tests are used to assess venous insufficiency (VI)?

A

ABI, Venous Fill Time, Edema measurement

30
Q

What is the wells criteria?

A

A clinical tool used to assess the risk of DVT

31
Q

What is the buerger allen exercise?

A

Goal: Promote blood flow

Elevate legs (60-90 degrees) for 30-80 seconds (or until blanching) while having the patient dorsi and plantarflex, then have patient dangle legs over the table for 2-5 mins until hyperemia is achieved, then add one minute

32
Q

What are the 3 phases of the venous hypertension cycle?

A
  • Venous hypertension
  • Retrograde venous flow
  • Venous distention
33
Q

Describe the venous refill time test

A

The “gold standard” test to predict venous insufficiency

Have patient in a supine position, then observe the superficial veins on the dorsal aspect of the foot

AI: Blood takes >20 secs to return

Normal: Blood returns within 5-15 secs

VI: Blood takes <5 secs to return

34
Q

Why is it important to take a patient’s ABI before using compression?

A

To make sure that the patient has adequate blood flow

For example, if a patient has PAD, he or she already has impaired blood flow to the extremities meaning if compression is applied, blood flow will restrict it even more which could lead to severe issues

35
Q

Which grading system is used for pressure?

A

NPIAP

36
Q

What mechanism is considered to be the gold standard to assessing chronic venous insufficiency (CVI) in a medical setting

A

Doppler Ultrasound

37
Q

List the Edema Scale grades

A

0: No clinical edema
1+: Barely noticeable depression (<2mm)
2+: Easily noticeable depression, takes <15 secs to return to normal (2-4mm)
3+: Depression rebounds in 15-30 secs (5-7mm)
4+: Depression lasts for >30 secs (>7mm)

38
Q

Describe and list the Clinical Etiology - Anatomy - Pathophysiology (CEAP) classification system

A

A classification system used to assess chronic venous insufficiency

C0: Asymptomatic
C1: Spider veins <3mm
C2: Varicose veins >/= 3mm
C3: Leg edema
C4: Skin and subcutaneous tissue changes
C5: Healed venous ulcer
C6: Current venous ulcer
CS: Symptoms of leg achiness, heaviness, tightness, and/or pain caused by venous dysfunction

39
Q

Differentiate between pitting and non-pitting edema

A

Pitting Edema: When pressure is applied to skin, it will leave a dent that remains even after you remove your finger

Non-Pitting Edema: When pressure is applied to skin, it will not leave any indentation

40
Q

What are the healing times for full-thickness venous ulcers with appropriate interventions?

A
  • 8 weeks average
  • 5-7 weeks (smaller ulcers)
  • 10-16 weeks (larger ulcers)
41
Q

T or F? Wounds that do not show signs of healing in 4 weeks should be referred back to an MD

A

True

42
Q

T or F? If bone or capsule is exposed with a venous ulcer, he/she should be sent back to an MD

A

True

43
Q

What are some predictors for good CVI ulcer healing?

A
  • Smaller ulcer size
  • Decreased size within the first 2-3 weeks
  • No deep vein involvement
  • Will adhere to compression therapy
44
Q

What are some predictors for poor CVI healing

A
  • Large ulcer size
  • Ulcer present for 3 months prior to intervention
  • Increased wound size after 4 weeks of intervention
  • Concomitant arterial insufficiency
  • Old age
  • High BMI
45
Q

How are venous ulcers treated?

A
  • COMPRESSION
    (reduces diameter of major veins, increases cardiac pre-load and output by 5%, reduces white cell adhesion to capillaries, increases tissue pressure and oxygen, enhances muscle pump)
  • Elevation (7-8 inches)
  • Therex
  • Antibiotics (if infected)
  • NPWT
  • Pulse lavage
46
Q

How should compression be applied?

A

Sustained compression with the most at the foot, and least at the knee (moves blood back to heart)

47
Q

If a patient has a low ABI of .71-.90 (mild/mod PAD), how much compression should be used?

A

Low to Medium compression

48
Q

If a patient has an ABI of <.70 (Mod arterial disease), how much compression should be used?

A

Cannot use (contraindicated)

49
Q

If a patient has an ABI of .9-1.1 (normal), how much compression can be used?

A

Any amount… Patient is healthy

50
Q

What are the contraindications to compression therapy?

A
  • ABI <.7
  • Acute infection
  • Pulmonary/cardiac edema
  • Congestive heart failure
  • Active DVT
  • Claustrophobia
  • Spasticity
  • Complex regional pain syndrome
51
Q

Explain the compression standard table

A

Class 0 (<20mmHg): Non-ambulatory patients

Class 1 (20-30mmHg): Mild venous insufficiency, or venous insufficiency with mild arterial insufficiency

Class 2 (30-40mmHg): Moderate venous insufficiency

Class 3 (40-50mmHg): Severe venous insufficiency

Class 4 (>50mmHg): Severe venous insufficiency (compression rarely required)

52
Q

Differentiate between in-elastic systems, elastic systems, and multilayer systems

A

Inelastic: minimal stretch (unna boot)

Elastic: more stretch

Multilayer: combination of both

53
Q

T or F? Short-stretch compression is best for ambulatory patients

A

True

54
Q

Describe paste bandages

A
  • Nonelastic compression
  • Gauze that is impregnated with zinc oxide, calamine, glycerin, or gelatin
  • Hardens into semi-rigid support
  • Stays on for about 1 week
  • Used on AMBULATORY patients (must encourage the patient to walk)
55
Q

Describe multilayer compression bandages

A

Inner layer: absorbs excess drainage and provides padding
Middle layer: absorbs drainage
Outer layer: provide compression

  • Reusable
  • Stays in shape well
56
Q

Describe compression garments

A
  • Used for long term management
  • Most garments range form 20-55mmHg (at the ankle)
  • can lose shape over time (leads to innefectiveness)
  • Replace every 3-6 months
  • Donning aid can be used to independently put garment on
57
Q

T or F? Patients with Unna boots should be walking often

A

True

58
Q

What are the types of surgical interventions used with venous ulcers?

A
  • Debridement
  • Skin grafting
  • Vein surgery (ligation, stripping, sclerotherapy, SEPS, PAPS)
59
Q

T or F? The only contraindication to an ABI test is a blood clot

A

True

60
Q

T or F? Compression pressure should be ______ to _____mmHg at the ankle, and __________ at the knee

A

30-40 mmHg, 10mmHg

(if patient has severe VI, increase to 40-50 mmHg at the ankle)

61
Q

T or F? Unna boots and short stretch are best for ambulatory patients

A

True

62
Q

T or F? Mixed ulcers account for 15-25% of all LE ulcers

A

True

63
Q

T or F? The ABI assessment is contraindicated for suspected DVT (blood clots)

A

True

64
Q

T or F? Always use wells criteria before ABI when working with a venous wound

A

True

Integumentary Systems (10 decks)

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