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Integ chapter 11 > Integ 2 > Flashcards

Integ 2 Flashcards

1
Q

70-90% of leg ulcers are do to

A

VI

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2
Q

Who is at greatest risk for VI?

A

Women 3x greater risk, and if they over 65

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3
Q

The _____system is a low pressure system and stores _____% of total blood volume. and rely on ______to return blood that is high in ______to the heart.

A

Venous, 70-80%, muscle pump, co2 and metabolic waste

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4
Q

What are considered “deep veins” that carry 80-90% of the blood back tot he heart, and are located in the the ______ and are parallel to the arterial system.

A

Femoral, popilteal and tibial. Muscle

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5
Q

What are considered “superficial veins” and what are their 2 major functions?

A
  1. Greater and lesser saphaneous
  2. Drain skin and subcutaneous tissue
  3. assist with temperature regulation and are vulnerable to trauma
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6
Q

What are “perforating veins”

A

connect deep and superficial veins, pierce/perforate the fascia

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7
Q

Because the venous system flows uphill against gravity to the heart form the LE, ____in the veins are very important to prevent _____

A

valves, (allow for unidirectional flow to the heart) prevent backflow (which can lead to edema)

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8
Q

Distal to proximal venous flow relies on

A
  1. respiratory pump-pressure changes that occur during breathing
  2. Calf muscle pump-contraction in calf musculature, compress veins located within them
  3. Valves- prevent black flow, that can lead to venous HTN
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9
Q

When diaphragm descends it causes an _____in abdominal pressure, thus the greater the inspiration the ____effect it will have on the venous system.

A

increase, greater

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10
Q

What are 2 common causes of VI?

A
  1. Vein dysfunction

2. Calf muscle pump failure

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11
Q

What are the 2 main theories as to the etiology of VI ulcers? Likely caused by a combo of these two theories

A
  1. Fibrin cuff theory-HTN and distention cause an increase in vascular perm. which leads to peripheral edema–>fribrogen –>fibrin–>cuff around capillary wall–>creates barrier to exchange of oxygen
  2. WBC trapping theory- venous HTN and distention causes congestion. Decrease BF causes margniation of WBCs–>adhere to vessel walls further impedes circulation–>activated WBC release inflammatory cells–>edothelial damage

ulceration then occurs due to local hypoxia due to congestion, WBC trapping an dincreased demand on the affected tissue by the inflammatory process.

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12
Q

Risk Factors to VI:

Calf Pump Failure

A
  • calf weakness/paralysis
  • decreased DF
  • prolonged standing
  • Incompetend valves
  • decreased mobility

(without the pressure gradient created by calf muscle contraction there is increased risk of venous HTN)

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13
Q

Risk Factors to VI:

Trauma

A

trauma can lead to edema which can induce local tissue hypoxia which can lead to ulcer

note that the presence of edema increases the diffusion distance for oxygen and nutrients

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14
Q

Risk Factors to VI:

Advanced age

A

-mostly due to valve deneragtion and decreased immune response/slowed inflammatory response

(decrease collagen in vessels)

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15
Q

Risk Factors to VI:

Previous VI ulcer

A

scar tissue from prior ulcer increase risk of skin breakdown

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16
Q

Risk Factors to VI:

Diabetes

A

Impairs all 3 phases of wound healing. Poor control over blood sugar levels, leads to sustained hyperglycemia and greater adverse effects.

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17
Q

DVT LE clinical Scale, patients scoring______should be considered to have high probability of DVT and further medical assessment should be considered

A

score of 3 or higher

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18
Q

What is included in the DVT LE screen?

A
  1. Does the patient have active cancer
  2. paralysis, paresis, cast immobilization
  3. bedridden for greater than 3 days
  4. Localized tenderness
  5. entire leg swelling
  6. Calf swelling by more than 3 cm (measured 10 cm below tibial tuberosity)
  7. Collateral superficial veins
  8. Alt. dx as likely or more likely than that of DVT (-2)
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19
Q

What are the DVT predictor variables of the UE?

A
  1. Presence of venous material (catheter?)
  2. Pitting edema
  3. Localized pain in upper limb
  4. Another dx is at least plausible (-1)
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20
Q

For the UE DVT a score of ____is predictive of UE DVT?

A

greater than 2

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21
Q

Compression is contraindicated for VI if ABI is less than

A

0.7

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22
Q

Indications to perform ABI

A
  1. Lower le ulcer (to rule out AI or VI)

2. Suspected AI or VI

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23
Q

When is performing an ABI be contraindicated?

A

When suspected DVT

24
Q

Trendelneberg test is used for what?

A

used to identify vein incompetence. (differentiates deep or perforating vien incompetence from superficial vein incompetnece)

pt. supine, leg elevated to 45 deg, for 1 min, note venous distention, tourquiet applied, patient stands upright, note time for venous distention and then release tourniquet.

25
Q

Trendelenburg Test (Tourniquent on) time to venous distention less than 20 sec, what is the suggested pathology

A

Deep or perforating vein incompetence

26
Q

Trendelneburg test (tourniquent off) less than 10 sec time to venous distention, suggested patho?

