Skin changes Flashcards
Arterial occlusions cause what?
6 P’s , which reflect blood loss and can cause amputation
- Paresthesia
- Perishing cold,
- Pulselessness
- Pain
- Paralysis
- Pallor/pale
___________ and _________ can indicate poor venous return d/t incompetent valves in veins => backflow and dilation of of vessels
- Superficial variscosities
- Edema
What are Superficial variscosities?
- small, irregular blue lines that indicate venous congestion
What contributes to poor venous return?
Systemic HTN
Chronic venous changes: _____________
superficial varicosities and edema
Stasis dermatitis: red/brown/prurple discoloration that develops overtime (chronic) due hemosiderin deposits from RBC breakdown
How does stasis dermatitis occur?
decrease flow or statsis on venous side of circulation
As stasis dermatitis becomes advanced, what changes do we see?
- Skin is thick and firm
- If swollen, called “brawny edema”
what are signs of venous insuff?
- 1. edema
- 2. varicose veins
- 3. skin changes and discoloration (stasis dermatitis)
- 4. skin ulceration
What is Cellulitis
acute or chronic?
Chronic Inflammation of skin and subcutaneous tissue that is most often infectious.
Skin is red, warm, swollen, and weeping w/o open sores.
bacterial endocarditis causes what skin changes?
- Acute janeway lesions; irregular macules on soles and palms that are NON-tender
- Last days- weeks
bacterial endocarditis causes what to appear on fingers and toes?
Acute Osler nodes that are 1mm - over 1 cm nodes that are tender and last hours -days
Bacterial endocarditis causes what on the periphery of nail beds?
Splinter hemorrhages: microemboli from vavular pathology
if splinter hemorrhages are isolated or minimal, they are most likely due to what
nail trauma
Whta is the most common form of xanthoma (lipid deposits due hyperlipidemia)?
chronic or acute?
Chronic
Xanthelmas palpebra: on eyelid
what lesions occur in patients in some patients with hyperlipidemia on the shoulder?
acute or chronic?
eruptive xanthomas, which are umbilicated lesions (dent in center)
chronic
eruptive xanthomas can look like ___________. If seen, what should we do?
molluscum contagiosum (viral infection)
check cholesterol and other screenings
what chronic skin change can occur in COPD?
clubbing,
what contributes to clubbing?
- Peripheral hypoxia
- Platelet and endothelial growth factors
Vascular claudication
How does it change after walking?
What makes it better?
What makes it worse?
Pulses?
- doesnt change after walking
- stopping activity makes it better
- walking uphill or increased metabolic demands makes it worse
- no pulses
Neurogenic claudication
How does it change after walking?
What makes it better?
What makes it worse?
Pulses?
- Weaker after walking
- Bending over (like on grocery cart, bike) or sitting (generally foward) takes pressure off nerves and makes better
- Worse: walking downhill (leaning forward) or increased lordosis
- Pulses are present
who produces purent sputum and a cough
chronic bronchitis or emphysema?
chronic bronchitis
with emphysema; pts have SOB and little cough
central vascular disease affects what?
aorta, IVC, major organ vessels
Determine risk factors for peripheral and central vascular disease
- nicotene
- vaping
- sedentary life
- obesity
- diet
- HTN/hyperlipidemia
- DB
- FHx
- Genetic predispotion (Buregers)
- alchol
how does alcohol excess cause problems
- cardiomyopathy and mT/endothelial dysfunction
- Dehydrates, causes slugding or impairment of good BF in vasculature
LO # 6: Formulate a plan to implement Therapeutic Lifestyle Changes (tlc) to modify symptoms and slow progression
- •Smoking cessation
- •Exercise
- •Weight loss
- •Support hose (stockings)
- •Compression hose (stockings)
- •Psychosocial support – multidisciplinary approach
- •Follow-up regularly (eg every 3 months) to monitor for changes and encourage patient, and re-enforce/revise plan of care
how do we LO # 6-a: Prioritize step-wise behavior modification to optimize patient success
- work with pt to ask which is the most managable to start with
- may need measures, like meds, BUT INVOLVE THE PT!!!
-
increase pts info base and engangemnet by considering
- social serve
- PT
- OT
- couseling
- diet ed
- follow up
- set realistic goals
LO #7: Prioritize diagnostic evaluation (AFTER thorough H & P!) for possible further therapeutic intervention
- consider underlying risk factors for CP disease
- CBC, lipid panel, fasting glucose
- EKG, CXR
- Ankle/branchial index
- Venous/arterial doppler US based on US
- Radiology or cardiology for diagostic arteriogram and therapeatuic intervention
how to
- Create a plan to prevent complications
same as TLC, except ADD MEDS
Compression socks are based on what
amount of pressure desired (mmHg)
Which of the following findings on physical exam represents a risk factor for cardiopulmonary disease?
A. Xanthelasma
B. Splinter hemorrhages
C. Osler’s nodes
D. Janeway lesions
E. Cellulitis
A
Which of the following is the most cost effective and safest diagnostic modality for cardiopulmonary disease?
A. Doppler ultrasound
B. Arteriogram
C. MRI
D. CT scan
E. PET scan
A
