Vascular Evolution

Question 1

What are the 3 steps to vascular assessment?

Answer 1

Medical history–want to know particular vascular events a person has had.
Physical examination–color changes, wound, edema, varicose veins, hemosiderin staining.
Specific vascular testing

Question 2

What should Physical examination include? 3

Answer 2

Inspection–most things can easily be seen.

Palpation–Palpate all the pulses. Dorsalis pedis will signify good circulation (low down the leg)

Special diagnostic physical exam maneuvers.

Question 3

Name all the pulses of the leg–4

Answer 3

Femoral
Popliteal
Dorsalis pedis (most distal…in older pts, pulse may be weak but still normal.)
Posterior Tibialis (2nd most distal)

Question 4

Adequate history includes what details? 2

Answer 4

Focus on specific vascular-related events (blood clot, MI, stroke, pulmonary embolism.)

Inclusion of prescription and nonprescription medications (including herbs. Some interract w prescription meds. Also Want to know where Nitro is during therapy–want it close)

Question 5

Risk Factors for Peripheral Vascular Disease

Cardiac history 4

Answer 5

Heart disease (cardiac catheterization? result?)
Heart attack (date of last event)
Chest pain (note location of the pain, how is pain relieved, onset?)
Stroke (date of event, note location of weakness of speech deficit)
Hypertension
Hyerlipidemia
Smoking history
Diabetes
Concomitant illnesses (renal disease, collagen vascular disease, arthritis, pulmonary disease, malignancy, spine problems)
Family history of arterial disease.

Question 6

Risk Factors for Venous Disease

7

Answer 6

Trauma
Deep vein thrombosis
Prolonged inactivitiy or standing activity.
Multiple pregnancies–varicose veins
Family history of venous disease or varicose veins.
Obesity.
Clotting disorders (cumudin, asperin.)

Question 7

History and Physical Examination
What can distinguish the cause of a wound?
What must be differentiated for involvement in order to accurately diagnose?
What must be taken into consideration?

Answer 7

Symptomatology

Differentiate between Arterial and Venous involvement.

Claudication

Question 8

Types of Pain

What is claudication?
What is rest pain?
What is fatigue &/or swelling?

Answer 8

Pain in calf after walking some distance. Pain stops after activity ceases. Generaly cause by artery blockage in peripheral artery disease.

REsult of inadequate blood supply to the foot. Pain in forefoot associated with elevation.

Tiredness in limb. Swelling in limb.

Question 9

Vascular testing

Noninvasive testing–what is the most used medical technique for looking for DVT?

Invasive testing–what are the 2 most used techniques?

Answer 9

Ultrasound

Contrast injection and Data acquisition using radiographs.

Question 10

Continuous Wave Doppler
(most commonly used noninvasive diagnostic tool for a PT. )

Used to determine what? 2
How does continuous wave doppler present its data?

Answer 10

Velocity and Direction of blood flow.

Phasic flow pattern respresenting 3 phases. (has to be heard. makes the doppler subjective. Radiology prefers if they use it…not us )

Question 11

Ankle Brachial Index
What to things does it compare?
What do you do first?
What do you do second?
Which arteries do you observe?
What calculation do you make?

Answer 11

Compares ankle systolic pressure to arm systolic pressure.
First assess the highest arm pressure.
Place the BP cuff just above the ankle and obtain the systolic number with the Doppler.
Both posterior tibial artery and dorsalis pedis are observed.
Ankle pressure is then divided by arm pressure.

Question 12

What modality is contraindicated for Arterial issues?

What does the following mean? What do you do?
ABI 1.00

Answer 12

Compression

1.00 Referral to vascular specialist. Indicates calcified vessels if diabetic.

Question 13

Arterial Insufficiency
Pain
Color
Skin temp

Answer 13

pain–Intermittent claudication, may progress to rest pain. Chronic, dull aching pain, progressive throughout the day.

color–Pale to dependent rubor, a dull to bright, reddish color, more common with advanced disease.

skin temp–Piokilothermic, taking on the environmental temperature. Much cooler than normal body temperature.

Question 14

Arterial Insufficiency
Pulses
Edema
Tissue changes
Wounds

Answer 14

pulse–diminished to absent without Doppler stethoscope.

Edema–Usually not present unless combined disease or can be related to cardiac disease and congestive heart failure.

Tissue–thin and shiny, hair loss, trophic changes of the nails, muscle wasting.

Wounds–Distal ulceration, especially on toes and in between in the web spaces. May develop gangrene and severe tissue loss.

Question 15

Venous Insufficiency
Pain
Color
Skin Temp

Answer 15

No pain.

Color–normal to cyanotic, more common with advanced disease.

Skin temp–Usually no effect on temp.

Question 16

Venous Insufficiency
Pulses
Edema
Tissue changes
Wounds

Answer 16

Pulse–Usually normal, may be difficult to palpate, secondary to significant edema. (may not find in extreme edema)

Edema–Present from mild to severe pitting edema. Can have weeping edema fluid from open wounds (weeping edema looks like tears coming out of leg.)

Tissue changes–Stasis dermatitis with flaky, dry, and scaling skin. Hemosiderin deposits–brownish discoloration. Fibrosis with narrowing of the lower legs, “bottle legs.”

Wounds–Shallow ulcers in the gaiter distribution of the foot and ankle, usually the medial surface.