Vascular, Lymphatic, and Integumentary Disorders Flashcards
Name some of the important functions of the arteries
Carry oxygenated blood away from heart
3-layered walls give strength/elasticity
Ability to change diameter in response to BP or ANS (no valves) Lead to capillaries where gas exchange occurs
Name some important characteristics of the veins
return de-oxygenated blood to heart
superficial = above the fascia
deep = below the fascia
perforating = in between deep/superficial also 3-layered, but HAS valves lower pressure
What are the 2 primary functions of the Lymphatic System? To which part of the cardiovascular system does it connect?
Functions : 1) immune response
2) facilitation of fluid movement between bloodstream and interstitial fluid
**includes lymph vessels, fluid, tissues and organs
Connects/works with Venous System
Describe Phase 1 of healing
Phase 1 = Inflammation
initial decrease in circulation to prevent blood loss
necrosis: programmed death/destruction of damaged cells –creation of clean wound
later, increased blood flow to deliver O2
from injury to day 10 of repair
Describe Phase 2 of healing
Phase 2 = Proliferation
new tissue growth skin integrity restored, differentiation of epithelial cells may lead to fragile scar tissue formation
Angiogenesis: new blood vessel growth
Day 3-20
Describe Phase 3 of healing
Phase 3 = Maturation/Remodeling
continued differentiation of epithelium: scar tissue turns from pink to white
new skin reaches 80% of original tensile strength
replacement of granulation tissue
Day 9- 2 years
What’s different about deep wounds in Phase 3 healing?
hair, sweat glands, sebaceous glands and nerves are rarely ever replaced
What are the main functions of Oxygen in wound healing? How can we help keep a wound oxygenated?
O2 supports healing, helps prevent infection
keep area warm, avoid smoking, stay hydrated, control pain and anxiety
What can prevent oxygen from getting to a wound? what are the results?
Edema and necrotic tissue prevents oxygenation of healing tissue
this leads to higher likelihood of infection
What is debridement? what are the two major types?
Debridement = cleaning necrotic tissue out of the wound
Selective and Non-selective
why is it important to keep wounds moist?
dryness inhibits epithelial cell migration, as well as the supply of nutrients and blood flow
also causes scabbing and eschar (dead black tissue)
**in the right conditions, the body’s own enzymes will degrade eschar (autolytic debridement)
HOW do we keep wounds moist?
use occlusive dressings, only remove bandages when the exudate begins to leak out, keep wounds at the proper temperature
Is nutrition important for wound healing? if so, how do we manage it?
YES! manage through diet, NOT supplements
necessary nutrients include: iron, B12, Folic acid, Vitamin C, Zinc, Vitamin A, Arginine, and protein
What are the important bony landmarks prone to bedsores?
What are the important characteristics of wounds to be noted, measure, and documented?
Etiology: diabetic, vascular, traumatic, etc
Appearance, Location, Size, Shape, Stage of healing
Depth, edges, tunneling/undermining
Base of the wound: what’s happening inside?
Edema, maceration
Pain level
Name the 3 kinds of Wound Closure, and describe them
Primary Intention: edges surgically closed
at risk for **dehiscence: **when wound opens again because of maceration or infestation
Secondary Intention: the wound is left to heal on its own
Tertiary Intention: allowed to heal by secondary intention, but closed by primary
What are the signs of Infection?
Increased drainage
change in color/odor
lingering swelling
redness, warmth
pain and/or tenderness
tissue culture is positive
fever, nausea, fatigue, loss of appetite
Define Arterial Insufficiency and name the main cause
Arterial Insufficiency: lack of adequate blood flow to a region(s) of the body (typically the legs)
main cause = Peripheral Vascular Disease: disrupted arterial blood flow to/ venous return from the extremities
may be related to smoking, cardiac disease, Diabetes Mellitus, Hypertension, renal disease, elevated cholesterol & triglycerides
**obesity and sedentary lifetyle are secondary contributors
Name and define 5 more causes of arterial insufficienty
Arteriosclerosis: thickening, hardening, and loss of elasticiy in arterial walls
Atherosclerosis: plaque formation
Ateriosclerosis Obliterans: peripheral manifestation of arteriosclerosis -throphic changes and resting pain observed, most likely to lead to ulceration
Thromboangitis Obliterans: inflammation leads to arterial occlusion and tissue ischema
Raynaud’s Disease: vasomotor disease of small arteries and arterioles -leads to pallor and cyanosis of fingers and feet, unknown etiology, agravated by cold and emotional distress
What is Intermittent Claudication? Which arterial insufficiency displays it?
