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Advanced Health Assessment > Module 7: PVD > Flashcards

Module 7: PVD Flashcards

Bates Ch. 12

1
Q

What surrounds the lumen of all blood vessels?

A

The intima, a single continuous lining of endothelial cells with remarkable metabolic properties.

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2
Q

What does intact endothelium do?

A

Synthesizes regulators of thrombosis like prostacyclin, plasminogen activator, and heparin-like molecules. It produces molecules such as Von Willebrand factor and plasminogen activator inhibitor. Modulates blood flow and vascular reactivity through synthesis of vasoconstrictors like endothelia and angiotension converting enzyme and vasodilators such as nitric oxide and prstacyclin.

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3
Q

What does the intimal endothelium do?

A

Regulates immune and inflammatory reactions through elaboration of interleukins, adhesion molecules, and histocompatibility antigens.

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4
Q

Which part of the vessel helps to accommodate blood pressure and flow?

A

Media

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5
Q

What are the immediate branches of the aorta?

A

Examples: pulmonary, common carotid, and iliac arteries.

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6
Q

Examples of muscular arteries:

A

Coronary and renal

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7
Q

What helps to propagate arterial pulsatile flow?

A

The elastic recoil and smooth muscle contraction and relaxation in the media of large and medium sized arteries.

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8
Q

The leg veins are more susceptible to what?

A

irregular dilation, compression, ulceration, and invasion by tumors.

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9
Q

How much of the blood return do the deep veins carry?

A

90%

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10
Q

Which veins connect the superficial venous system with the deep venous system?

A

The perforating veins.

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11
Q

What do cells within the lymph nodes do?

A

Engulf cellular debris and bacteria and produce antibodies.

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12
Q

What are the only nodes accessible in a physical exam?

A

cervical, axillary, and nodes in the arms and legs.

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13
Q

What are the two groups of the superficial inguinal nodes?

A

The horizontal group which lies in a chain high in the anterior thigh below the inguinal ligament and the vertical group which clusters near the upper part of the saphenous vein and drawings a corresponding region of the leg.

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14
Q

What does the horizontal group help drain?

A

Lower abdomen, buttock, external genitalia (NOT TESTES), anal canal and perianal area, and lower vagina.

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15
Q

What are some common or concerning symptoms of patients?

A

Pain in the arms or legs, intermittent claudication, cold, numbness, pallor in the legs along with hair loss, swelling in the calves, legs, or feet, color change in fingertips or toes in cold weather, and swelling with redness or tenderness.

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16
Q

What is peripheral arterial disease (PAD)?

A

It refers to stenotic, occlusive, and aneurysmal disease of the aorta, its visceral arterial branches, and the arteries of the lower extremities, exclusive of the coronary arteries.

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17
Q

________ can cause symptomatic limb ischemia with extortion.

A

Atherosclerosis; distinguish this from spinal stenosis, which produces leg pain with exertion that may be reduced by leaning forward (stretching the spinal cord in the narrowed vertebral canal) and less readily relieved by rest.

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18
Q

What is pain or cramping in the legs during exertion that is relieved by rest within 10 minutes?

A

Intermittent claudication.

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19
Q

Hair loss over the anterior tibiae occurs with ______ arterial perfusion.

A

Decreased; Dry or brown black ulcers from gangrene may ensue.

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20
Q

Do people with PAD report a lot of symptoms?

A

NO so it is pertinent to ask specific questions about symptoms. especially in patients >50 years and those with risk factors such as smoking, diabetes, hypertension, elevated cholesterol, CAD.

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21
Q

Symptom location suggests the site of arterial ischemia:

A 
Buttock, hip; Aortoiliac
Erectile Dysfunction; Illiacpudendal
Thigh; Common femoral or Aortoiliac
Upper calf; Superficial femoral
Lower calf; Popliteal
Foot; Tibial, peroneal
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22
Q

What should you ask about?

A

Fatigue, aching, numbness, or pain that limits walking or exertion to the legs, erectile dysfunction, any poorly healing or non healing wounds of the legs or feet, pain at rest in the lower leg or foot and changes when standing or supine, abdominal pain after meals with “food fear” and weight loss.

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23
Q

What do abdominal pain, “food fear”, and weight loss suggest?

A

Intestinal ischemia of the celiac or superior or inferior mesenteric arteries.

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24
Q

What is the prevalence of AAA in first degree relatives?

A

15%-28%

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25
Q

What increases the prevalence of PAD?

A

Age and the presence of cardiovascular risk factors.

26
Q

What are the risk factors for lower extremity PAD?

A

Age younger than 50 with DM or atherosclerosis risk factor of smoking, dyslipidemia, HTN, or hyperhomocysteinemia, Age 50-69 with hx of smoking or DM, age 70 or older, leg symptoms with exertion or ischemic rest pain, abnormal lower extremity pulses, and known atherosclerotic coronary, carotid, or renal artery disease.

27
Q

What test is used to asses for PAD?

A

Arterial-Brachial Index (ABI). They are reliable, reproducible, and easy to perform in the office, with a sensitivity and specificity of 90% and 95%.

28
Q

What classifies an AAA?

A

Infrarenal aortic diameter greater than 3.0 cm. Increased risk of rupture at 5.5 cm in diameter.

