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Peripheral Vascular Disease Flashcards

1
Q
  1. what is the peripheral vascular system?
  2. What are the structures?
A
  1. all blood vessels outside of the heart
  2. Aorta and its arterial branches (arterioles and capillaries)
    Vena Cava and its vein branches (venules and capillaries)
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2
Q

what are the components of all blood vessels (4)?

A
  1. Tunica externa (adventitia) (outer layer) provides structural support and shape to the vessel
  2. tunica media (middle layer) elastic and muscular middle layer that regulates the internal diameter of the vessel
  3. tunica intima (innermost layer) the endothelial lining that provides a frictionless pathway for the movement of blood
  4. Lumen is the hallow passageway where the blood flows
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3
Q
  1. what type of blood do the arteries carry?
  2. What is the composition of the arteries? what influences them?
A
  1. oxygenated blood to organs and muscles
  2. arteries are elastic and muscular and influenced by the ANS
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4
Q
  1. what are the muscular arteries?
  2. what are the elastic arteries?
A
  1. brachial, femoral, radial
  2. those closest to the heart
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5
Q

what percentage of total blood supply is in the arterial system?

A

10-15%

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6
Q
  1. what is the job of the arterioles?
  2. What input do they respond to?
  3. What do they play a role in?
A
  1. The arterioles supply blood to the organs
  2. They are primarily smooth muscles that respond to ANS input
  3. Due to lack of elastin, they play a role in peripheral resistance (HTN)
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7
Q

What is the job of the capillaries?

A

thin, single endothelial layer that allows for the exchange of oxygen and nutrients

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8
Q
  1. What are the venuoles and where do they receive blood from?
  2. what is the job of the venuoles?
  3. what can they NOT withstand?
A
  1. the venuoles are small and receive blood from venous capillaries after sphincter
  2. participate in the nutrient exchange process
  3. can not withstand high pressure and can rupture
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9
Q
  1. where do the veins receive blood from?
  2. What is the composition of veins and what is their job?
  3. what % of total blood is in the venous system?
  4. Describe the valves of the veins and blood flow
A
  1. receive blood from the venuoles
  2. The veins have similar anatomy to arteries but they accommodate much LESS pressure. Veins are thin walled and elastic. They have high capacitance meaning they accommodate large blood vol at low pressures.
  3. 75% of blood is in the venous system
  4. veins have one-way valves that maintain forward blood slow toward the heart against gravity
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10
Q

Compare and contrast arteries and veins

A
  1. Arteries have thicker walls, more smooth muscle, and a small lumen. Arteries maintain pressure throughout the system and appear rounder.
  2. Veins have thinner walls, less smooth muscle, and a larger lumen. Veins return blood to the heart and lungs and appear more collapsible.
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11
Q

What is peripheral vascular disease?

A

An umbrella term that encompasses diseases of the arterial, venous, and lymphatic systems.
Includes diseases of the aorta, PAD, venous diseases, Vasospasms

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12
Q

What are the most common clinical conditions of the aorta?

A

Aneurysm, dissection, obstruction

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13
Q
  1. What type of trauma is the aorta commonly subjected to?
  2. What happens to the composition of the aorta as we age?
A
  1. The aorta is subject to mechanical trauma due to continuous exposure to high pulsatile pressure
  2. The aorta has high elastin content in the tunica media which allows for significant distensibility (ability to stretch and expand).
    Systole= Expansion
    Diastole= recoil
    As we age, elastin degenerates and the aorta becomes stiffer which increases systolic BP
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14
Q
  1. what is a pseudoaneurysm?
  2. what is the common cause?
A
  1. A contained rupture of the vessel lumen that develops when blood leaks out of a hole in the intima and media layers and is contained by the adventitia. Very unstable and prone to rupture.
  2. caused by infection, trauma, puncture such as cardiac cath
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15
Q
  1. What percentage of dilation is classified as an aneurysm?
  2. What is considered a true aneurysm?
A
  1. when increased by 50% compared with normal
  2. dilation of all 3 layers of the aorta, creating a large bulge in the vessel wall
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16
Q

what are the most common aneurysms?

A

abdominal is the most common followed by thoracic

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17
Q

what are the causes/ conditions associated with aortic aneurysms?

