Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Integ - PTH 703 - Unit 1 > PVD and Vascular Wounds > Flashcards

PVD and Vascular Wounds Flashcards

1
Q

In Maine, what kind of tissue can PTs debride?

A

They can debride necrotic tissue; no healthy tissue. There should be NO bleeding

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are signs of arterial insufficiency?

A 
Dependent rubor
Slow nail growth
Faint pulses, or absent. (e.g. Dorsal Pedal)
Skin is cool, pale, and shiny (atrophic)
Loss of hair
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

How fast to fingernails grow?

A

3mm / month on average

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What causes pain during intermittent claudication?

A

Too little blood flow, usually during exercise. Usually affects the blood vessels in the legs. May progress to pain at rest

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the most significant arterial disease associated with ulcer development?

A

Atherosclerosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are warning signs for atherosclerosis, if symptomatic?

A

Mild - intermittent cluadication
Severe - rest pain
Lying down at night; pain in a dependent position

Risks: age, male, cigs, DM, HTN, hyperlipoproteinemia, elevated WBC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the difference between IC and lateral stenosis?

A

During treadmill test (PAD):

IC - 10 mins, pain, but relief w/ sitting. Walks less after incline

LS - 10 mins, pain. Relief w/ sitting. But will walk equal or more when inclined (due to the spine being flexed)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Is DM a risk factor for PAD

A

Yes

More common, earlier onset, more rapid, bilateral.
2:1 in Males with DM

(without DM, 30:1 M:F)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Where do arterial ulcers develop?

A

Distal extremities first

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the characteristics for arterial ulcers?

A

Edges are well-demarcated
Base of ulcer is pale and dry
Minimal drainage
No granulation tissue present (no blood flow to promote proliferation)
May be area of wet necrosis or a dry scab (you don’t want arterial ulcers to get wet?)
Periwound may be black, gangrenous

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is the first step in treating an arterial wound?

A

See if you can treat the underlying cause first!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Are arterial ulcers painful

A

Usually, yes.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Clinical tests for an arterial ulcer?

A 
Peripheral pulses - doppler
ABIs
Rubor of Dependency
Capillary Refill
Venous Refill
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

How do you grade peripheral pulses??

A 
0 - absent
1+ - thready
2+ - weak
3+ - normal
4+ - bounding
post tib and dorsal pedis are most important)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

How to calculate ABI?

A

systolic LE / systolic UE

Use HIGHER UE value after testing each arm
Use LE value of the side you want to check
*Can also try exercise ABI
*Check pressure afterwards with a doppler

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Why is it bad if ABI is > 1.2?

A

Incompressible arteries. You want it between 0.8-1.0

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is triphasic doppler sound?

A

The result of the combination of ventricular systole, elasticity of the blood vessles, and backflow caused by the closing of the semilunar valves - best

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Biphasic sounds?

A

Occurs in more distal blood vessels as the result of ventricular systole and the elasticity of the blood vessels

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Monophasic sounds?

A

Occurs when the flow of blood is no longer pulsatile - bad

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

How to test rubor of dependency?

A

Patient is supine
-Observe plantar aspect of the foot for color

Elevate to 60 degrees (hip flexion with knee extension) for one minute. Foot should not go pale (stop if pain reported)

45-60 sec = mild arterial insufficiency
30-45 = moderate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is dependent rubor?

A

Reactive hyperemia - dilated vessels get “rush of blood”

Dependent rubor is a fiery to dusky-red coloration visible when the leg is in a dependent position but not when it’s elevated above the heart. The underlying cause is peripheral arterial disease (PAD), so the extremity is cool to the touch.

22
Q

How to test capillary refill?

A

Observe color of distal great toe, push with enough pressure to blanch

After releasing, return of color should be less than 3 seconds

23
Q

What’s the deal with Venous Refill? How do you test it?

A

Only valid test of arterial blood flow IF pt doesn’t have venous insufficiency - still relevant for someone with arterial insufficiency

Supine, observe DORSAL aspect of foot for colors / veins
-Elevate to 60 degrees for one minute. Then place patient in dependent position (seated) and WATCH FOR FILL TIME!

20 ( or >30) seconds = arterial insufficiency

24
Q

Lab tests for venous REFILL?

A 
ABIs
Toe-Brachial Index
Transcutaneous partial pressure of oxygen (TcPO2) / Transcutaneous Oxygen Measurement (TCOM)
Doppler Imaging
(Imaging w/ contrast
-Arteriogram (Radiograph)
-Computed tomography angiography (CTA)
-Magnetic resonance angiography (MRA)
25
Q

TcPO2 - what do the results mean?

A

LEss than 20 mmHg = significantly impaired bloodflow with little to no healing expected

Above 30 mmHg = adequate bloodflow for healing

Above 40 mmHg = normal

26
Q

How to treat Arterial Insufficency?

A 
Walking program (see Bb file)
Hyperbaric oxygen - 100% O2 (5x week for 3-4 hours for 1+ months - may need long-term housing)
Medical - meds
Surgical - stents and bypass grafts
27
Q

Benefits of hyperbaric oxygen?

A

Enhances fibroblast activity
Promotes collagen synthesis
Neovascularization
Increase in tissue O2 is beneficial to leukocytes and acts as antimicrobial would

Remimbursed for DFU Stage 3+ and CO poisoning

28
Q

How do you treat Arterial Ulcers?

