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DPT 629: Cardio > PT Exam and Interventions of the Vascular System > Flashcards

PT Exam and Interventions of the Vascular System Flashcards

1
Q

what is peripheral arterial disease (PAD)?

A

plaque buildup in arteries (atherosclerosis)

systemic-affects all arteries

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2
Q

if someone has PAD, it is likely they also have what?

A

coronary artery disease (CAD)

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3
Q

t/f: ischemic stroke can be caused by plaque buildup from atherosclerosis

A

true

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4
Q

what are the VTEs?

A

DVT and PE

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5
Q

what are the types of peripheral vascular disease?

A

peripheral arterial disease (PAD)

venous insufficiency

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6
Q

what is a clot that has not dislodged?

A

a thrombus

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7
Q

what is a clot that has dislodged?

A

an emboli

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8
Q

what is a VTE?

A

the formation of a blood clot in a vein

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9
Q

what are the risk factors for VTE formation?

A

Virchow’s triad

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10
Q

what is Virchow’s triad?

A

1) vascular stasis
2) endothelial injury
3) hyper-coagulability

cause a coagulation cascade

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11
Q

what may cause venous stasis?

A

immobility

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12
Q

what can cause endothelial injury?

A

surgery

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13
Q

what is the main concern of a DVT?

A

it turning into a PE

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14
Q

what is PTS (post thrombotic syndrome)?

A

permanent damage to valves in veins; blood reflux

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15
Q

what are the complications of DVT

A

PE

post thrombotic syndrome (PTS)

chronic symptoms: aching, pain, edema, limb heaviness, leg ulcers

long term outcomes: impaired fxnal mobility, poor QOL, increased healthcare cost

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16
Q

what are the chronic symptoms of DVT?

A

aching, pain, edema, limb heaviness, leg ulcers

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17
Q

what are the long term outcomes of DVT?

A

impaired fxnal mobility, poor QOL, increased healthcare cost

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18
Q

what are the complications of PE?

A

death

chronic thromboembolic pulmonary HTN (CTPH)

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19
Q

what are the PT responsibilites for VTEs?

A

prevent VTE

assess for VTE

discuss safe initiation of mobility w/VTE

educate pts

prevent long term consequences

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20
Q

to prevent VTEs, PTs should advocate for what in all practice settings?

A

a culture of mobility and physical activity

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21
Q

why is it so difficult to practice advocate for a culture of mobility?

A

bc we don’t know who’s responsibility it is since we don’t get paid for it

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22
Q

t/f: when a pt is high risk for VTE, we should provide preventative measures, including education on the s/s of VTE, activity, exercise, hydration, mechanical compression, and referral for medical treatment

A

true

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23
Q

what should PTs promote for pts at risk for VTE?

A

LE exercises, ambulation, hydration, mechanical compression, medical referral

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24
Q

how do we assess risk for DVT?

A

during the initial interview and physical exam, assess risk of DVT in pts with reduced mobility

Padva prediction score

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25
Q

according to the Padva prediction score, what are the most items with the highest risk for DVT?

A

active CA (CA within the last 6 months)

prior VTE

reduced mobility

thrombophilia condition

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26
Q

what conditions increase risk for DVT?

A

CA

inherited protein diseases

COVID-19

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27
Q

what predicts the presence of DVT?

A

when a pts presents with pain , tenderness, swelling, warmth, and/or discoloration in the LE, establish the likelihood of a LE DVT

use the Wells criteria for presence of DVT

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28
Q

what is the lab blood test used for ruling out a DVT?

A

D-Dimer

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29
Q

t/f: if a D-Dimer is positive, the pt has a DVT

A

false, it doesn’t have good specificity to rule it in

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30
Q

if the PT observes s/s of DVT or suspects DVT, what should they do?

A

perform Well’s test to determine likelihood and communicate results to medical team for further action

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31
Q

if a PT observes s/s of DVT or suspects DVT, they perform Well’s test to determine likelihood and communicate results to medical team for further action and it is <2 (DVT unlikely), what do we do?

A

D-Dimer

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32
Q

if a PT observes s/s of DVT or suspects DVT, they perform Well’s test to determine likelihood and communicate results to medical team for further action and it is >2 (DVT likely), what do we do?