A
  1. medical degeneration: marfans, elher-danlos, loeys- dietz, aortic valve problems, genetics
  2. atherosclerosis
  3. infections
  4. vasculitis
  5. trauma or aortic dissection
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18
Q

what are the main causes of descending aortic and abdominal aneurysms? (4)

A
  1. atherosclerosis; commonly seen in older male with hx of smoking, HTN, dyslipedemia, and caucasian
  2. genetic predisposition
  3. vessel inflammation
  4. weakened tunica media due to infection from salmonella, staphylococci, streptococci, TB, or syphillis
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19
Q

what is the clinical presentation of aortic/ abdominal aneurysms? (4)

A
  1. Most patients are asymptomatic but can sometimes feel a pulsatile mass or sensation in the abdomen
  2. feeling of another organ (kidney or intestine) being constricted or pressed
  3. non-specific back pain, nausea, abdominal pain, pain in the flanks that radiates to the legs
  4. general malaise if due to infection, weight loss if due to inflammation
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20
Q

What is the presentation of a thoracic aneurysm?

A

Often asymptomatic but when they are symptomatic there is compression of neighboring structures such as the trachea, main bronchus, and esophagus.
Can present with cough, dysphagia, and hoarseness due to the recurrent laryngeal nerve

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21
Q

what is the clinical presentation of an aneurysm of the ascending aorta?

A

aortic regurgitation and symptoms of CHF

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22
Q
  1. What is the common presentation of slow leaks (aneurysms)?
  2. What is the common presentation of a rupture?
A
  1. diffuse, deep belly pain, GI symptoms, bloating, cramping
  2. hypovolemia, hypotension, deep pain in the back or abdomen, vomiting, diaphoresis, loss of consciousness
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23
Q

what are risk factors for rupture?

A

Increasing size
Rapid expansion
Tobacco use
Increased or uncontrolled HTN
Cardiac or renal transplant COPD (increased intrathoracic pressure)
Female (decreased tensile strength and increased wall stress)
Recent surgery (stress on the body)

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24
Q

What is required for diagnosis of a aortic aneurysm?

A

imaging, screening (men 65-75 who have hx of smoking), abdominal palpation (mainly reliable with large AAA)

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25
Q
  1. what is the treatment for a unruptured aneurysm?
  2. what is the treatment for a rupture aneurysm?
A
  1. manage underlying disease process and risk factors, repair surgically or endovascularly
  2. emergent surgery, survival rate is <50%
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26
Q

What is an aortic dissection? Where is it most common?

A

A tear in the intima and media that spreads along the artery causing blood to flow in between the layers of the blood vessel which can lead to an aortic rupture. Most commonly happens in the thoracic aorta. It is life threatening.

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27
Q

what are risk factors for aortic dissection?

A

atherosclerosis, blunt trauma to the chest, and HTN

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28
Q

What is the common presentation of an aortic dissection?

A
  • Sudden onset of chest or back pain with a tearing or ripping sensation that can radiate to the shoulder, jaw, arm, and neck.
  • Signs of hypoperfusion like dizziness or syncope
  • nausea and vomiting
  • rapid and weak pulse
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29
Q

what is the most common cause of PAD?

A

atherosclerosis

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30
Q

what are risk factors for PAD?

A
  1. CAD/ atherosclerosis
  2. advanced age
  3. hypercholesterolemia
  4. smoking
  5. HTN
  6. diabetes
  7. overweight
  8. family HX
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31
Q

What patients are at an increased risk of PAD? (table 3)

A
  1. age >65
  2. age 50-64 with risk factors for atherosclerosis such as DM, hx smoking, hyperlipidemia, HTN, family hx
  3. age <50 with DM and 1 risk factor for atherosclerosis
  4. people with known atherosclerosis in another vascular bed (coronary, carotid, subclavian, renal, mesenteric stenosis, AAA)
  5. AAA
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32
Q

what hx findings are suggestive of PAD? (table 4)

A
  1. claudication
  2. non joint related exertional LE symptoms
  3. impaired walking function
  4. ischemic resting pain
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33
Q

what findings on physical examination are suggestive of PAD? (table 4)

A
  1. abnormal LE pulse examination
  2. vascular bruit
  3. nonhealing LE wound
  4. LE gangrene
  5. elevated pallor and dependent rubor
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34
Q
  1. What is the pathophysiology of PAD? 2. What happens to the blood vessels?
A
  1. Similar to CAD, there is a mismatch of the demands of the organs and muscles and the supply of O2 due to a atherosclerotic stenosis of the peripheral arteries.
  2. There is reduced diameter of the blood vessels which leads to ischemia
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35
Q

Describe pathophysiology of PAD and exercising muscle

A
  • During exercise skeletal muscles metabolism produces adenosine which acts to dilate arterioles to increase blood flow to the muscles. Obstructed arteries cant respond to the vasodilating stimuli which means blood flow becomes limited leading to ischemia.
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36
Q

what are the adaptations to chronic ischemia? (PAD)

A
  • changes to muscle fiber metabolism and skeletal muscle degeneration = LE weakness
  • ischemic changes in the arteries can lead to ischemic symptoms at rest that are similar to angina
37
Q

What arteries are commonly affected with PAD?

