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536 Body Systems > Vascular > Flashcards

Vascular Flashcards

1
Q

layers of blood vessels include:

A

tunica externa: adventitia - outer layer to support and shape
tunica media: elastic/muscular
tunica intima: inner layer of endothelial tissue, smooth to reduce friction
lumen: hollow passageway

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2
Q

how much of the blood supply is in the arterial system?

A

10-15%

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3
Q

elastic vs muscular arteries

A

elastic closer to heart
muscular: femoral, brachial, radial

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4
Q

function of arterioles

A

supply blood to organs
use smooth muscle responding to ANS input
create peripheral resistance

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5
Q

function of capillaries

A

O2 and nutrient exchange
sphincter between arterial and venous

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6
Q

function of venuoles

A

receive blood from capillaries
part of nutrient exchange
can rupture to form varicose veins

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7
Q

function of veins

A

less pressure than arteries
thin wall
elastic
large capacity
one way valves, aided by muscle contraction

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8
Q

how much blood is in venous system?

A

75%

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9
Q

PVD umbrella term includes

A

aorta diseases: aneurysm, dissection, obstruction
PAD
venous diseases
vasospasms

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10
Q

aortic aneurysm cause

A

infection
trauma
cath puncture
associated with: connective tissue disorders, vasculitis, atherosclerosis, trauma/aortic dissection

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11
Q

% dilation of aneurysm

A

at least 50%

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12
Q

true aneurysm

A

involving all 3 layers of vessel

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13
Q

pseudoaneurysm

A

contained rupture of vessel lumen
blood leaks out of intima and media layers into externa
prone to rupture

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14
Q

aortic aneurysm clinical presentation

A

asymtomatic
pulsatile mass
back pain
nausea
abdominal pain to flanks radiating to legs
malaise

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15
Q

risk factors for rupture of aortic aneurysm

A

Increasing size
Rapid expansion
Tobacco use – smoking cessation is the SINGLE MOST non-surgical intervention
Increasing or uncontrolled HTN
Cardiac or renal transplant due to steroids for immunosuppression
COPD (whether or not they have quit smoking) - ? Due to increased intrathoracic pressure
Female&raquo_space; strong predictor; even though lower incidence overall - ?
Decreased tensile strength and increased wall stress in women
Recent surgery of all kinds> ? Overall stress of surgery

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16
Q

diagnose aortic aneurysm

A

imaging, incidental
abdominal palpation
Screening

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17
Q

aortic dissection

A

tear in intima/media spreading along artery, can lead to rupture
life threatening

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18
Q

aortic dissection risk factors

A

atherosclerosis
blunt trauma to chest
HTN

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19
Q

clinical presentation of aortic dissection

A

hypoperfusion signs
nausea/vomiting
rapid/weak pulse

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20
Q

pathophys of PAD

A

atherosclerosis of peripheral arteries reducing diameter and O2 to LE
during exercise muscles get ischemic when body can’t compensate by dilation of vessels

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21
Q

risk factors for PAD

A

CAD/atherosclerosis
advanced age
hypercholesterolemia
smoking
HTN
diabetes
overweight
family history

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22
Q

pt history indicating PAD

A

claudication
impaired walking function
ischemic rest pain
abn lower pulses
non healing LE wounds
gangrene
palor/rubor abn

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23
Q

clinical presentation of PAD

A

often aorta, femoral, popliteal
intermittent claudication, atypical pain, or asymptomatic
symptoms distal to stenotic area
can have ulceration/infection with chronic
diminished pulses
atrophy
palor when elevated
rubor of dependency
trophic changes
reduced sensation

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24
Q

ACSM intermittent claudication scale

A
  1. discomfort
  2. mod discomfort
  3. intense pain
  4. unbearable pain
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25
Q

ABI values

A

> 1.1: normal, no symptoms
.5-1: claudication, calf pain while walking
.2-.5: critical limb ischemia, atrophy, pain at rest, wounds
<.2: severe ischemia, gangrene, necrosis

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26
Q

grading of pulses

A

0: absent
1+: diminished
2+: expected
3+: full/normal
4+ bounding

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27
Q

critical limb ischemia and phases of progression

A

PAD progression so circulation can’t meet metabolic needs at rest
1. at first body will compensate then wounds will form as blood is shunted to muscle
2. pain with exercise
3. resting pain, non healing wounds, gangrene

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28
Q

acute cold leg

A

vascular emergency
acute arterial occlusion due to embolism, often femoral a.
high risk of amputation

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29
Q

s/s acute cold leg

A

sudden onset (perishingly) cold, pale, pulseless, pain, parasthesia, paralytic
6 Ps

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30
Q

acute cold leg treatment

A

revascularize
embolectomy, thrombolysis, angioplasty, bypass surgery
amputation if leg is mottled, non blanching, woody

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31
Q

phases of acute cold leg viability - arterial and venous dopplers

A

arterial doppler only heard on viable limb with no threat
venous doppler heard on viable, marginally threatened, and immediately threatened limbs, absent on irreversible damage

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32
Q

ACSM recommendations PAD

A

aerobic: 3-5x week, RPE 12-16, 20-60 min
elicit claudication in 3-5 min of walking, rest once at moderate severity
resistance: 2x week, emphasis on LE
flexibility: 2-3x week

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33
Q

supervised exercise for PAD benefits

A

supervised exercise equivalent positive effect to stenting with mod PAD
lasted 1 year beyond

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34
Q

angioplasty for PAD

A

immediate improvement in claudication, heals distal wounds, resume exercise 72 hours post

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35
Q

bypass surgery for PAD

A

harvest vein from another part of the leg
resolve symptoms, OOB day 1, limit on lifting for 6 weeks

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36
Q

femoral popliteal bypass for PAD

A

used for critical limb ischemia
OOB day 1, return to activity after limb healing

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37
Q

superficial, communicating, deep veins, percentage of blood carried?

A

superficial contain 10-15% of LE blood, drain in communicating veins
drain into deep veins which carry 85-90% of blood back to heart

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38
Q

risk factors for venous disorders

A

prior hx of blood clot
family hx
obesity
pregnancy
prolonged standing
hx of ankle injury/immobility
trauma
illness
surgery
lifestyle

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39
Q

clinical presentation of venous disorders generally includes:

A

edema in LE
fatigue
LE heaviness
hemosiderin staining
warmth
ulcers/wounds above the ankle
frequent infections

40
Q

varicose veins

A

dilated tortuous superficial veins
caused by intrinsic weakness in vessel wall increasing pressure/volume overload
also trauma

41
Q

risk factors for varicose veins

A

female 2-3x
pregnancy
obesity
family hx
prolonged standing
hx of infection

42
Q

s/s of varicose veins

A

heaviness
dull ache
bulging veins
local hematoma

43
Q

stages of varicose veins

A
  1. reticular/spider veins
  2. varicose
  3. edema
  4. venous ulcer
44
Q

manage varicose veins

A

compression stockings
elevation
manage edema
avoid prolonged standing
sclerotherapy IV injection
endovenous thermal ablation w laser
surgical ligation/removal

45
Q

VTE - venous thromboembolism

A

DVT blood clot in deep vein
can also include PE in lungs

46
Q

pathogenesis of VTE

A

virchow’s triad of venous stasis, vascular injury, and hypercoagulability
this triggers coagulation cascade in response to tissue bleeding
happens in areas of altered blood flow

47
Q

risk factors for DVT

A

post op
obesity
pregnancy
post partum
HF, respiratory failure
tobacco
oral contraceptives
cancer/chemo
prolonged travel
trauma
diabetes/HTN/CVA/SCI
varicose veins
increasing age

48
Q

risk factors of UE DVT

A

central venous catheters
PICC lines
pacemaker insertion

49
Q

s/s of LE DVT

A

UL edema
tenderness/pain in leg/calf
warmth/erythma
fever
cognitive changes in elderly

50
Q

testing to diagnose DVT

A

serum D-Dimer: degradation of fibrin, normal test excludes and abn requires more testing
Doppler US: 95% sensitive proximal veins, 75% calf veins
MRI/contrast venography

51
Q

Well’s clinical prediction rule for DVT

A

+1 active cancer
+1 paralysis/immobilization of LE
+1 bedridden 3+ days within 4 weeks
+1 localized tenderness along deep veins
+1 entire leg swollen
+1 UL calf swelling
+1 UL edema
+1 collateral superficial veins
-2 alt diagnosis as likely or more as DVT
2+ = DVT likely

52
Q

UE DVT clinical prediction rule

A

+1 venous material in subclavian/jugular OR pacemaker
+1 localized arm pain
+1 UL pitting edema
-1 alt diagnosis as likely or more
highly likely if 2+

53
Q

Homan’s sign

A

passive DF and squeeze calf
not reliable for DVT

54
Q

DVT treatment

A

compression stockings/compression
anti-coagulation meds (heparin/coumadin) continued at least 3 mo
consider IVC filter if anticoagulation not possible

55
Q

When to mobilize after meds administered

A

LMWH/heparin: 3-5 check w doc, 5+ hours
fondaparinus: 2-3 check w doc, 3+ hours
UFH: 24-48 check w doc, 48+ hours
NOAC: 2-3 check w doc, 3+ hours
Coumadin: when INR 2-5
Mobilize if IFC filter in place

56
Q

guidelines for mobilizing with DVT

A

needs to be anticoagulated or on IVC filter

57
Q

IVC filter

A

prevents DVT from becoming PE by traveling
placed in IVC above level of clot

58
Q

CPG takeaways on DVT

A

early mobilization = prevention, safety in parameters
stratify risk for those w reduced mobility, post op
assess risk factors in high risk pts
provide prevention measures for those high risk for VTE
Use Wells score for LE DVT liklihood
Establish likelihood of UE DVT when pt presents with symptoms
establish likelihood of PE w symptoms by clinical prediction
confirm pharm management before mobilization, wait until therapeutic levels achieved
allow UE activites w UE DVT when therapeutic level of anticoagulation
mechanical compression not recommended for new DVT
mobilize w IVC filter
mobilize PE when anticoagulation therapeutic level achieved

59
Q

Padua prediction score

A

+3 active cancer
+3 previous VTE
+3 thrombophilia
+3 reduced mobility
+2 trauma/surgery within the month
+1 elderly
+1 acute MI/stroke
+1 acute infection
+1 obesity
+1 hormone treatment
high risk VTE = 4+

60
Q

Khorana risk score for VTE

A

VTE depending on cancer and other factors
site of cancer
+2 stomach, pancreas
+1 lung, lymphoma, gyn, bladder, testes
+1 pre chemo platelet count
+1 prechemo hemoglobin
+1 BMI
1-2 med risk
high risk 3+

61
Q

post thrombotic syndrome

A

permanent damage to vein valves causing reflux of blood in venous system
causes venous hypertension reducing muscle perfusion, increases tissue permeability

62
Q

s/s of post thrombotic syndrome

A

chronic aching arm or leg pain, intractable edema, limb heaviness, leg ulcers, skin changes, heaviness in limb affected by DVT

63
Q

pulmonary embolism

A

clot breaking off from DVT traveling into IVC, throigh R heart into lungs

64
Q

PE s/s

A

dyspnea, pleuritic chest pain, hemoptysis, cough, syncope, tachypnea

65
Q

diagnose PE

A

same as DVT, EKG, CTA, v/q scan

66
Q

PE treatment

A

anticoagulation, thrombolytic therapy

67
Q

Well clinical prediction rule for PE

A

3+ clinical symptoms
3+ other diagnoses less likely than PE
1.5+ HR>100
1.5+ immobilization
1.5+ prev DVT, PE
+1 hemoptysis
+1 malignancy
>6 high risk
2-6 mod

68
Q

chronic venous insufficiency
S/s and associated with what symptoms?