A

further medical dx testing

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33
Q

if we do a D-Dimer, and it is negative, what do we do?

A

encourage mobility and physical activity in addition to any additional preventative measures

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34
Q

if we do a D-Dimer and it is positive what do we do?

A

further medical dx testing

bc there are lots of false positives

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35
Q

if we do a D-Dimer and it’s positive, so we do a further testing and it is negative for DVT, what do we do?

A

encourage mobility and physical activity in addition to any additional preventative measures

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36
Q

if we do a D-Dimer and it is negative, what do we do?

A

encourage mobility and physical activity in addition to any additional preventative measures

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37
Q

if we do a D-Dimer and it is positive, so we do further medical dx testing and it is positive for DVT, what do we do?

A

consider medical interventions based on the location and person’s current medical status

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38
Q

what is the gold standard test for diagnosing DVT?

A

US Dopler

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39
Q

t/f: when a pt presents w/dyspnea, chest pain, presyncope/syncope, and/or hemoptysis, evaluate the likelihood of PE and take appropriate action based on results

A

true

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40
Q

what is the test for PE?

A

revised Geneva clinical predication rule for PE

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41
Q

t/f: when a pt w/a recently diagnosed LE DVT reaches the therapeutic threshold of anticoagulant med, physical therapist should mobilize the pt

A

true

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42
Q

why is being immobile post VTE dangerous?

A

bc it puts them at risk for more DVTs from not moving

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43
Q

what are the types of medication that affect mobilization?

A

LMWH

Fondaparinux

UFH

DOACs

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44
Q

if a pt is on a preventative dose of LMWH, what should we do?

A

wait for a higher dose to be given

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45
Q

if a pt is on a new dose LMWH, what should we do?

A

wait for initial dose to be given

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46
Q

if a higher dose LMWH was given 2 hours ago, should we mobilize the pt?

A

no

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47
Q

if a higher dose of LWMH is given 4 hours ago, should we mobilize the pt?

A

check with the medical team first

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48
Q

if a higher dose LMWH was given 6 hours ago, should we mobilize the pt?

A

yes

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49
Q

if LMWH was given <3 hours ago, what should we do?

A

wait to mobilize

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50
Q

if LMWH was given 3-5 hours ago, what should we do?

A

check with the medical team

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51
Q

if LMWH was given >5 hours ago, what should we do?

A

mobilize them

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52
Q

if Fondaparinux was given <2 hours ago, what should we do?

A

don’t mobilize the pt

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53
Q

if Fondaparinux was given 2-3 hours ago, what should we do?

A

check with the medical team

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54
Q

if Fondaparinux was given >3 hours ago, what should we do?

A

mobilize the pt

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55
Q

if UFH was given <24 hours ago, what should we do?

A

don’t mobilize them

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56
Q

if UFH was given >24 hours ago, what should we do?

A

check with the medical team and/or check the aPTT is bw 1.5-2.5x the control value

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57
Q

if a DOAC was given <2 hours ago, what should we do?

A

don’t mobilize the pt

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58
Q

if a DOAC was given 2-3 hours ago, what should we do?

A

check w/medical team

59
Q

if a DOAC was given >3 hours ago, what should we do?

A

mobilize

60
Q

what kind of drug is Lovenox (enoxaparin)?

A

LMWH (low molecular weight heparin)

61
Q

how is LMWH given?

A

subQ injection

62
Q

when is the peak levels of LMWH?

A

3-5 hours

63
Q

t/f: LMWH is often given prophylactically to prevent DVT

A

true

64
Q

what kind of drug is Arixtra?

A

Fondaparinux

65
Q

how is Fondaparinux given?

A

subQ injection

66
Q

what are the peak levels of Fondaparinux?

A

2-3 hours

67
Q

how is prophylactic UFH given?

A

subQ injection

68
Q

how is treatment UFH given?

A

IV infusion

69
Q

when are the peak levels of UFH?

A

> 24 hours

70
Q

what do we need to monitor with UFH?

A

aPTT levels

71
Q

what levels should aPTT be?

A

1.5-2.5x the control value

72
Q

if UFH is overdosed and supratherapeutic what is the risk?

A

spontaneous bleeding

73
Q

what kind of drugs is Xarelto (rivaroxaban) and Eliquis (apixaban)?

A

direct acting oral anticoagulants (DOACs)

74
Q

when is the peak levels of DOAC?

A

2-3 hours

75
Q

what is the international normalized ratio (INR)?

A

measures of prothrombin test time (PT)

monitors Coumadin (warfarin) levels

76
Q

what is the reference range for INR?

A

.8-1.1

77
Q

what is the critical value for INR?

A

> 5.5

78
Q

what is the risk of INR >5.5?

A

spontaneous bleeding

79
Q

what is the therapeutic range for INR for DVT prophylaxis?

A

1.5-2.0

80
Q

what is the therapeutic range for INR for hx of TIA or CVA?

A

2.5-3.5

81
Q

what is the therapeutic range for INR for PE?

A

2.5-3.5

82
Q

what is the therapeutic range for DVT, a-fib, mechanical heart valve, orthopedic surgery?

A

2-3 hours

83
Q

when a pt is on Coumadin, why are they usually given a heparin drip too?

A

bc it takes a few days to work

84
Q

do we typically look at Coumadin and INR when mobilizing pts?

A

nope

85
Q

when a pt w/a non-massive, low risk PE reaches therapeutic threshold of anticoagulant medication, should we mobilize the pts?

A

yup!

86
Q

UE DVT is associated with what?

A

cancer and use of indwelling central venous catheters

87
Q

what are the s/s of UE DVT?

A

swelling, pain, edema, cyanosis, dilation of superficial veins (similar to LE DVT)

88
Q

t/f: there is risk for PE with UE DVTs

A

true

89
Q

if a pt presents with s/s of an UE DVT, what should we do?

A

use clinical tools to assess likelihood of DVT

90
Q

if UE DVT is confirmed, when can we begin UE activities?

A

when therapeutic anticoagulation is achieved (use the same decision tree as LE DVT)

91
Q

what does a PICC line put someone at risk for?

A

UE DVT

92
Q

what population is a common group to see UE DVTs in?

A

cancer pts bc of PICC line use for treatments

93
Q

what is an IVC filter?

A

an inferior vena cava filter placed in the inferior vena cava to catch clots b4 they can reach the lungs and cause a PE

94
Q

who are IVC filters used for?

A

those who can’t be anticoagulated

95
Q

when can we mobilize a pt after they have an IVC filter placed?

A

once hemodynamically stable and no bleeding at the puncture site

96
Q

what should we do for a pt w/DVT below the knee who aren’t anticoagulated and don’t have an IVC filter?

A

discuss the risk vs benefit of mobility w/the pt and medical team

97
Q

what population will often not be anticoagulated or have an IVC filter placed when there is a DVT?

A

oncology pts

98
Q

when we have a pt w/DVT below the knee who aren’t anticoagulated and don’t have an IVC filter, what is usually the ultimate decision made?

A

to still mobilize them

99
Q

when is compression recommended?

A

when a person is high-risk of VTE to prevent a DVT

when symptoms of PTS, esp pain and swelling, are present

100
Q

t/f: compression helps prevent PTS

A

false, we don’t really know if it does or not

101
Q

t/f: there is good evidence that mechanical compression can prevent DVTs

A

true

102
Q

what characteristics of arterial insufficiency can we gain from the pt interview?

A

intermittent claudication

pain with elevation

relief of pain with dependency

103
Q

what is the intermittent claudication pain seen in arterial insufficiency?

A

LE pain w/exertion

reproducible (after a predictable distance or effort every time)

104
Q

why is there pain with elevation in arterial insufficiency?

A

bc it makes it harder to push blood through the arteries to get to the end of the extremity

ischemic pain

105
Q

what are the signs of arterial insufficiency?

A

cool skin

pale skin

shiny skin

dry skin

absent hair

brittle nails

106
Q

what does capillary refill assess?

A

peripheral arterial flow

107
Q

what is the technique for capillary refill?

A

compress the nail bed or finger pad

release when it turns white

time how long it takes to return to normal

108
Q

what is a positive result from capillary refill test?

A

when it takes >2 seconds

109
Q

what may a positive capillary refill test indicate?