A
  1. aorta & iliac (butt, hip, thigh, calve pain) femoral & popliteal (calve pain) tibioperoneal, brachiocephalic & subclavian & axillary (arm pain)
38
Q

What is the clinical presentation/ common symptoms of PAD? (10)

A
  1. intermittent claudication which leads to buttock, hip, thigh, and calf pain (only in 1/3 of patients) (1/3 patients asymptomatic) (can be atypical such as leg pain carry on which means that they are able to keep exercising)
  2. symptoms distal to the stenotic artery
  3. if chronic ischemia –> ulceration, infection, skin necrosis
  4. diminished or absent pulses distal to stenosis
  5. muscle atrophy
  6. pallor and reduced temperature upon elevation
  7. shiny taut skin with hair loss and thick and brittle toe nails
  8. wounds, gangrene, necrosis of the foot and digits
  9. reduced sensation
  10. DM
39
Q

What are the grades of the ACSM Intermittent Claudication Scale (PVD pain)

A

Grade 1: definite discomfort or pain but only initially or modest levels
Grade 2: moderate discomfort or pain from which the patients attention can be diverted by conversation
Grade 3: intense pain from which the patients attention can not be diverted
Grade 4: Excruciating and unbearable pain

40
Q

what is the ankle brachial index?

A

An ankle brachial index (ABI) is a non-invasive test that measures the ratio of blood pressure in the ankle to the blood pressure in the arm. It’s used to assess vascular health and determine if there’s resistance to blood flow in the lower extremities.

41
Q

What are each ABI measurements indicative of?

A

> 1.10: no possible symptoms, normal clinical presentation
0.5-1.0: claudication, pain in the calf with ambulation
0.2-0.5: critical limb ischemia, atrophic changes with resting pain and wounds
<0.2: severe ischemia, gangrene and severe necrosis

42
Q

What are the pulse grades?

A

Grade 0: absent, no pulse
Grade 1+: diminished barely palpable
Grade 2+: brisk, expected
Grade 3+: full and normal
Grade 4+: bounding and strong

43
Q
  1. what is critical limb ischemia?
  2. what are the phases?
A
  1. A progression of PAD in which circulation cannot meet rising metabolic demands.
  2. -1st critical phase is when collateral circulation cannot meet the needs of metabolic demand = Limited blood supply will shunt to muscles and skin with wound will be compromised
    -2nd critical phase is when pain is experienced with exercise increasing muscle O2 demand
    - 3rd critical phase is seen with resting pain, non-healing wounds subject to infection, risk for gangrene
44
Q
  1. What is an acute cold leg?
  2. what is the likely cause?
  3. what is the clinical presentation?
  4. how is it treated?
  5. what are the 6 P’s?
A
  1. A vascular emergency due to acute arterial occlusion = risk of limb loss
  2. Due to in situ thrombotic occlusion most often in the femoral artery or from an embolism
  3. sudden onset of cold, paleness, pulseless, painful, parasthesia, paralytic leg
  4. treated with revascularization via embolectomy, interarterial thrombolysis, angioplasty, bypass surgery
  5. pain, paralysis, pulselessness, perishingly cold, pallor, paresthesia
45
Q

what are the ACSM guidelines for PAD?

A
  • aerobic activity 3-5 times per week at RPE of 12-16 for 20-60mins per session
  • Walking speed should be at a pace to elicit claudication symptoms within 3-5 min., once they reach mod. severity (level 3-5) then continue interval, ideally 35-50 min.
  • resistance exercise 2x/week with emphasis in major muscle groups (LE)
  • flexibility 2-3x/wk (static, dynamic, PNF)
46
Q

What were the results from the study regarding supervised exercise and PAD

A
  • stenting or supervised exercise are equally beneficial for patients with PAD and moderate to severe claudication
  • Supervised exercise or stent surgery provides biological benefits aiding in improvement of limb strength, efficiency and performance …. And benefits remained up to a year following the supervised exercise phase
47
Q

What are options for surgical interventions for PAD?

