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Physiotherapy Across Lifespan II > Vascular Overview > Flashcards

Vascular Overview Flashcards

1
Q

what is an aneurysm

A

Degeneration / weakening of arterial wall
Risk of rupture in intraluminal pressure > tensile strength of vessel wall

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2
Q

pathophysiology of _

A

decrease blood flow to extremity / organ secondary to formation of atherosclerotic plaques
Stenosis
decreased blood flow
decreased pressure

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3
Q

what is atherosclerosis

A

Accumulation of lipids around heart and major vessels

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4
Q

consequences of atherosclerosis

A

Hardening of vessels’
Integrity of endothelium
Narrowing & stenosis
Altered haemodynamics
Changes Intima + Media layers of vessel

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5
Q

risk factors of atherosclerosis

A

Genetics
Smoking
Diabetes
Hypertension
Obesity
Diet

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6
Q

list stages of atheroslcerosis

A
  1. build up of fibrous tissue surrounded by layer of cholesterol and lipid
    causes changes in initima and media
  2. clacification - calcification of border surrounding fibrous tissue
  3. haemorrhage
  4. ulceration - initima layer blood vessel bursts
  5. thrombosis
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7
Q

peripheral vascular disease symptoms

A

Pain / cramps LL - walking / exercise / rest
Intermittent claudication
Numbness or coldness feet
Discoloration toes cyanosis / pallor
Tingling & weakness
Infection

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8
Q

what causes pain/cramps of patient with peripheral vascular disease when walking/exercising

A

if there is an obstruction of blood vessel cannot excrete metabolic byproducts

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9
Q

symptoms on activity of intermittent claudication

A

Increased requirements of exercising muscle
Insufficient blood supply through narrowed vessel Symptoms produced by significant narrowing of arteries supplying limb

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10
Q

what is critical limb ischaemia

A

Persistent recurring pain requiring regular analgesia > 2/52
Ulceration or gangrene foot
Absent peripheral pulses
90% require surgical

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11
Q

gangrene definition

A

the destruction of living tissue due to obstruction of the blood and oxygen supply.

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12
Q

what bacteria causes gangrene

A

Clostridium (gas gangrene) or a combination of streptococci and staphylococci.

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13
Q

causes of dry gangrene

A

caused by gradual loss of blood
Causes
Diabetes
Atherosclerosis
Frostbite

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14
Q

what is dry gangrene

A

Skin painful / dark
Dead skin dry & drops off
Not life threatening

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15
Q

describe moist gangrene

A

More serious - fatal
Loss of blood supply
Dead cells leak fluid
Affected tissue becomes moist
Bacteria flourish
Skin swollen / blisters
Can spread quickly

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16
Q

what is gas gangrene

A

Most deadly form
Occurs in wounds affected by bacteria
Low O2 environment
Release of gas / poisons into body
Fever / brown pus gas bubbles
Rapid death

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17
Q

abdominal aortic aneurysm

A

Localised enlargement lumen abdominal aorta
Pulsatile swelling abdomen

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18
Q

how is abdominal aortic aneurysm monitored

A

use ultrasound
above 4cm may rupture

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19
Q

possible complications of diabetes

A

Small vessel damage
Retinopathy
Renal failure
Peripheral neuropathy
Sensory deficits hands / feet
PVD / Small artery disease
Ischaemia