Intermittent Claudication: pain that occurs when exercising muscles don’t recieve the blood perfusion needed
occurs in Arteriosclerosis Obliterans
What are the symptoms of arterial insufficiency we’ll see in the clinic?
10-25% of Lower Extremity Ulcers
more likely to lead to limb loss
most frequently on lateral malleoli and the dorsum of feet and toes
most patients have diabetes
trophic changes: abnormal nail growth, decreased foot/leg hair, dry skin, skin is cool to touch
wounds are painful, base is usually necrotic/pale
skin around the wound may be black
decreased pulses, pallor when elevated, rubor when dependent (below the heart)
How do we treat arterial insufficieny?
1 preventative measure: QUIT SMOKING
restore chemical and gaseous homeostatis
provide wound care
if the wound is not healing, or gangrene is present, may have to amputate
Define Venous Insufficiency and name some of the predisposing factors
Venous Insufficiency: Inadequate drainage of venous blood from body parts, resulting in edema and/or skin abnormalities -deemed chronic when it persists for long periods of time
**incidence is much higher than arterial insufficiency: most common cause of leg ulcers
Predisposing Factors: age, lack of exercise, obesity, pregnancy, long hours standing/sitting, heredity
*predictors of ulceration due to Chronic Venous Insufficiency also include history of Deep Vein Thrombosis, # of pregnancies, family history
What symptoms of Venous Insufficiency will we see in the clinic?
Swelling in one or both legs
complaints of itching, fatigue, aching, and/or heaviness of the involved limb
Skin changes: fibrosis (thickening of dermis)
Increased temp in skin of lower legs
Wounds: usually just proximal to medial malleoli, not significantly painful, wet tissue bed, large amount of exudate
May see signs of lymphedema
How do we treat Venous Insufficiency?
Compression Therapy: specialized bandages/garments, intermittent compression unity
Gait training
Exercise
Manual lymphatic drainage
What is Lymphedema? What’s the difference between Primary and Secondary?
Lymphedema: abnormal accumulation of lymph fluid in the tissues of one or more body parts/regions due to mechanical disruption of the lymphatic system
Primary: congenital or hereditary condition
hypoplasia: fewer lymphatic vessels than normal
Secondary: injury to one or more components of the lymphatic system
more common than primary; most common causes = surgery, radiation, or Chronic Venous Insufficiency
What symptoms of Lymphedema will we see in the clinic?
swelling distal/adjacent to area of impairment that is not alleviated by elevation
pitting edema in early stages (when you press your finger into the swelling and the indent remains)
non-pitting edema in late stages
fatigue, heaviness, pressure, tightness in affected limb
dermal abnormalities like cysts
increased susceptibility to infection
loss of ROM and mobolity
Impaired wound healing
How do we treat Lymphedema?
Manual Lymphatic Drainage
Compression Therapy: elevation, bandaging, compression garments, intermittent pneumatic compression, positioning, and pressure redistribution devices (for skin protection)
What is a Pressure Ulcer? In what population are they most common?
Pressure Ulcer: wound caused by unrelieved pressure to dermis and underlying vascular tissues -tissue cannot repair/recover without care
**superficial dermis can tolerate ischemia cause by pressure for 2-8 hours before breaking down: deepr muscle, connective and adipose tissue tolerance is less than 2 hours
most common in immobilized individuals
What are the symptoms of pressure ulcers?
**First sign is blanchable erythema (area of red/irritated skin that turns white and stays white when you press on it)
Progresses to a superficial abrasion, blister, or shallow crater in the skin
Full Thickness = deeper crater, minimal bleeding, warm tissues, eschar, and tunneling
6 Primary bony areas: sacrum, coccyx, greater trochanters, ischial tuberosity, calcaneus, and the lateral malleoli
How do we treat pressure ulcers?
Facilitate homeostasis: wound care
reduction of pressure to the area
use of turning/positioning schedules
education of pt, caregivers, and family
Other factors: nutrition, sensation, co-morbitidies, mobility status
What is Neuropathy? How does it affect diabetic patients?
Neuropathy: disease on nerves- peripheral, cranial, or autonomic that exists in many disease processed
**results in altered or lack of sensation
Diabetic Neuropathy: majority will occur in lower extremities -foot insensitivity and ulceration possible
What are the symptoms of Neuropathy?
Ulceration on weight-bearing surfaces or over bony prominences
sensory neuropathy: no sense of pain or pressure, increased risk of skin breakdown due to mechanical, repetitive stresses placed on skin
motor neuropathy: loss of intrinsic muscle control- leads to hammer/claw toe deformities and foot-drop
Autonomic neuropathy: decreased/absent sweat/oil production = dry inelastic skin, increased risk of skin breakdown, and heavy callus formation
Dysvascular symptoms: usually arterial, ischemia, impaired healing time, imparied O2 transport, antibiotics & nutrients needed for healing
How do we treat neuropathy?
patient/caregiver education
wound care
maintaining appropriate blood glucose levels (for Diabetic pt)
Possible AD for foot wounds
Orthotics
Exericise
Modalities
Name and describe 5 methods of Selective Debridement
Sharp: removal of necrotic tissue with sterile instruments (Gold Standard)
Chemical/ Enzymatic: topical agent applied to dissolve necrotic tissue (includes autolytic)
Biosurgery: maggot debridement therapy (most recently used to help with MRSA)
**Medical Grade Honey: **high osmotic potential, low pH, assists in autolytic debridement (medihoney)
Autolytic Debridement: endogenous enzymed on wound bed digest devitalized tissue and promote granulation tissue formation
Name and describe 4 methods of Non-Selective Debridement
Wet-to-Dry dressings: wet dressing applied, dries, and debrides the wound when removed
frequently VERY uncomfortable, can cause bleeding and trauma
Surgical Debridement: for large wounds, tunneling wounds, necrotic and/or infected to the bone
Pulsatile Lavage: water + suction debrides and cleans
Whirlpool
What Modalities can we use to help aid the healing process?
Whirlpool: cleaning and debridement
Pulsatile Lavage: wound irrigation + suction (more debridement)
Ultrasound: stimulates cell activity to accelerat healing
E-stim: eliminate bacteria, promote granualtion, decrease inflammation, reduce edema, reduce wound pain, augment blood flow
Diathermy
UV Radiation
Hyperbaric Oxygent Therapy
Cold Laser Therapy: similar to ultrasound, but works at the cellular level –no pt sensation
What are some important things to remember when treating pt for Lymphedema?
Compression is important, but be careful not to apply too much pressure: this will occlude the superficial lymph capillaries
complete decongestive theory: Phase1 -skin care, MLD, lymphedema bandaging, exercise, compression garments
Phase 2 -(self management phase) skin care, compression garment during the day, exercise, lymphedema bandaging at night, MLD as needed
**should be done by certified CDT therapist
Name the different dressings used in wound care, and describe them
Gauze
Impregnated gauze: prevents gauze from sticking
Transparent Film: doesn’t allow bacteria or moisture to get it
Foam: highly absorbant (for wounds with excessive exudate)
Hydrogels: increase moisture in dry wounds
Hydrocolloids: most moisture retentive, most occulsive
Alginates: absorb 20-30 times their own weight, easy to apply/remove
Hydrofibers: selective absorbent capacity, combines foam and gel dressing benefits