A
  1. Angioplasty with or without a stent: claudication is generally improved right away and aids in healing of distal wounds, exercise can resume 72 hrs post
  2. Bypass surgery: harvest a vein from another part of the leg (aortobifemoral, iliofemoral, femoral); symptoms resolve, OOB day 1, encourage regular physical activity once wounds heal and limit lifting for 6wks
  3. Femoral popliteal bypass: used for critical limb ischemia, OOB walking day 1, resume physical activity once wounds heal, and monitor the limb through healing
48
Q

What are the different types of venous disorders?

A
  • varicose veins
  • DVT
    -PE
  • chronic venous insufficiency
49
Q

Compare and contrast superficial and deep veins

A
  • superficial veins carry approximately 10-15% of blood in the LE’s which drain into communicating veins and flow into deep veins
  • deep veins lie inside the muscle and carry 85-90% of blood back to the heart
50
Q

what are risk factors for venous disorders?

A

Prior history of blood clot
Family history
Obesity
Pregnancy
Prolonged standing
History of ankle injury or immobility
Trauma, illness, surgery
Lifestyle

51
Q

What is the clinical presentation for venous disorders?

A

-Edema generally in LE’s
-Fatigue
-Heaviness feeling in LE’s
-Hemosiderin staining
-Warmth on palpation
-Ulcers/wounds are commonly found on the LE above the ankle
-Frequent infections

52
Q
  1. what are varicose veins? 2. what veins are the most common?
  2. what is the most common cause?
A
  1. dilated tortuous superficial veins
  2. saphenous and tributaries
  3. intrinsic weakness of the vessel wall, volume overload, congenital weakness, incompetent valves, chronic backflow
53
Q

what are risk factors for varicose veins?

A

Females 2-3x more likely than men
Pregnancy
Obesity
Family history
Prolonged standing
History of infection

54
Q

what are common symptoms for patients with varicose veins?

A

heaviness, dull ache, bulging veins, may see a local hematoma small venuoles rupture

55
Q

what are the stages of varicose veins?

A

Normal veins
Stage 1: spider veins or reticular veins
Stage 2: varicose veins or venous nodes
Stage 3: edema of the lower leg
Stage 4: varicose eczema or trophic ulcer

56
Q

What is the route of management for varicose veins? (4)

A
  1. Conservative: compression hose, elevating feet, managing edema, avoiding prolonged standing
  2. Sclerotherapy – localized IV injection of irritating chemical to fibrose veins
  3. Endovenous thermal ablation – use laser or radiofrequency to deliver heat to obliterate varicose saphenous veins
  4. Surgical – vein ligation and removal
57
Q

what is the pathogenesis for VTE?

A

Virchow’s Triad: Venous stasis, Vascular Injury, Hypercoagulability —> coagulation cascade (5-6weeks)–> decreased or mechanically altered blood flow (LE)
- can commonly develop weeks after discharge

58
Q

what are risk factors for DVT?

A

Post-operative
Obesity
Pregnancy and post partum period
Heart failure or respiratory failure
Tobacco use
Use of oral contraceptives
Cancer and chemotherapy
Prolonged airline, car or train travel
Trauma
Diabetes, HTN, CVA, SCI
Varicose veins
Increasing age

59
Q

what causes increased risk for UE DVT?

A

Central Venous Catheters, PICC lines and pacemaker insertions

60
Q

What are signs and symptoms of LE DVT?

A
  • Unilateral Edema
  • Tenderness and pain in leg (especially calf
    Warmth and erythema)
    -Low-grade fever
  • Cognitive changes in elderly
61
Q

How is DVT diagnosed?

A
  1. Serum d-Dimer: Blood test that measures degradation of fibrin
  2. Doppler US
    95% sensitive for proximal veins, 75% sensitive for calf veins
  3. MRI and contrast venography
62
Q

What are the items of the Wells Clinical Prediction Rule for DVT? What is the score interpretation?

A
  1. active cancer (within 6 months)
  2. paralysis, paresis, or immobile LE
  3. bedridden for more than 3 days because of surgery (within 12 weeks)
  4. localized tenderness along distribution of deep veins
  5. entire leg swollen
  6. unilateral calf swelling of >3cm
  7. unilateral pitting edema
  8. collateral superficial veins
  9. previously documented DVT
    Risk interpretation: 2 pts or more = DVT likely
63
Q

what is the clinical prediction rule for UE DVT

A
  • venous material in subclavian or jugular vein or pacemaker: +1
  • localized arm pain: +1
    -unilateral pitting edema: +1
  • alternative diagnosis: -1
64
Q

what should not be used for DVT?

