Integ Test 2 Flashcards
What system in the body is considered a high pressure system of vessels that carries blood from LV–>Aorta–>body tissues
Aterial system
What happens to blood pressure as blood moves distally and away from the heart?
it get’s lower
Which layer of of aterial vessle contains smooth muscle and what is the innevation?
Tunica Media (middle layer), smooth muscle Innervated by sympathetic nervous system, increase in sympathetic output causes smooth muscle to contract thereby inducing VASOCONTRICTION, and thus limiting blood flow.
What layer of aterial vessels does gas exchange occur?
Tunica Intima. (this layer is fragile and easily traumatized)
Large Muscular arteries are used to distrubte blood pressure, what is the normal pressure
90-100 mmHg
What is the normal blood pressure in Aterioles and how to they play a significant role in maintaining blood pressure.
- 25-35 mm Hg
2. Blood Pressure is maintained through sympathetic innervation
Where does gas exchange take place (oxygen and nutrients in and carbon dioxide out of tissues to/from capillaries via DIFFUSION)
capallaries
How does blood return to the heart from the capallaries
venous system
What is the primary cause for arterial insufficiency?
Arteriosclerosis
other causes: Trauma Acute embolism Diabetes RA Thromboagitis (Buerger's disease) most often seen in young adults that smoke
Thickening or hardening/loss of elasticity of arterial walls is known as
Arteriosclerosis
Systemic disease, where arterial lumen is gradually and progressively enchoarched upon (caused by a build up of fatty plaques and cholesterol) is known as
Atherosclerosis
What effect does cholesterol have on Arterial Insufficiency?
High LDLs enhance cholesterol deposition, lipids, calcium deposits, and scar tissue accumlate on the initmal layer, causing progressive stenosis.
make sure you look at the LDL/HDL ratio, because low HDLs can also contribute
Normal LDL<200
Describe Intermittent Claudication and what are the pain characteristics
- Acitivity Specific discomfort due to local ischemia (activity increases the oxygen/blood demand)
- Pain stops within 1-5 minutes of ceasing the provocative activity
- Pain is described as cramping, burning, or fatigue.
What percentage of stenosis does a vessel need to have to be classified as claudication
50%
With Claudication, the body may try to accomodate by decreasing ________ causing vasodilation. However, once ___ occulusion occurs, even maximal vasodilation will not be adequate to meet the demands of the tissue. Tissues _____to occlusion will become ischemic and painful
sympathetic input, 70%, distal
Claudication pain scale range
0: No pain-
4: Maximal Pain
List the progression of Aterial Insufficiency
AS–>IC–>Ischemic rest pain–>Ulcer
How is ischemic rest pain characterized?
it’s a burning pain that is exacerbated at night or with elevation, relieved by dependency.
note that is is because circulation is so poor that gravity takes effect on it. With the limb elevated, blood has to flow against gravity to reach the distal limb.
What percentage of stenosis has to occur in the vessel to be classified as ischemic rest pain?
-> 70%
Why do arterial ulcers or gangrene occur?
anything that increases the oxygen requirements on the tissues has the potentially to fatally upset the balance between oxygen supply and tissue demand therefore resulting in ulceration
Aterial Insufficiency ulcers are most commonly due to
trauma to an ischemic limb, 5-10% of all LE ulcers
What can arterial insufficiency ulcers turn into?
gas gangrene, which can be systemic and go to other areas in the body and is considered fatal
List the Risk Factors of Aterial Insufficient Limbs
- Hyperlipidemia/Elevated LDL
- Smoking
- Diabetes
- Advanced age
- Trauma
- Hypertension
Causes vasocontriction, decreases perfusion and oxygen availability, increases clot formation and increased cholesterol Depostion
SMOKING
HTN intitaties and perpetuates endothelial cell injury and arteries respond by thickening the tunica media, increasing vasocontristive agents. Which is more damaging Systolic HTN or Diastolic?
Systolic
What causes the vessels are less adaptable based on the metabolic demands of the tissue. There is also an increased rate of Comorbididies, and patients have slow immune response, decreased inflammatory response
Advanced age
This condition causes calcium to accumulate in the arteries, impairs all 3 phases of wound healing, decreases ability to fight infection, increases risk of neuropathy (making patient unable to sense pain)
Diabetes
Hyperglycemia decrease wound healing because high blood sugar levels decrease collagen synthesis angiogensis, fibroblast and tensile strength.
