SPE # 2 Flashcards
Possible risk factors/histories that may contribute to DVT (11)
prior DVT
hx cancer, sx or lupus
major infection, sx, trauma
chemotherapy
pregnancy
immobility
use of oral contraceptives
genetic clotting disorder
what would a pt with DVT possible tell you from a history stand point
gradual onset
dull ache/tightness and pain in calf (or other region)
possibly some swelling
symptoms worse with walking and dependent position (i.e. when leg is hanging down)
rest/elevation makes better but relief is consistently lessening
possible red/warm
questions specific to DVT CDRs to ask pts
any hx of cancer
any paralisis or recent immobilization
have you recently been bedridden
noticed any swelling? if so whole leg or just calf?
can you see any new veins on your legs
pitting edema (have you noticed if you poke your leg does it leave a mark?)
what path does the pain travel?
referral for DVT
urgent if less than 2 CDRs
emergency if 3 or more CDRs
risk factors for PAD
over 45
family hx of MI or sudden death before 55
smoking
physical inactivity
metabolic syndrome (CHECK THE COMPONENTS)
S&S of PAD
LE pain (usually calf) with activity and elevation; can be unilateral or bilateral
gets better with rest and dependent (hanging) position
described as cramping/weakness/pressure/aching
if severe pain may occur at rest
noticeable signs distal to ischemic area from lack of blood flow
what might you see distal to the ischemic area with PAD
loss of pulses
TTP
muscle atrophy/weakness
loss of hair
cool/blue skin
bruit with ausculation
possible wound/necrosis
what test might you preform to assess for PAD
ankle brachial test
post tib and brachial aa systolic ratio
less than 0.9 is bad; lower = worse
over 1.4 indicates compressed veins
how to differentiate between PAD and lumbar stenosis
lumbar with bicycle test; gets better with flexion
DVT is better with elevation
PAD is worse with elevation
PAD referral
urgent to vascular MD
questions specific to PAD
do you smoke?
how often do you exercise?
any family hx of sudden death/MI?
personal medical hx? (metabolic?)
where is pain?
is it worse or better with elevation?
have you noticed any changes in your foot?( I.e. cold, loss of hair, sores, weakness, etc)
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Questions specific to osetonecrosis about Risk factors
any vascular diseases?
history of radiation/alcohol/smoking use?
hx of sickle cell disease?
any use of contraceptives or corticosteroids?
any hx of bone marrow pathologies?
metabolic hx?
S&S of osteonecrosis
groin/anteromedial thigh pain; could go to knee
onset sudden if trauma; if gradual symptoms are intermittent but worsening
can affect gait
referral for osteonecrosis
urgent to MD
S&S for chondrosarcoma
progressive/localized pain and swelling
cancer S&S
fx S&S if advanced
may be mechanical