A

Protect from pressure (bed rest, off-loading, positioning)

Increase blood flow / oxygen

  • Hyperbaric oxygen
  • Arterial bypass
  • Angioplasty and stents

Wound care

  • ISCHEMIC ULCERS SHOULD BE KEPT DRY
  • Ischemic tissue macerates in water and promotes bacterial growth
29
Q

Arterial Wounds?

A

High risk of infection

If the eschar is dry, stable, and no signs and symptoms of infection: dress and protect with a DRY dressing (e.g. non-adhereant foam) - not broke, don’t fix it.

If there is significant oxygen perfusion distal to the site indicating adequate blood flow (ABI > 0.8): proceed with DEBRIDEMENT and MOIST wound healing
-Never debride if you are not sure what is underneath

30
Q

Dressings for Arterial Ulcers?

A

Dry, foam non-adhereant if covering stable uninfected eschar

Dressings with antimicrobials impregnated desirable due to high-risk of infection in arterial wounds

Be careful about using dressings that add moisture or are occlusive as this can increase the likelihood of infection in necrotic tissue

31
Q

What is Venous stasis?

A

Venous blood flow insufficiency - permanent damage to the vein

Compression will help blood flow back to the heart. Can use mechanical debridement?

80% get better

Gravity keeps less in foot, veins cannot bring it back, pressure builds.

Shallow sore, uneven, inner lower leg near ankle

32
Q

What is the first sign of DVT?

A

Edema in the ankles at night.

Risk factors: overweight, heredity, pregnancy, lots of standing or sitting

33
Q

What is Venous Hypertension?

A 
Normal venous pressure is 60-90 mmHg in foot veins (in standing)
-Venous hypertension is >90mmHg
Causes:
-Thombolitic
-Obstruction
34
Q

What is Chronic Venous Hypertension?

A

Failure of the system to reduce venous pressure

Early signs: Varicosities

Late signs: pitting edema

  • Lipodermatosclerosis / fibrotic tissue
  • Hemosiderin staining
  • White plague
35
Q

First complaint of venous insufficency?

A

Swelling of legs that is relieved with elevation

Mechanical insufficiency:
-High ambulatory venous pressure
Failure of valves, valf mm

36
Q

Characteristics of Venous Ulcers?

A

Pathogenesis unclear

Wounds found on distal, medial 3rd of LE prox to medial malleolus

Characteristics:
-Irregular shape
Shallow
Granulation tissue present, pink to red
Borders are flat
Wet, excessive drainage
37
Q

Lab tests for venous insuffiency?

A

Venous plethysmography - test of venous refill time
Venous Doppler scanning
Venography

38
Q

Compression therapy for Venous Ulcers?

A

Short-stretch bandages improve calf-pump during ambulation by containing the muscle against the valves, but MUST have adeqaute arterial blood flow before you compress.

Wound care:

  • Typically need absorptive dressings because of exudate
  • Foam, calcium alginate, hydrofiber, hydrocolloid

This is different than an ACE wrap. An ACE wrap loosens with activity. This is like an extra layer of muscle

39
Q

How do Unna Boots work?

A

Semirigid dressing of gelatin / zinc oxide / calamine - like a cast. Improves calf pump and reduces edema; can be placed directly on the wound

Least expensive, no dressing needed on wound itself - depends on amount of exudate

40
Q

Coban 2?

A

Easy to put on, can wear own shoes and clothing. 2-layer system (see lab for full details)

41
Q

Profore?

A

4-layer. see lab for full details

42
Q

What is Intermittent Pneumatic Compression?

A

Intermittent pneumatic compression is a therapeutic technique used in medical devices that include an air pump and inflatable auxiliary sleeves, gloves or boots in a system designed to improve venous circulation in the limbs of patients who suffer edema or the risk of deep vein thrombosis (DVT) or pulmonary embolism (PE).[1]

Indications?

Contrainidcations (absolute and relative)

  • DVT
  • ABI
43
Q

IS arterial or venous more common?

A

Venous. 1 in 4 have it

44
Q

How does ambulatory exercise training work for IC?

A

Walk 5 min at 2 mph at 12% incline - measure arm and ankle pressures ever 2 min until return to baseline or 20 min.

45
Q

What are the goals of this ex program? When do you see benefits?

A

Relieve IC sx, restore ex capacity, decrease CV disease risk. You will see benefits in 1-2 months

*See Bb sheet for full details; likely will be Qs from there

46
Q

Should you have cool downs and warm ups with Ambulatory Exercise Training for Intermittent Claudication?

A

Yes, 5-10 mins each

47
Q

Does the patient rest in sitting or standing with Ambulatory Exercise Training for Intermittent Claudication?

A

Either, until pain subsides. Then repeat ex-rest-ex cycles

48
Q

How far into Ambulatory Exercise Training for Intermittent Claudication are you trying to elicit symptoms?

A

3-5 mins

49
Q

How long is each session for Ambulatory Exercise Training for Intermittent Claudication?

A

first session = 35 mins
-Each session increased 5 mins until 50 mins of intermittent walking is achieved

Program continues 2-3 months or until functional goals are met (patient can exercise without supervision)

50
Q

Wait pain level on the VAS do you want to achieve?

A

8/10.

Integ - PTH 703 - Unit 1 (9 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions