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UM - Cardiovascular Conditions > Vascular Disorders > Flashcards

Vascular Disorders Flashcards

1
Q

What is a DVT?

A

A deep venous thrombosis is a condition in which a blood clot forms in a vein deep inside the body, typically in the large veins in the lower leg and thigh, that can cause back flow or even break off and move through the blood stream, causing a blockage in the brain, lungs, heart, or other area

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2
Q

What is a venous Thromboembolism (VTE)

A

Partial or complete occlusion of the vein with secondary inflammatory reaction of the blood vessel wall that could be platelets, RBC, WBC, fibrin or may even be fat

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3
Q

What are some risk factors for VTE?

A

Smoking
Inactivity
Oral contraceptives
Surgery

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4
Q

What is Virchow’s Triad?

A
  • 3 things that can happen that contribute to thrombosis, that when all 3 occur, increases risk of VTE 3 fold:
    1) Stasis or turbulence
    2) Endothelial injury
    3) Hypercoagulability
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5
Q

What to do if your patient is high risk for VTE?

A

1) encourage mobility and physical activity
2) use mechanical compression
3) consult with physician about medication
4) provide education on VTE prevention

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6
Q

What are the symptoms of DVT?

A
  • changes in skin color (redness) in one leg
  • increased warmth in one leg
  • leg pain in one leg
  • leg tenderness in one leg
  • edema of one leg
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7
Q

What should you do if a DVT is found to be likely following Well’s Criteria?

A

Further medical testing to rule in or out:
- if positive, then consider medical intervention

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8
Q

What should you do if a DVT if found to be if unlikely following Well’s Criteria?

A
  • D-Dimer test:
    if positive, complete farther medical testing and complete appropriate steps
    If negative, encourage mobility and physical activity
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9
Q

What score is needed on Wells Criteria for a DVT to be likely?

A

2 or more points

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10
Q

What are some characteristics of Wells?

A
  • cancer
  • bedridden
  • edema or pitting edema
  • calf swelling
  • DVT
  • other
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11
Q

What are the goal of DVT treatment?

A

1) stop blood clot from getting bigger
2) Prevent blood clot from breaking off and moving to the lungs
3) reduce reoccurrence of another blood clot

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12
Q

What are things PTs should do per the CPG for VTE

A
  • advocate for a culture of mobility and activity
  • assess for risk of VTE
  • assess for additional risk factors of VTE
  • provide preventative measures for those high risk for VTE
  • establish likelihood of LE and UE DVT and PE when pts have symptoms
  • assess med intervention
  • confirm pharm mgt
  • mobilize when therapeutic level of anticoag is achieved
  • allow UE Activities in Pts with UE DVT when ther level of anticoag is achieved
  • do not routinely recommend mechanical compression
  • mobilize individ w/IVC filter for LE DVT
  • consult the med team to initiate mobility for PT w/LE DVT w/o treatment
  • mobilize individ w/non-massive PE when ther level achieved
  • DO NOT mobilize massive PE or submassive intermediate high risk PE
  • refer for re-eval w/o improvement
  • refer pts for med mgt of LT consequences of VTE
  • recommend mech compression w/s/s of PTS are present
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13
Q

What are the labs for VTE?

A
  • PT
  • PTT
  • INR
  • APT
  • D-Dimer
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14
Q

What are the diagnostic tests for VTE?

A

Venous ultrasound doppler
Venography
CT/MRI

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15
Q

What is the gold standard test for establishing a DVT?

A

Veography

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16
Q

What is the best non-invasive diagnostic method for DVT?

A

Ultrasonography Doppler

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17
Q

What test do most patients use for DVT?

A

Ultrasonography Doppler

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18
Q

What it Protime test?

A

Test for DVT that tests the extrinsic system of the clotting cascade (aka time it takes to form a clot)

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19
Q

What is activated partial thromboplastin time (aPTT)?

A

Test for DVT that tests intrinsic system often ordered in conjunction w/PT

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20
Q

What is the International Normalized Ratio (INR)?

A

Used to monitor the effectiveness of blood thinning drugs such as warfarin - should be 2.0-3.0

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21
Q

What is the anti-factor Xa Assay?

A

A test for DVT that is useful to detect a sigle factor deficiency due to a lack of Vitamin K, liver disease, or amyloidosis often used with unfractionated heparin and low molecular weight heparin

22
Q

What is a D-Dimer test?

A

A test used to rule out the presence of a thrombus (DVT, PE, or CVA) that can help diagnose diseases and conditions that cause hypercoagulability

23
Q

What PT education can we provide for Pts on anticoagulants?

A
  • use a soft bristle toothbrush
  • use a humidifier
  • be cautious w/ sharp objects
  • avoid activities that can result in injury
  • use appropriate safety equipment w/physical activity
  • avoid aspirin
  • wear a tag alert
24
Q

What are some pharmalogical treatment of DVTs?

A
  • anticoagulants (oral: Eliquis, pradaxa, xarelto; injection: heparin, lovenox, warfarin)
  • thrombolytics (TPA)
25
Q

List surgeries for DVT

A
  • IVC filter
  • thrombectomy
26
Q

What is an IVC Filter?

A

Placement of IVC filter in the IVC to stop blood clots from reaching the lungs, but does not prevent new clots from being formed and can increase the risk of developing blood clots

27
Q

What are possible complications from a DVT?

A
  • post-thrombotic syndrome
  • pulmonary embolism
  • increased risk for developing another DVT
  • bleeding if on anticoagulants
28
Q

What is a PE?

A

A blood clot that travels to a lung artery where it suddenly blocks blood flow

29
Q

What are symptoms of PE?

A
  • new chest pain w/difficulty breathing
  • a rapid heart rate and/or a feeling of lightheadedness or dizziness
30
Q

What has been found to be true w/coagulation and COVID-19

A

Typically have elevated D-dimer levels
may have a VTE if critically ill
DVT was the cause of mortality in 7/12 patients

31
Q

What is the timeframe for developing post thrombotic syndrome (PTS)

A

Up to and beyond 2 years post DVT

32
Q

What are risk factors for developing post thrombotic syndrome (PTS) post DVT?

A

Increase age
Increased BMI
Thrombophilia
Recurrent DVT events
Effectiveness of initial oral anticoagulation regimen

33
Q

What are signs/symptoms of PTS

A
  • edema and swelling
  • chronic arm or leg pain
  • skin changes
  • heaviness of the limb affected by DVT
34
Q

What are recommendations for PTS

A
  • hydration
  • mechanical compression
  • mobility
  • education
35
Q

Prognosis for PTS

A
  • high morbidity and lower QOL
  • can be chronic and lifetime
  • if discovered quickly and proper action taken, can be resolved
36
Q

What is the function of the venous system?

A

Carry CO2 and cellular waste products back to the heart

37
Q

What is an essential component of venous return?

A

Muscle action

38
Q

What is chronic venous insufficiency

A

Damaged or destroyed valves of the vein that creates a high pressure leading to venous HTN
- hemosiderin staining can occur

39
Q

What is hemosiderin staining?

A

RBC fluid leaking into the interstitial tissue w/chronic venous insufficiency causing a red discoloration of the tissue

40
Q

What are risk factors for developing chronic venous insufficiency?

A
  • age
  • genetics
  • obesity
  • prolonged standing
  • smoking
  • sedentary lifestyle
  • trauma
  • varicose veins
  • neoplasm
  • female hormones (estrogen)
41
Q

What are s/s of chronic venous insufficiency

A

Skin changes
swelling
wounds
heaviness of extremities

42
Q

What is the onset and course of chronic venous insufficiency

A

Onset: pending cause, but usually at greater than 50 yo
Course: Gradual (and typically bilateral)

43
Q

Prognosis of chronic venous insufficiency?

A

Long term w/poor recovery
Likely to lead to leg ulcers

44
Q

What are medical tests for chronic venous insufficiency?

A
  • Doppler to assess venous and arterial
  • culture if suspect infection
45
Q

What is the treatment for chronic venous insufficiency

A

Compression therapy

46
Q

What do we assess for in PT for chronic venous insufficiency?

A
  • vitals
  • skin inspection (trophic changes)
  • strength/ROM
  • sensation
  • palpation (pulses and edma)
  • ABI
  • Gait
    Balance
  • Fun mobil
47
Q

What are trophic skin changes

A

Dermatitis, weeping, and staining skin

48
Q

What is lipodermatosclerosis

A

Changes in skin of the lower legs as a form of panniculitis (inflammation of the layer of fat under the skin)

49
Q

What are the s/s of lipodermatosclerosis

A

Pain
hardening of skin
change in skin color
welling
tapering of legs above the ankles

50
Q

What are interventions for venous disease

A

Compression wraps and compression stockings

UM - Cardiovascular Conditions (5 decks)

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