Leg Edema and Cramping Flashcards
Normal venous pressure
80mm Hg in deep veins
20-30mm Hg in superficial veins
Cephalad venous blood flow
what brings blood back up from veins towards heart
Biscuspid venous valves
Effective muscle contractions
Normal respirations
Dark areas on face or ankles
blood pooling, can’t move onto next location and is stuck in one area breaking down= dark purple/brown (may see this under eyes when someone has allergies)
LE edema occurs in response to
Increased venous or lymphatic pressures
Decreased intravascular oncotic pressure
Increased capillary leak
Local injury or infection
Most common cause of LE edema
chronic venous insufficiency
Always check….
Always check potassium AND magnesium levels
May need to give magnesium too
How hyperthyroidism
- If pt hypothyroid, taking TOO MUCH medication, TSH is low and they have induced hypothyroidism= may get leg CRAMPING
- If someone isn’t taking ENOUGH thyroid medication= may see leg SWELLING
DVT causes
Malignancy, esp untreated
Recent limb immobilization or paralysis
Bedridden >3 days due to surgery in past 4wk
Previous DVT
DVT Signs/Symptoms
Localized tenderness along deep veins Swelling of entire leg Swelling of one calf >3cm (normal for \_\_\_ calf to be larger than \_\_\_) Ipsilateral pitting edema Collateral superficial veins
For DVT, you MUST use _______
NEED to use DVT prophylaxis (ex: heparin, lovanox, compression stockings)
Check for Homann sign
DVTs and women over 35 years old
Oral contraceptives over the age of 35, be careful (larger amount of hormone predisposes them to coagulopathy)
Bilateral involvement with improvement after awakening may be caused by
Systemic (heart failure, cirrhosis)
Heavy legs or itching may be caused by
Chronic venous insufficiency
LE swelling or inflammation with recent DVT may be caused by
Postphlebetic syndrome
Ultrasound is used diagnostically to test for
arterial or venous insufficiency depending on cause
DVT- venous doppler
Arterial- arterial or venous doppler
Checking for clots and narrowing
D-dimer
usually done in ER only, if VERY high may indicate coagulopathy or inflammation
Other diagnostic testing for LE edema
- Ankle brachial pressure index
- CT (can see muscle tear, subcutaneous swelling)
- D-dimer
- Ultrasound
- Kidney function/urine analysis (looking for protein first, and also RBC or WBC casts, looking for signs of nephritis)
Chronic liver cirrhosis, LFTs will _______
NOT be elevated, it wont be putting anything out anymore (due to excessive damage over time)
Treatment- Compression stockings are used for
for VENOUS issue, not usually arterial issues; helps bring blood back UP to heart, reason it doesn’t help with arterial problems, because in arteries blood is moving AWAY from heart
Treatment- OMM is better for
- better for VENOUS issues, don’t do OMM for ARTERIAL issues; venous stasis, lymphedema, etc. can do OMM
- will see skin changes, can feel changes in muscle
Treatment- Aspirin and walking helps for
-PAD: for ARTERIAL disease, walking helps because if you have a clogged vessel and force a lot of blood through, eventually breakdown of clot will occur, it will open up the vessel more, OR it will create microcirculation, more new vessels form around the area of blockage to help perfuse the area better, lessens pain eventually. Aspirin thins blood which helps it move through easier
If left untreated, cellulitis may lead to
compartment syndrome (infection can spread from this, it’s a medical emergency, may cause sepsis) -Can use CT to check for compartment syndrome if you suspect this (can see infection or changes in muscle and fascia)
LIFE THREATENING cases of LE edema
- High risk for DVT
- Compartment syndrome
- Acute edema that impairs ability to function
