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Patient Evaluation > Peripheral Vascular > Flashcards

Peripheral Vascular Flashcards

1
Q

AAO etiologies ?

A

Thrombosis (clot)
Embolism
Arterial spasm

Can occur in association with atherosclerosis

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2
Q

AAO 6P’s?

A

Pallor

Pain – sudden, severe, esp distal to the occlusion, no position alleviates pain

Paresthesia
Paralysis
Pulselessness
Poikilothermia - varying temp

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3
Q

AAO tx?

A

dependent on cause, but urgent
Thrombectomy
+/- heparinization

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4
Q

Raynaud’s Disease patho?

A

Episodic spasm of small arteries and arterioles. No organic occlusion

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5
Q

Raynaud’s Disease and Phenomenon

A

secondary to other conditions such as CT diseases, vasc diseases, blood dyscrasias or occup exposures ( LUPUS, scleroderma)

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6
Q

Raynaud’s Disease and Phenomenon epidemiology?

A

young females

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7
Q

Raynaud’s Disease symptoms and triggers?

A

Symptoms – 1 or more distal fingers, usually bilaterally. None/mild pain. Numbness, tingling lasting few minutes

Triggers – exposure to cold, emotional upset

bettie in warm environment

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8
Q

Raynaud’s Disease signs?

A

color changes

white – blue – red

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9
Q

Raynaud’s Disease tests?

A

Tests – no specific tests, but rule out the diseases that can cause phenomenon

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10
Q

Raynauds Tx?

A

Tx – keep hands warm

- maybe vasodilators, if severe

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11
Q

Varicose Veins patho?

A

Superficial veins that are dilated, tortuous

Valves have become incompetent

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12
Q

VV epidemiology?

A

Familial
Long periods of increased venous pressure
Secondary to thrombophlebitis

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13
Q

VV symptoms and signs?

A

Symptoms – maybe none, or leg fatigue, ache, heaviness

Signs – dilated veins, +/- tissue changes

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14
Q

VV Dx?

A

Clinical, doppler

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15
Q

VV Tx?

A

Prevention
Support hose
Surgical stripping

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16
Q

Superficial Thrombophlebitis patho?

A

Usually involves the saphenous system

Clot formation and inflammation in a superficial vein

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17
Q

ST symptoms and signs?

A

Symptoms – sudden inflammation and localized pain

Signs – local redness, pain, mild edema, palpable cord

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18
Q

ST causes?

A

-spontaneous
-pooled blood (pregnancy, post partum,
varicose veins)
-secondary to trauma (e.g. IV, contusion)

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19
Q

ST tx?

A

heat, bedrest, elevation, anti-inflam. Usually benign and brief unless deep system is affected, too

Anticoagulation therapy not needed

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20
Q

DVT patho?

A

Clot in a deep vein, often originating in the calf

50-80% of calf DVTs propagate proximally to deep thigh veins (ilial, femoral and popliteal)

DVT in iliofemoral veins cause most PEs

Most calf DVT’s spontaneously resolve

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21
Q

DVT risk factors/ epidemiologist?

A 
CHF	 		
Recent hip surgery 
 Neoplasm
              Pelvic fx                      
	OC’s 			Smoking
	Varicose veins	Prolonged inactivity
    Trauma
22
Q

DVT symptoms and signs?

A

Symptoms – often painless at first, can be a tight, bursting pain, worse with walking, better with elevation

Signs – edema, +/- calf tenderness
- resultant PE may be the first sign

23
Q

DVT Dx?

A

Doppler, venogram

24
Q

DVT prevention

A

leg exercises during bedrest

- anticoagulants
- leg elevation
- elastic stockings
25
Q

CVI patho?

A

Chronic venous engorgement from
a. Incompetent valves
b. Venous occlusion (trauma and/or
edema of surrounding tissues)

26
Q

CVI epidemiology?

A

Epidemiology - +60 y.o., obese, history of leg injury or prolonged standing

27
Q

CVI symptoms?