29
Q

What are the key components of the peripheral artery exam?

A

Measure BP in both arms, palpate carotid upstroke & auscultate for bruits, auscultate for aortic, renal and femoral bruits, palpate aorta and determine maximum diameter, palpate all the arteries (fem, brachial, radial, etc), inspect ankles and feet for color, temp, and skin integrity.

30
Q

Asymmetric BP are seen in what conditions?

A

Coarctation of the aorta and dissecting aortic aneurysm.

31
Q

What do prominent veins in an edematous arm suggest?

A

Venous obstruction.

32
Q

If an artery is widely dilated it is ____________.

A

Aneurysmal

33
Q

Bounding carotid, radial, and femoral pulses are seen in ______ __________.

A

Aortic insufficiency.

34
Q

Asymmetric diminished pulses in arterial occlusion are from _____________ or ___________.

A

Atherosclerosis or Embolism.

35
Q

Are popliteal and femoral aneurysms common?

A

NO

36
Q

Atherosclerosis most commonly obstructs arterial circulation in the ______.

A

Thigh

37
Q

Coldness, especially when unilateral or associated with other signs, suggests what?

A

Arterial Insufficiency.

38
Q

In DVT, the extent of edema suggests what?

A

The location of the occlusion.

39
Q

Brownish discoloration or ulcers just above the malleolus suggests what?

A

Venous Insufficiency

40
Q

Thickened brawny skin suggests what?

A

Lymphedema and advanced venous insufficiency.

41
Q

T or F: Arterial occlusive disease is much less common in the arms than in the legs.

A

True

42
Q

What is rubor?

A

A dusky redness. It may take a minute to appear. Persisting rubor on dependency suggests arterial insufficiency. When veins are incompetent, dependent rub or and the timing of color return and venous filing are not reliable tests of arterial insufficiency.

43
Q

What is one of the most common complications following surgery?

A

Venous thromboembolism(VTE) is one of the more common complications seen in patients following surgery or with cancer, trauma, or prolonged immobilization.

44
Q

What are the two manifestations of VTE?

A

VTE refers to all forms of thrombosis in the venous circulation and manifests in 2 ways: deep vein thrombosis (DVT) and pulmonary embolism (PE).

45
Q

How is a VTE formed?

A

– Immobility
– Venous obstruction
– Increased venous pressure – Venous dilation
– Increased blood viscosity

46
Q

What is the more dangerous DVT?

A

Proximal deep vein thrombosis (PDVT) is the more dangerous form of lower‐extremity DVT because it is more likely to cause life‐ threatening PE and may result in a greater risk of postthrombotic syndrome.

47
Q

What has helped to decrease the incidence of DVT?

A

Early discharge home; Age helps to increase the risk of DVT.

48
Q

Who has a low risk of DVT?

A

Asians and Native Americans have a lower incidence of PE than whites or African Americans.

49
Q

What surgeries increase the risk of DVT?

A

Orthopedic and Neuro;Risk factors that increase the rates of VTE in neurosurgery patients include intracranial surgery, malignant tumors, duration of the surgery, and presence of paresis or paralysis of the lower limbs.

50
Q

What are the S/S of DVT?

A

Pain, tenderness, swelling, and discoloration.
-Other symptoms include lower extremity edema, fever, extremity warmth, and pain.
– Symptoms can serve only as a trigger for further diagnostic inquiry; they cannot, by themselves, rule a DVT in or out.

51
Q

What is an ABI?

A

The Ankle-Brachial Index (ABI) is a screening tool used to 1) detect asymptomatic arterial disease in the legs to prevent progression to claudication or limb ischemia; and 2) detect individuals at high risk of cardiovascular events.

52
Q

How do you measure an ABI?

A

The ABI is the ratio of systolic blood pressure at the ankle to that in the arm. It is measured with the patient supine using a sphygmomanometer and Doppler ultrasound probe. Systolic pressure is measured in both arms and at the posterior tibial and dorsalis pedis arteries in each ankle. The ABI is calculated as the higher pressure at the ankle divided by the higher of the left and right arm pressures.

53
Q

What does an ABI between 0.71 - 0.90 indicate?

A

Mild obstruction.

54
Q

What is a normal ABI?

A

Above 0.90

55
Q

An ABI of 0.41-0.70 indicates what?

A

Moderate obstruction.

56
Q

An ABI <0.40?

A

Severe Obstruction.

57
Q

What age should you be screened for vascular risk?

A

40 years or greater

58
Q

What are the standards for managing diabetes and PAD?

A

Medical management of both diseases includes goal HbA1c lower than 7.0%, blood pressure lower than 130/80, low density lipoprotein lower than 70 mg/dL, and treatment with aspirin and possibly clopidogrel.

59
Q

What is PAD?

A

PAD is inflammatory damage to the vessel wall due to endothelial cell dysfunction resulting in stenosis and occlusion.

60
Q

T or F: Supervised exercise therapy is clearly the most effective medical intervention.

A

True

61
Q

What does an ABI greater than 1.3 indicate?

A

An ABPI in the high range of 1.3 to 1.4 is abnormal and indicates arterial calcification often caused by underlying diabetes or renal disease.

Advanced Health Assessment (12 decks)

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