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Patient Assessment > Peripheral Vascular > Flashcards

Peripheral Vascular Flashcards

1
Q

What can peripheral vascular system involve?

A

arteries, veins, lymphatics

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2
Q

Who gets PAD?

A

men >50 yo or high risk

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3
Q

What are high risk for PAD?

A 
Diabetes 
CAD
HTN
Smoking
Abnormal cholesterol
Strokes
Kidney dz requiring hemodialysis
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4
Q

What are the two most important PAD?

A

atherosclerosis of large arteries and microvascular disease

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5
Q

What do you see with exercise in PAD?

A

ischemia

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6
Q

What can PAD also be the results of?

A

vascular trauma, radiation therapy, vasculitis

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7
Q

What are the symptoms of PAD?

A

Pain, fatigue, discomfort, heaviness, burning

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8
Q

Where does PAD usually occur?

A

muscles of feet, claves, thighs

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9
Q

How do the legs feel in PAD?

A

cool, skin is pale, numb

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10
Q

What do you get with severe PAD?

A

Erectile dysfunction
Pain and cramps at night
Pain/tingling so severe, bedsheets or clothes are painful
Pain worse when leg is raised, improved when leg is down
Skin that looks dark blue
Sores that do not heal

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11
Q

What does PAD atherosclerosis cause?

A

AAA

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12
Q

Where does AAA occur?

A

below renal arteris, extends to external iliac

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13
Q

What AAA size has 20% risk of rupture?

A

> 5 cm in 1 year, 50% in 5 yr

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14
Q

Who is AAA more common in?

A

men and whites

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15
Q

Who gets PAD microvasculature disease?

A

diabetics

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16
Q

What does microvascular disease cause?

A

peripheral neuropathy - sensory, motor or autonomic

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17
Q

What is the rule of 15 in diabetics?

A

15% get foot ulcer –> 15% osteomylitis or 15% amputation

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18
Q

What is the rule of 50 in diabetics?

A

50% amputation above knee
50% get second amputation in 5 yrs
50% die in 5 years or less

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19
Q

What holds 70% of blood?

A

venous system

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20
Q

What controls veins?

A

neural and hormonal stimuli, valves, less sturdy and more distensible

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21
Q

What two things does PVD go to?

A

venous stasis or thrombotic disorders

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22
Q

What is a severe complication of thrombotic disorder?

A

PE

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23
Q

When is venous pressure the highest?

A

upright posture

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24
Q

What are complications of chronic venous insufficiency?

A

pigment changes, dermatitis, celluiltits, ulcerations, thrombus

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25
Q

What does PVD cause?

A 
Pain: UEs, LEs, abdominal, flank or back
Intermittent claudication
Changes in skin color and temp, numbness, hair loss
Ulceration
Edema
Emboli
Neurologic symptoms
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26
Q

pain in the LE during exc and relieved by rest. Site of pain is always distal to the occlusive dz.

A

intermittent claudication

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27
Q

pain with DVT. Combo of venous valvular incompetence, outflow obstruction, and muscle pump function derangement.

A

venous claudication

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28
Q

What is pain at rest, worse with cool temps or elevation (IC or VC)?

A

Intermittent claudication

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29
Q

What is motionless standing painful, walking less (VC, IC)?

A

Venous claudication

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30
Q

common in lumbar spinal stenosis, or spinal neuritis, often related to posture.

A

Neurogenic claudication

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31
Q

chronic aortoiliac obstruction  severe atherosclerosis at the aortic bifurcation  IC and ED

A

leriche’s syndrome

32
Q

bilateral LE pain or numbness while walking and resting  MSK dz in the lumbar area

A

Pseudoclaudication

33
Q

What are the features of IC?

A 
pain - dull, cramp, fatigue
onset - gradual, consistent
relief - stop walking, rest
location - muscles
legs - one
34
Q

What are features of VC?