A

superficial vein incompentence

27
Q

T/F reliance of the Trendlenburg test has decreased due to the increase availiablity and accuracy of ultrasonography

A

T

28
Q

What is considered the GOLD STANDARD for dx of VI, differientiates between normal venous flow form incompetence or obstruction?

A

Doppler ultrasound

29
Q 
Resting Test (use doppler like you normally would)
Spontaneous signal indicates
A

no pathology present

30
Q

Resting Test

No spontaneous signal

A

venous obstruction

31
Q

Augmented test (apply pressure in the form of quiz squeeze distal to the probe placement) in a health vien sound should

A

enhance

if it doesn’t enhance then that is indicative of partial vein obstruction

32
Q

Reflux test: apply a similar presssure proximal to probe placement. In healthy veins compression should make the signal…

A

DISAPPEAR

if signal is enhanced that is indicative of valve incompetence

33
Q

For doppler test probe should be placed at what angle to the patient’s leg?

A

45

34
Q

Classification of VI:
C2
C5
C6

A

Varicose veins, Healed venous ulcer, Current venous ulcer

35
Q

Patient with a VI

5PT

A

Pain: Mild to Mod, BUT decreased with elevation or compression

Position: Medial Mal, Medial LL, Areas of trauma

Wound Presentation: Irregular shape, Red wound bed, yellow or clossy coating. COPIOUS DRAINAGE

Periwound: EDEMA

PULSES: NORMAL or decreased due to EDEMA

Temp: NORMAL or MILD warmth

36
Q

Prognosis for VI Ulcer healing
Average
Small ulcers less than 10cm
Large Ulcers

A

8 weeks avg.

5-7 weeks small

10-16 big

37
Q

GOOD VI ulcer healing potential

A

Small size

Decreased in size in the first 2-4 weeks

No deep vein involvement

Adherence with compression

38
Q

List 4 factors NOT predictive of VI Ulcer Healing

A
  1. Gender
  2. Race
  3. Skin Condition
  4. Presence of Infection
39
Q

50% of patients with VI ulcers were found to be allergic to

A

Lanolin or some type of antimicrobials

40
Q

Inappropiate whirlpool use will

A

exacerabeate VI and slow venous ulcer healing this is because whirlpool requires dependent positions, which exacerabate edema and venous hypertension. Warm water will also enourage dilation and increased EDEMA! Also we don’t want to add moisture to an already exudating wound.

41
Q

Name 5 reasons why would should request further testing be done on our patients?

A
  1. Patients with a 3+ on DVT clinical predicition guidelines
  2. Wounds that fail to progress
  3. Wound culture –>suspect infection
  4. Bone or xray –>if exposed capsule/bone
  5. Wounds that do not present with typical VI ulcer characteristics
42
Q

Goals for patients with VI ulcers. List 4

A
  1. Protect the surrounding skin
  2. Absorb drainage
  3. Enhance venous return
  4. Educate patient/caregivers
43
Q

What is the Standard Care for venous insufficiency provided that arterial insufficiency is not present.

A

COMPRESSION!!
For Moderate VI
30-40 mmHg at the Ankle and then decrease to 10 mmHg at the infrapatellar notch

For Severe can increase distal pressure to 40-50mmHg
For Mild can decrease distal pressure to 20-30 mmHg

44
Q

What are the CONTRAINDICATIONS TO COMPRESSION

A
  1. ABI,<0.7
    2.Actue Infection
    3.Pulmonary Edema
  2. Uncontrolled CHF
  3. Active DVT
    (claustrophopbia is relative not absolute)
45
Q

Types of Compression:

Paste Bandage used primarily on

A

semi-rigid support used primarily on ambulatory patients and stays on up to 1 week. (can smell and become itchy)

46
Q

Types of Compression:

Short-Stretch Compression Bandage used for

A

Spiral and Figure eight wrap, used on ambulatory or non-ambulatory patients. Uses (LAPLACE’s LAW) to determine amount of compression (if she makes us calculate this..I will smack her)

needs frequent wrapping so will need to train patients

47
Q

Types of Compression:

Multilayer Compression Bandage System used for

A

Draining wounds, usually shaped limbs, ability to maintain compression longer.

48
Q

Types of Compression:

CircAID

A

Removable, Sustained Compression (semi-rigid)

need for patient adherence/daily use

49
Q

Types of Compression:

Tubular Bandages

A

Off the shelf, allows for graduated compression (bandages tend to lose shape over time)

50
Q

Key to long term Management are Compression Garments: Most garments range from ______at the ankle. Practioners should use _______. One disadvantage, need to

A

20-55 mmHG at the ankle
Use the LOWEST compression that is effective
replace every 3-6 months

51
Q

Anti embolous stockings ONLY for

A

NON-AMBULATORY PAT.

52
Q

What do open toe stockings allow for

A

checking pulses and capillary refill

53
Q

Compression Levels:

Class 0

A

less than 20 mm Hg, non ambulatory patients

54
Q

Compression Levels

Class 1

A

20-30 mmHg

mild venous insufficiency, or venous insufficieny with mild arterial arterial insuf.

55
Q

Compression Levels:

Greater than 50 mmHg

A

Severe VI

```
class 2 is mod. and class 3 is severe
ranges 30- 40, 40-50 respectively)
~~~

Integ chapter 11 (1 decks)

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