A

painless or diffuse leg ache, worse with dependency and as day wears on, alleviated with elevation

28
Q

CVI signs?

A
  • chronic edema, particularly at ankle
    • stasis dermatitis
    • brown pigmentation
    • +/- ulceration that is painLESS
      normal pulses
    • thickened skin (or narrowed extremity)
    • normal temperature
    • no gangrene
29
Q

CVI Dx?

A

clinical, duplex doppler

30
Q

CVI Tx?

A

leg elevation

elastic stocking

31
Q

Interstitial Edema patho?

A

increased interstitial fluid

32
Q

IE etiologies?

A

lymphatic dysfunction
- problems with hydrostatic or osmotic
pressure in capillary bed as blood goes
from artery to vein

CHF
	Nephrotic syndrome
    Cirrhosis 
    Malnutrition
    Medications
    Prolonged sitting or standing or ill-fitting shoes (orthostatic edema)
33
Q

IE PE?

A

No ulcer, pigmentation, ulcers or skin thickening

Usually bilateral, involves foot also

34
Q

Lymphedema etiology?

A

congenital

- inflammatory 
- mechanical
35
Q

Lymphedema - mechanical causes?

A

tumor, trauma, fibrosis, metastatic node disease, post-op patients (e.g. s/p lymph node dissection)

36
Q

Lymphedema PE?

A

Soft at first, becomes hard and non-pitting

Skin thickens

No ulceration or pigmentation changes

Usually painless

37
Q

Lymphedema Tx?

A

elevation

- elastic bandages
- massage
- avoid secondary cellulitis
- possible intermittent diuretic
38
Q

Acute Lymphangitis patho?

A

Acute bacterial infection

Portal of entry – chronic ulcer or acute injury

Infection spreads up lymphatic channels

39
Q

Acute Lymphangitis Sxs?

A

tenderness to palpation

- fever, chills, malaise
 - red streaks on skin
 - tender, enlarged lymph nodes
40
Q

Acute Lymphangitis Tx?

A

AB’s, heat, elevation, immobilization, pain meds

41
Q

Thromboangiitis Obliterans
(Buerger’s disease) patho?

A

Occlusion of small arteries and veins of fingers, toes due to inflammation or thrombus

42
Q

Thromboangiitis Obliterans
(Buerger’s disease) epidemioogy?

A

young men> women, less than 40, smokers

43
Q

Thromboangiitis Obliterans severities?

A

Intermittent claudication – typically arch of foot, or hands that ↑with exercise,
↓ with rest

Rest pain – chronic and persistent

44
Q

Thromboangiitis Obliterans signs?

A

distal coldness, numbness, cyanosis, ulceration, gangrene

45
Q

Thromboangiitis Obliterans Tx?

A

Stop smoking! Otherwise intermittent course with possible amputation

46
Q

Pressure ulcers 
(Decubitus ulcers, bedsores) epidemiology?

A

bed/wheelchair-confined patients, especially:

 - emaciated 
 - elderly
 - neuro-compromised, (unconscious,
    paralyzed)  
  - diabetic
47
Q

Pressure sores result from?

A
  1. Sustained compression which obliterates blood flow to skin
    Ex – wheelchair, bedridden
  2. Shearing forces
    Ex -from dragging pt up in bed
    instead of lifting
48
Q

Pressure sore sites?

A

sacral area, buttocks (ischial tuberosity), greater trochanters, knees, heel, occiput, ears, elbows

Roll your patient over and check all areas

49
Q

Pressure sore Tx?

A
  • turn patient every hour
    • water or air-filled mattress
    • alternating pressure mattress
    • foam pads, egg crate mattresses
50
Q

Pressure sores - early ulcer tx?

A

topical tx to promote granulation

51
Q

Pressure sore - advanced ulcers tx?

A

surgical debridement

treat any accompanying infection

Patient Evaluation (29 decks)

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