URR Signs and Symptoms of Venous Disease

Question 1

risk factors?

Answer 1

-high risk for DVT (#1 is recent hip or knee replacement, and bed rest)
-increased incidence of left DVT due to extrinsic compression by right iliac artery
-economy class syndrome (long distance travel while seated in a cramped area; causes venous stasis and increases the risk of DVT formation
-smoking has demonstrated an increased risk of DVT formation, especially when accompanied with oral contraceptive use and or sedentary lifestyle

Question 2

what is may-thurner syndrome

Answer 2

left DVT due to extrinsic compression by right iliac artery

Question 3

what is virchows triad?

Answer 3

-trauma (endothelial damage, intrinsic drugs or extrinsic falling down
-stasis -bed rest, MI, CHF, COPD, hypotension, obesity, pregnancy, surgery, paraplegia
-hypercoagulability (pregnancy, cancer treatment, estrogen intake, myeloproliferative disorders, polycythemia vera

Question 4

signs and symptoms of venous disease

Answer 4

-pain
-homan sign
-swelling
-redness/rubor (most commonly seen w/ cellulitis but can be seen w/ DVT
-warmth
-pitting edema
-pallor w/ phlegmasia alba dolens
-cyanosis w/ phlegmasia cerulea dolens
-venous HTN
-hyperpigmentation
-ulcers
-venous gangrene

Question 4

what is homan sign?

Answer 4

pain experienced w/ quick dorsiflexion of the foot

Question 5

what can cause lower swelling?

Answer 5

-acute unilateral DVT usually presents w/ 2 cm difference in calf circumference
-DVT causes acute swelling in the leg that starts at the ankle
-bilat lower extrem edema that starts at the foot is usually due to CHF
-lymphedema can also cause leg and foot swelling, usually unilateral
-chronic swelling is a symptom of insufficiency

Question 6

what is pitting edema and nonpitting edema?

Answer 6

-occurs w/ fluid accumulation from thrombosis, electrolyte imbalance, renal dysfunction or CHF
-press finger on the leg in the area of edema and when the finger is removed a depression remains in the leg
-the length of time that the depression remains indicates the severity of the edema
nonpitting=
-lymphedema occurs due to obstruction of the lymphatic system
-fluid accumulation leads to foot and leg edema that will resist depression and pulls the skin taught
-elevating the leg does NOT alleviate the fluid retention

Question 7

how often do you see venous ulcers of the lower extrem?

Answer 7

75% lower extrem ulcers are venous; insufficiency of the posterior arch vein is the most common cause of a venous stasis ulcer
-wet, oozing, usually NOT painful
-caused by chronic venous disease
-stagnant blood causes RBC and fluids to leak into tissues
-brawny color in “gaitor zone” from broken down RBCs and improper tissue nutrition

Question 8

difference between arterial gangrene and venous?

Answer 8

venous usually involves the foot and all toes, while arterial gangrene usually involves one or two toes

Question 9

what is a ddimer

Answer 9

-measures the amount of fibrin in the blood
-increased levels can indicate DVt
-also increases w/ pregnancy, malignancy, recent surgery, trauma
-more accurate predictor of negative DVT diagnosis (higher negative predictive value) than for a positive diagnosis due to numerous other conditions that elevate the D-dimer level
-normal ( < 500 ng/ml)
-abnormal (>500 ng/ml)