Test and Measures for Aterial Insufficiency:Pulses
- Check…?
- Mc site for occulsion
- What artery is the blood supply to the foot
- Absence of palpabable pulse should be followed up by
- check bilaterally (femoral, DP Posterior tibialis-located between flexor digitorum longus and flexor hallucis longus)
- bifurcation of common femoral (superificial and deep) is the most common site
- Posterior tibial main blood supply for the foot
- use doppler
Scale for categorizes Aterial pulses 0 1+ 2+ 3+
0-Absent
1+-weak/thready
2+normal
3+=bounding/strong
When pulses are not easily palpable, using a doppler should be your method of choice. If there are diminished or absent pedal pulses this likely represents
proximal arterial occlusion (lack of sound through doppler suggests lack of fluid movement and thus lack of perfusion)
Ankle Brachial Index
Ratio of the HIGHEST SBP (in R or L) of the LE (ankle)/ SBP UE (brachial)
Pulses should be assessed in what position?
supine
Pulses are palpable if pulse pressure is greater than?
80 mmHg
Procedure for determinig ABI
- Patient is in supine
- Apply BP cuff around arm/lower leg
- Position doppler/stethoscope over brachial/dorsal pedal artery
- Inflate cuff until aterial signal disapperars
- Deflate cuff slowly until arterial sound is heard, indiciating the SBp
- Repeat in both Arms and legs
NEVER apply more than one cuff at a time
Absence of both pedal pulses is evidence of
PAD
ABIs and possible intervention
1.1-1.3
Vessel calcification, ABI is not a valid measure of perfusion
ABIs and possible intervention
0.9-1.1
NORMAL
ABIs and possible intervention
0.7-0.9
Mild to mod aterial insuff.
conservative interventions normally provide satisfactory wound healing
ABIs and possible intervention
0.5-0.7
Moderate aterial insuff., intermittent claudication
May perform trial of conservative care, physican may consider revascularization
ABIs and possible intervention
less than 0.5
Sever aterial insuff. or rest pain
wound is likely to heal without revascularization, limb-threatening arterial insufficiency.
ABIs and possible intervention
less than 0.3
Rest pain and gangrene
Revascularization or amputation
A drop of ankle SBP of more than _____from resting value is considered _____ and consistent with with Aterial Insuff. On repeat examination a drop of 0.15 is indicative of PVD progression.
15 %, abnormal
Rubor of Dependency define and state exam steps
Indirectly assesses LE aterial flow
patient supine, note plantar foot color
Elevate the LE 60 deg for 1 min, note foot color
For the rubor dependency test, what is considered nomral aterial flow?
little to no color change with elevation
Normal Aterial flow: returns to normal in 15-20 sec (between elevation and return to surface)
Rubor Dependency test results:
Pallor after 45-60 sec of elevation
Mild aterial insuff.
Rubor Dependency test results:
Pallor after 30-45 seconds of elevation
Moderate art.
Rubor Dependency test results:
Pallor within 25 sec of elevation
severe arterial insufficiency
Venous Filling time is a predictor of what?
Aterial Insuff.
How to check Venous filling time
Patient in supine, note superificial veins on DORSAL foot
Elevate limb 60 deg for 1 min or until veins are drained by gravity
Lower limb to dependent position, not time for veins to refill
Venous filling time that is less than 5 sec
Venous Insufficiency
Venous filling time 5-15 sec
Normal
Venous filling time greater than 20
Arterial Insufficiency
5 PT Method
(noted pain for claudication)
Describe position for AI
-Primarily in the LE
MC toes, lateral Mal and Ant. Leg (rarely above the knee)
What is considered the key precipitating factor of AI?
trauma
Presentation of AI
-Minimal no bleeding or draininage, round regular
Periwound of AI
Thin, shiny, loss of hair
Thick yellow nails (pain cyanotic skin)
Pulses of AI
absent or decreased**
Temperature of AI
Decreased
Unifected Ulcers with low ABIs (what should you avoid)?
Avoid compression, sharp debridement of dry eschar covered ulcers with low ABIs