A 
pain - aching, heavy, tight
onset - gradual
relief - activity
location - whole leg
legs - one
35
Q

What are features of neurogenic claudication?

A 
pain - pins and needles, going down
onset - immediate
relief - sitting, stop, flex  hip
location - poor localized
leg - both
36
Q

What are the skin chanages in chronic arterial insufficiency?

A

cool and pale, hairless, shiny, superficial ulcers

37
Q

What are the changes in chronic venous?

A

warm, red, edema

38
Q

What are the changes in acute arterial insufficency?

A

embolus –> mottled

39
Q

What is necrobiosis lipoidica diabeticorum?

A

skin disorder in DM, severity not related to severity of DM, occurs prior to frank DM

40
Q

What is the hallmark of NLD?

A

waxy yellow reddish brown sharply demarcated plaquelike lesions

41
Q

What causes ulcerations?

A

persistent ischemia

42
Q

What are the ulcers like in artieral insufficency?

A

trauma caused

painful, discrete, punched out, crusted, rapid, red

43
Q

What are ulcers like in venous insufficency?

A

light trauma cause, painless, ankles, brawny changes, cobblestone, slow developing

44
Q

usally indicates insufficiency from prolonged dependent positions, or right sided heart failure

A

orthostatic pitting edema

45
Q

What causes edema without pitting?

A

arterial insufficiency

46
Q

What causes unilateral edema?

A

occlusion of major vein

47
Q

What does lymphadema look like?

A

nonpitting edema, painless, rough skin

48
Q

What are symptoms of an emboli?

A

SOB from PE
abdominal pain from renal or intestinal
neurologic from basilar artery
pain and paresthesia from peripheral artery emboli

49
Q

Where do you check pitting edema?

A

prominence of tibia or medial malleolus

50
Q

What is contour and whats normal?

A

waveform - smooth, round, dome shape

51
Q

What is amplitude?

A

force

52
Q

bounding, aneurysmal

A

4

53
Q

full, increased

A

3

54
Q

normal

A

2

55
Q

diminished

A

1

56
Q

absent, not palpable

A

0

57
Q

What arteries do you palpate?

A 
Carotid
Brachial
Radial
Femoral
Popliteal
Dorsalis pedis (DP)
Posterior tibial (PT)
58
Q

PAD in butt and hip =

A

aortoiliac = leriche’s syndrome

59
Q

PAD in thigh =

A

femoral or external iliac

60
Q

PAD in upper calf =

A

superficial femoral

61
Q

PAD in lower calf =

A

popliteal

62
Q

What are the 5 p of acute arterial occlusion?

A

pain, pallor, paresthesia, paralysis, pulselessness

63
Q

How do you check UE PAD?

A

allens test

64
Q

How do you test LE PAD?

A

elevation/dependency test or ankle brachial

65
Q

How do you check LE and UE PAD?

A

cap refill

66
Q

What areas do you ausculatate?

A

carotid, renal, AA, iliac, femoral

67
Q

Where does head of bed need to be for JVD?

A

45

68
Q

What can you do to help assess JVD?

A

hepatojugular reflux

69
Q

When comparing calf what is the significant sign?

A

2 cm larger

70
Q

What is the sign where you dorsiflex the foot and causes pain and means DVT?

A

homan’s sign

71
Q

What is the gold standard for looking at DVT?

A

doppler US

72
Q

An exaggerated spasm of the digital arterioles (occas in nose and ears) usually in response to cold exposure

A

Raynaud Phenomenon and syndrome

73
Q

An inflammatory dz of the branches of the aortic arch, including the temporal arteries

A

temporal arteritis

74
Q

A pathologic communication between an artery and a vein.

A

arteriovenous fistula

75
Q

jvd =

A

INCREASE right atrial pressure

76
Q

What is the first wave in JVD?

A

a wave

77
Q

When does BP decrease?

A

preg first trimester

Patient Assessment (23 decks)

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