A

valve incompetence/obstruction causing leaking and edema into surrounding tissues
associated with varicose veins, skin inflam, hyperpigmentation, ulcers

69
Q

treat chronic venous insufficiency

A

treat edema with diuretics,
antibiotics
compression
dressing changes for wounds

70
Q

types of compression wraps for edema

A

spiral wrap: 50% overlap of bandage for 2 layers
figure 8: 50% overlap provides 4 layers
compression stockings
unna boot w zinc oxide

71
Q

vascular examination: venous insufficiency Hx

A

chronic edema
slow healing
infections
varicose veins
pain in peripheral extremities
ask about alc/tobacco, HTN, diabteres, hyperlipidemia, ulcers

72
Q

vascular exam: arterial insufficiency Hx

A

aching/cramping distal limbs
poor wound healing
limited mobility due to claudication

73
Q

vascular exam: what to look for in inspection

A

skin color
edema
atrophy
venous patterns
varicose veins
skin changes
gait abnormalities

74
Q

inspection: arterial vs venous

A

venous: heme staining, edema, varicose veins, wounds malleolus and proximal, wet wounds, low pain
arterial: pale extremities, atrophy, malleolus and distal wounds, dry wounds, painful due to ischemia

75
Q

vascular exam: palpation

A

arterial: diminished pulses
venous: normal pulses
compare edema and pulses BL

76
Q

characteristics of venous wounds

A

wounds above malleolus
insidious wounds with skin color texture changes
uneven edges
shallow
minimal eschar
serous drainage
less painful

77
Q

characteristics of arterial wounds

A

on foot at pressure points
round punches out appearance
yellow/brown/black
skin pale
dry wound
deep
very painful
toenails brittle, yellow
diminished pulse
cold to touch around wound

78
Q

cellulitis

A

bacterial skin infection, not vascular

79
Q

s/s of cellulitis

A

red, expanding area, quickly
swelling
tenderness
pain
warmth
open wound
fever
red spots
blisters
skin dimpling

80
Q

cellulitis treatment

A

long term antibiotics, wound care, reduce edema

81
Q

raynaud’s disease

A

decreases blood supply to distal extremities affecting small arteries

82
Q

s/s raynaud’s

A

cold fingers/toes
color changes in skin with stress or cold
N/T in fingers/toes
stinging/throbbing pain w warming or stress relieved
ulcers

83
Q

causes of raynaud’s

A

atherosclerosis
drugs causing vasoconstriction
autoimmune conditions
smoking
repeated injury

84
Q

Buerger’s disease

A

inflammation and thrombosis of small veins and arteries
associated w smoking
often in males 20-40
distal to proximal

85
Q

s/s of Buerger’s disease

A

temp and color variance, pain in hands/feet, painful ulcers, pain while walking

86
Q

vascular exam: observation and palpation should include

A

skin color
temperature
available ROM
trophic changes
deformities and abnormalities

87
Q

capillary refill

A

squeeze plantar toe for 5 seconds
should refill in:
<1 s child
1 s adult
1.7 s elderly
concerning: male 2 s, female 2.8s, elderly 4.5s

88
Q

venous filling time test

A

mark prominent dorsal veins
start supine, elevate LE 45 degrees for 1-3 min
lower feet to dependent and measure time to filling of dorsal veins
rapid filling indicates venous disease
slow filling indicates arterial issue

89
Q

rubor of dependency

A

start supine, elevate LE 45 degrees for 1-3 min
lower feet to dependent and assess color
redness and histamine response indicates PAD

90
Q

intermittent claudication testing

A

have pt walk starting timer and measuring distance
mark time and distance of first claudication symptoms (ICD) and time/distance where they have to stop (ACD)

91
Q

Active pedal plantarflexion

A

do double leg heel raises, up to 50
measure ABI before and after
doing less than 33 with severe pain indicates PAD

92
Q

percussion test/tap test

A

assess venous system
place Doppler on saphenous vein, other on proximal area
percuss/tap vein
increase in blood flow heard on Doppler indicates incompetent veins/backflow

93
Q

Trendelenberg test

A

assess peripheral venous system to differentiate superficial/perforating incompetent veins
1. elevate LE 45 degrees for 1 min
2. tourniquet thigh
3. assist patient in standing rapidly
4. filling <5s=incompetent valves of deep veins
5. remove tourniquet, filling <5s, incompetent valves of superficial veins

94
Q

Stemmer’s sign

A

base of 2nd toe, pinch and pick up skin
+ unable, indicate lymphedema

95
Q

Allen test

A

do in 90/90 position for both radial and ulnar arteries

536 Body Systems (11 decks)

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