Module 5 - Vascular and Lymphatic Conditions Flashcards
What is peripheral vascular disease
affects the peripheral circulation and comprises diseases associated with both the arteries and peripheral veins
What are some types of peripheral vascular disease
- Carotid Artery Disease
- Abdominal Aortic Aneurysm (AAA)
- Peripheral Artery Disease (PAD)*
What is the most common arterial disorder
Arteriosclerosis most common arterial disorder (loss of elasticity, thickening and calcification of arterial walls)
What is deep vein thrombosis (DVT)
Venous insufficiency
This pooling increases pressure on the walls of the veins and red blood cells can leak into the surrounding tissues causing ‘staining’
What is the skin like for arterial disease
Shiny
Hairless
Toenails brittle thin
Little or localised oedema
What is the skin like for venous disease
Scaly
Hair present
Stained skin in gaiter region
Usually bilateral oedema - engorged
What is the difference in location for arterial and venous disease
Arterial:
Toes, feet, bony prominence
Venous:
Inner ankle, sometimes outer ankle
What is the difference in ulcer appearance for arterial and venous disease
Arterial:
Small, deep, “punch hole”
Venous:
Superficial, pink
What is the difference in skin appearance for arterial and venous disease
Arterial:
Normal to atrophic
Pallor on elevation
Rubor on dependency
Venous:
Brown discoloration
Stasis dermatitis
Cyanosis on dependency
What is the difference in skin temperature for arterial and venous disease
Arterial:
Cool
Venous:
Normal
What is the difference in Edema for arterial and venous disease
Arterial:
Absent to mild
Venous:
Present to extreme
What is the difference in pain for arterial and venous disease
Arterial:
Usually severe
Intermittent claudication
Rest pain
Venous:
Usually mild aching pain - might be worse when dependent
What is the difference in gangrene for arterial and venous disease
Arterial:
May occur
Venous:
Does not occur
What is the difference in pulses for arterial and venous disease
Arterial:
Decreased or absent
Venous:
Normal
What is intermittent claudication
A muscle cramp-type pain
Reproduced with the same degree of exercise or activity
Relieved by rest
How can the site of arterial disease can be deduced from the location of claudication
because pain occurs in muscle groups below the disease.
What is the ankle brachial index?
The ABI is the ratio of the ankle and brachial systolic blood pressures.
It is an objective indicator of arterial disease
On the ankle brachial index, what does 0.85 and above mean
- Venous disease
- Normal arterial flow
- Compression used
On the ankle brachial index, what does 0.8 and below mean
- Arterial disease
- No compression
What are treatment/intervention strategies for Peripheral Arterial disease (collaborative)
- Arteriosclerosis and atherosclerosis:
Medications, dietary modifications and exercise are used to treat blood lipid levels - Reduce hypertension (medical intervention)
- Manage diabetes (other co-morbidities – medical intervention)
- Elimination of all controllable risk factors, particularly smoking
What are the 3 factors of Virchows Triad for venous thrombosis
Venous stasis: (blood flow reduced as in shock, veins dilated, muscle compression reduced as in immobility or paralysis or anaesthesia, crossing limbs)
Vessel wall injury: (trauma, chemical irritation, surgery, central venous catheters, pacing wires)
Altered blood coagulation: (withdrawal from anticoagulants, oral contraceptive use, blood dyscrasias.)
What are the manifestations of thrombosis
Variable
Oedema and swelling
Extremity may feel warmer than other extremity
Tenderness, a later sign
Signs of a pulmonary embolism may be the first signs
What are some prevention/treatment strategies for thrombosis
- Prevention: elastic ‘compression’ stockings (TEDs) body positioning, exercise, administration of unfractionated or low molecular weight heparin. (note this is for prevention of DVT)
- Anticoagulants (when in hospital)
What is chronic venous insufficiency
Obstruction of venous valves in legs, chronic venous hypertension from prolonged increase in venous pressure
Backflow of valves, obstruction, poor muscle pumping (each can contribute)
What are some Assessment findings for chronic venous stasis
oedema,
altered pigmentation – venous hypertension causes extravasation of blood, discolouring area,
stasis dermatitis:
pain – aching or heaviness – oedema irritating nerve endings
severe cases – stasis ulceration
Venous ulceration
What is the management of venous insufficiency (venous stasis)
Elevation of the legs – (15-30 minutes every two hours)
Sleep with foot of bed elevated
Encourage walking – to activate the calf muscle pump
Discourage pressure on popliteal space (crossing legs)
Compression of the legs with elastic compression stockings or wraps (NOT TEDS) either short stretch or high (long) stretch (indications for which type depend on the patient’s mobility)
Protect skin from trauma – hygiene, non restrictive clothing
What is Lymphoedema
can be caused by obstruction, chronic inflammation or removal of lymph vessels.
What is Maceration
Maceration is defined as the softening and breaking down of skin resulting from prolonged exposure to moisture
What is slough
dead tissue, usually cream or yellow in colour
What is alginate used for
it will help to soak up the ooze - it is for highly exudating (ooze) wounds.
How is venous leg skin best managed?
Cleanse with non soap cleanser, descale where appropriate, moisturise with non allergenic moisturiser daily
What is the most appropriate dressing for venous leg wound ulcers?
A silica foam such as mepilex
-the ulcers are shallow with good granulation beds and this type of dressing can be left on for a number of days, given the stage of healing this wound is at.
The patient’s ABI is .95, based on this assessment parameter what is the most correct course of therapeutic interventions
Compression therapy, encouraging balance between walking / elevation of legs
Wound care management / care options for arterial wounds include:
Cleansing • Protecting • Fill – if there is a cavity / sinus • Cover • Anti-microbial coverage
Why is debridement not used for arterial wounds
debridement will just cause the wound to get bigger.