A

Homan’s sign should NOT be relied upon (passive squeezing of calf with ankle DF)

65
Q

what are treatments for DVT?

A
  1. Compression stockings – anti-embolic stocking, sequential compression device (SCD)
  2. Anti-coagulation medications: IV heparin,
    Oral warfarin (Coumadin)
  3. 1st DVT diagnosis – usually on RX for 3 mos.
    If cannot anti-coagulate patient then IVC filter is considered
66
Q

what are the guidelines for mobilizing patients with DVT?

A
  1. If the patient is not on anticoagulants and has a known DVT AND does not have an IVC filter, check with medical team
  2. If the patient is anticoagulated:
    If on Coumadin (warfarin) – check INR levels (International Normalized Ratio)
    <1.1 in healthy normal NOT on Coumadin
    2-5 therapeutic range when on Coumadin
    >4.5 risk of hemorrhage
    <2 increased risk of clot
  3. Avoid consuming large amounts of green leafy vegetables with vitamin K (kale, spinach, Brussel sprouts, broccoli); green tea; cranberry juice, alcohol
67
Q

what is the guideline for mobilizing a patient with a DVT who is on unfractionated heparin?

A

< 24 hours: no mobility
24-48 hours: consult medical team
> 48 hours: mobilize

68
Q

what is the guideline for mobilizing a patient with a DVT who is on low molecular weight heparin?

A

< 3 hours: no mobility
3-5 hours: check with physician
> 5 hours: mobilize

69
Q

what is an IVC filter for DVT management?

A
  1. Prevent embolism of DVT from traveling to lungs
  2. Placed in Inferior Vena Cava by interventional radiologist or cardiologist
  3. Placed above the level of a diagnosed clot
70
Q

What does HASBLED score stand for?
What HAS-BLED score is concerning?

A

Hypertension, abnormal renal and liver function, stroke, bleeding, labile INR, elderly, drug or alcohol usage
If the HASBLED score is >4 = stop anticoagulation

71
Q

what is post thrombotic syndrome?

A

Permanent damage to the valves of the veins and reflux of blood in the venous system —> Leads to venous hypertension that reduces muscle perfusion, increases tissue permeability
* associated with high morbidity and lower QOL

72
Q

what are signs and symptoms of post thrombotic syndrome?

A

chronic aching arm or leg pain, intractable edema, limb heaviness, and leg ulcers, skin changes, and heaviness of the limb affected by DVT

73
Q
  1. what is a pulmonary embolism?
  2. when are they common?
A
  1. Clot, most often from DVT, breaks off dislodges and travels through the vena cava, right heart to the lungs and lodges in a part of the pulmonary vasculature –> Can be fatal (40% fatality rate if left untreated)
  2. Common, especially after surgery, trauma prolonged immobility
74
Q
  1. what is the presentation of a PE?
  2. what is the common course of treatment?
A
  1. dyspnea, pleuritic chest pain, hemoptysis, cough, syncope, tachypnea
  2. anticoagulation and thrombolytic therapy
75
Q

What is the Wells Clinical Prediction rule for PE?

A
  1. clinical symptoms of DVT (3)
  2. other dx less likely than PE (3)
  3. HR >100 (1.5)
  4. immobilization or surgery within past 4 weeks (1.5)
  5. previous DVT or PE (1.5)
  6. hemoptysis (1)
  7. Malignancy (1)
76
Q
  1. what is chronic venous insufficiency?
  2. what is it associated with?
A
  1. Valve incompetence or venous obstruction leads to extravasion (leaking) of edema into surrounding tissues
  2. Associated with varicose veins, edema, skin inflammations and hyperpigmentation and ulcerations
77
Q

what is the typical course of treatment for chronic venous insufficiency?

A
  1. Treat the edema
  2. Diuretics
  3. Antibiotics (when infection present)
  4. Compression – ACE vs. custom stocking
  5. Dressing changes: Unna boot, Dressing materials

Chronic wounds that are constantly infected puts patient @ risk for sepsis, multiple hospitalizations, reduced quality of life

78
Q

what will be common in the hx of someone with venous insufficiency?

A

May report chronic edema issues
Slow healing
h/o infection(s)
h/o varicose veins

79
Q

what is common in the hx of someone with arterial insufficiency?

A

Aching or cramping of distal limbs
Poor wound healing
Limited mobility

80
Q

what are the grades of the pitting edema scale?