A

PVD, shock, hypothermia, cool ambient temperature

older age

dehydration

110
Q

what are the peripheral pulses?

A

brachial
radial
carotid
femoral
popliteal
posterior tibialis
dorsalis pedis

111
Q

when we palpate peripheral pulses, what are we feeling for?

A

rate, rhythm (regular, regularly irregular, irregularly irregular), quality (absent, weak, normal, bounding)

112
Q

B/L coolness and diminished pulses may indicate what?

A

a more global effect (cold environment, anxiety, etc)

113
Q

where do we palpate the brachial artery?

A

medial antecubital fossa

UE supported w/elbow slightly flexed

114
Q

where do we palpate the radial artery?

A

distal radius at the base of the thumb

115
Q

where do we palpate the carotid artery?

A

bw the trachea and the medial border of the SCM

116
Q

where do we palpate the femoral artery?

A

midpoint bw the ASIS and pubic symphysis in supine

117
Q

where do we palpate the popliteal artery?

A

inferior popliteal fossa

deep

supine/prone with knee in relaxed flexed position

use 2 hands

118
Q

where do we palpate the posterior tibialis artery?

A

posterior to the medial malleolus

119
Q

where do we palpate the dorsalis pedis?

A

dorsal, medial aspect of the foot

lateral to the hallux extensor tendon

ankle slightly DFed

120
Q

which pulse is congenitally absent in some individuals?

A

dorsalis pedis

121
Q

what characteristics of venous insufficiency can be gained from the pt interview?

A

pain with dependency

pain relief with elevation

edema

122
Q

venous insufficiency is typically caused by what?

A

failure of the valves in the veins

123
Q

why is there pain with dependency in venous insufficiency?

A

bc it causes blood pooling and edema that leads to pain

124
Q

what are the signs of venous insufficiency?

A

edema

scaling skin

hardened skin

skin discoloration (ruddy and hemosiderin staining)

visible superficial veins

125
Q

what is the exercise intervention for arterial insufficiency?

A

supervised exercise programs that induce claudication pain

126
Q

what do supervised exercise programs do for arterial insufficiency?

A

they increase QOL and fxnal status for people with intermittent claudication

127
Q

what is the current main intervention for arterial insufficiency?

A

surgical intervention

128
Q

what is the strongest recommendation for intervention for arterial insufficiency?

A

supervised exercise program

129
Q

supervised exercise programs for arterial insufficiency are preferred in what settings?

A

hospital/outpatient settings but can be home based

130
Q

why don’t people with arterial insufficiency like supervised exercise programs?

A

bc it involved inducing their pain

131
Q

what is the frequency, intensity, timing, and type of exercise for supervised exercise programs for arterial insufficiency?

A

mod to max claudication pain 2-5x for 30-45 minutes at least 3x/week

walking, interval training

132
Q

what is the gold standard for walking in the supervised exercise program for arterial insufficiency?

A

treadmill walking

133
Q

what is a 0 claudication pain?

A

no claudication pain

134
Q

what is a 1 claudication pain?

A

initial minimal pain

135
Q

what is a 2 claudication pain?

A

moderate, bothersome pain

136
Q

what is a 3 claudication pain?

A

intense pain

137
Q

what is a 4 claudication pain?

A

max pain, can’t continue

138
Q

what is the range for claudication pain we want to induce with supervised exercise programs for arterial insufficiency?

A

2-3 pain (moderate to intense)

139
Q

what causes arterial insufficiency?

A

atherosclerosis

140
Q

what are the considerations for post-op revascularization?

A

check for bed rest or WB precautions

check for BP goals (many with have hypertensive responses)

monitor BP

pain (make sure they have adequate pain control)

signs of SC ischemia if the aorta is involved

141
Q

what are red flags for SC ischemia post-op revascularization?

A

decreased LE and saddle sensation

decreased mobility of the LEs

142
Q

what are the interventions for venous insufficiency?

A

muscles activation to pump blood back to the heart

compression wraps

143
Q

why is chart review and physical exam so important when it comes to using compression wraps?

A

bc they indicated for venous insufficiency but contraindicated for HF, both of which can present with edema

DPT 629: Cardio (11 decks)

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