A

1+: indentation barely visible
2+: slight indentation that returns to normal in 15 seconds
3+: deeper indentation that returns to normal in 30 seconds
4+: indentation that lasts greater than 30 seconds

81
Q

what are the characteristics of a venous wound?

A
  1. Location: Venous wounds tend to be above malleoli
  2. History of the wound:
    Venous wounds tend to be more insidious in onset, preceded by skin color and texture changes
  3. Appearance:
    Uneven edges, shallow depth, Chronic wounds may have rolled edges, Minimal eschar, Surrounding skin shiny, warm or scaly
  4. Drainage: Serous, unless infection is present
  5. Pain: Not typically painful in regard to the wound but dull, ache of chronic venous insufficiency

Most common wounds – 80-90% of all ulcers

82
Q

what are the characteristics of arterial wounds?

A
  1. Location:Arterial wounds occur most often on the foot, in between or at the tips of the toes, at pressure points from foot wear, on the heels and around lateral malleolus
  2. Size and shape:Most likely round, with a “punched out” appearance. They may range in size from small to large, with well-defined edges.
  3. Color:Often occur yellow, brown or black in color. Skin may also appear pale and non-granulating.
  4. Appearance:Arterial ulcers are often deep, but may also appear shallow in early stages. Skin surrounding the wound is often thin, smooth, taut and dry. Loss of hair on the leg is also common.
  5. Exudate:Unlike venous ulcers, arterial ulcers are often dry due to minimal drainage.
  6. Pain level:Reportedly very painful. Elevating the leg can increase this pain.
  7. Other distinguishing characteristics:
    -Toenails often appear brittle, yellow, deformed, thick and dry.
    -A patient’s pulse may be indistinguishable around the site of the wound.
    -The area around the wound is likely cool or cold to the touch due to minimal blood circulation.
83
Q
  1. what is cellulitis?
  2. what are common causes?
  3. what are symptoms
A
  1. NOT a vascular disorder but can be confused for a developing venous wound,
    Bacterial (Staphylococcus aureus or Streptococcus) skin infection of dermis or subcutaneous tissue
  2. Breaks in skin, splinters, bug bites, incisions, IV sites
  3. Symptoms: Red area of skin that tends to expand, Swelling, Tenderness, Pain, Warmth, occasional open wounds, Fever, Red spots, Blisters, Skin dimpling
84
Q

what is Raynauds disease and the common symptoms?

A

Intermittently affects small arteries and arterioles – decreased blood supply to distal extremity
Symptoms:
Cold fingers/toes
Color changes to skin in response to cold or stress
Numbness/tingling in fingers or toes
Stinging/throbbing pain when warming or stress relieved
Ulcers can occur on tips of fingers/toes (severe cases

85
Q

what are 5 treatments for Raynaud’s disease?

A
  1. stop smoking
  2. avoid caffeine
  3. avoid medications that cause tightening of blood vessels
  4. keep the body warm, avoid exposure to cold
  5. wear comfortable and roomy shoes and wool socks
86
Q
  1. what is Buergers disease?
  2. what are the common symptoms
  3. what is the treatment course
A
  1. Inflammation and thrombosis of small & medium sized veins and arteries that is commonly associated with smoking.
    Common in males age 20-40’s with Onset distal to proximal in extremities
  2. Temperature and color variance in hands/feet, pain in hands/feet can be severe (arch of foot), painful sores or ulcers hands/feet, pain during walking in LE
  3. Smoking cessation, pain management, improve circulation through surgery that restores blood flow
87
Q

what are the skin characteristics, pain levels, exudate, pulses, wound characteristics, and common sites for arterial wounds?

A
  1. Skin characteristics: Shiny, dry, cool/cold, loss of hair, rubor with dependent positioning, pallor in elevation
  2. Pain: Positive for pain due to ischemia
  3. Exudate: Not observable, dry
  4. Pulses: Can be absent or diminished
  5. Common sites: Toes, feet, distal to malleoli
  6. wound characteristics: small, defined borders, punched out, deep, tunneling, dry, necrotic tissue
88
Q

what are the skin characteristics, pain levels, exudate, pulses, wound characteristics, and common sites for venous wounds?

A
  1. Skin characteristics: Warm, pigmentation, mottling, thickened, rough skin, changes in appearance of skin after wound healing
  2. Pain: Wounds generally minimally painful
  3. Exudate: oozing
  4. Pulses: normal
  5. Common sites: above malleoli, distal 1/3 of lower leg
  6. wound characteristics: Uneven borders, shallow, drainage, can be large

Body Systems (9 decks)

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