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20
Q

what is varicose veins

A

Enlarged dilated tortuous veins in the lower limb

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21
Q

mechanism of varicose veins

A

Valve failure  venous hypertension  venous ulceration

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22
Q

investigation of veins

A

venography

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23
Q

management of varicose veins

A

Compressive stockings
Endovenous laser ablation

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24
Q

chronic venous insufficiency

A

Lower limb venous return impaired

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25
causes of chronic venous insufficiency
Venous hypertension Swelling & ulceration Varicose ulcer
26
thrombophlebitis
Saphenous veins often associated with varicosities
27
DVT
Thrombus forms in vein Secondary inflammation
28
symptoms of thrombophlebitis
Localized inflammation vein wall + secondary thrombosis Pain / tender / red / swollen Rest / elevation / analgesics / NSAID
29
Signs of DVT
Risk - post op / immobilisation Pain / swelling / red area calf Positive Honan’s sign US / Venogram
30
Rx of DVT
prevent PE / anti-coagulated / elastic stockings / heparin
31
Vascular examination methods
Doppler US Abdominal US Ankle pressures Exercise testing Arteriography Ambulatory pressure monitoring Angiography
32
Angioplasty
Insert small catheter with balloon advanced through vessel to site of blockage then inflated
33
Bypass Graft
Vein (often saphenous vein) graft from other part of body / artificial material used to create a detour around the blocked artery
34
Endarterectomy
Area of blockage identified Incision / Opening of vessel Diseased segment or atherosclerotic plaque removed
35
indications of endarterectomy removed
Symptomatic plaque throwing emboli Critical stenosis
36
causes of amputation
PVD e.g. atherosclerosis Diabetes Trauma, compound fracture, cold frostbite Tumour Osteosarcoma Chondrosarcoma Fibrosarcoma Severe burns / blast injury, compression injury Congenital limb deficiency
37
surgical considerations
UL - preservation of elbow joint LL - preservation of knee joint Greater success with functional prosthetic use
38
pre operative assessment
Physical domains Psychological considerations Social aspects
39
physio pre-operation
operation Level of amputation Incision Post op PCA IDC Wound drain Dressings Stump handling Pain / phantom limb sensation Positioning Rehabilitation - MDT Prosthetics chest physio joint mob strengthening falls prevention
40
what psychological issues may patient face with amputation
impact Response to loss Motivation Depression 30% Psychological morbidity Social isolation adjustment Loss / illness behaviour Past medical Hx Cause PTSD family/social support
41
Post op complications
Wound breakdown Infection Pressure areas Stump oedema Pain
42
physio post op amputation
Prevention of contractures & wound management a priority Mobility / strengthening 2 - 3 days Acceptance of limb – all members of MDT
43
what possible physio interventions for post op amputation
Chest physiotherapy Movement Stretching & positioning Strengthening Bed mobility Transfers & appropriate aids Balance & mobility Falls prevention
44
LL amputation physio active movements
Hip - flexion / extension / adduction / abduction Static quadriceps Knee flexion Bed mobility Bridging / rolling / moving up down bed / sit forward / use of UL
45
prevention method for ll contractures post op below knee amputation
Active extension Care with dressings Avoid trauma Pain may  flexion Passive ROM Extended position Stump board
46
prevention method for ll contractures post op ABOVE knee amputation
Monitor hip flexion & abduction Encourage hip extension / adduction Neutral hip position Minimise prolonged sitting Prone lying
47
Physio role for wheelchair use in post op amputation
Transfer technique - safety How to manoeuvre wheelchair Use of brakes / foot plates / arm rests Wheel drive Specialised pressure relief cushion? Liaise with OT / IWA seating/cushion
48
cause of residual limb oedema
bad bandaging trauma post op joint problems loss of muscle pump arterial disease poor venous return other conditions e.g kidney disease, diabetes, ccf
49
Consequences of residual limb oedema
delayed healing = infection = scar tissue = fitting difficultie s fitting difficulties = pressure points = residual limb breakdown
50
Residual limb oedema - management
Elevation Exercise - ROM ‘ankle / hip’ Bandaging - tissue support Shrinker socks - healed limb with oedema (image) Rigid dressing - POP Pneumatic mobility aids Intermittent variable air pressure application
51
Implementation exercise programme for primary amputee
RO wound drain Therapy environment Adequate analgesia Rehabilitation EARLY referral to prosthetic dept.
52
Implementation exercise programme for Established amputee
Residual limb breakdown Surgical revision Fracture Recurrence tumour Other medical conditions Social problems
53
management of a present contracture
Positioning Stretching Active movement Pain management Ice & mobilisation US Serial splinting
54
gait re-ed for amputation
Encourage mobility on ward / at home Also difficult access with wheelchair In the event of stump breakdown Avoid excessive hopping in early stage Alternatively toe-heel swivel
55
types of prosthetic construction
Cosmetic Endoskeletal Exoskeletal
55
Construction temporary prosthesis
Thigh corset Suspension Knee joint Socket Base Checks
56
Components of prosthesis
Prosthetic socket Auxillary suspension Prosthetic joints Interjoint segments LL - base / foot to contact floor UL - hand / other terminal device Cosmetic covering
57
components of prosthetic socket
Shape Suspension Materials Check socket Liners & socks
58
prosthetic referral considerations
Motivation / participate in rehab Level of mobility Independent transfers Independent ADL / self -care Dexterity Eyesight Cognition Social support / Accommodation QoL
59
what is followed after prosthetic fitting
Rehabilitation Gait re-education with physiotherapist Modifications to prosthesis / adjustments Final finish & Cosmesis Final limb Fully rehabilitated Discharge Follow up as necessary
60
patient advice for prosthesis
Care of residual limb Hygiene / stump socks Prevent complications Periods spent not wearing prosthesis Back care Footwear General health & weight
61
describe hindquarter level of LL prosthesis
Whole pelvis intact Tolerance in standing Support for abdominal / pelvic contents Total tissue contact socket Shoulder strap Hip & knee joint
62
transfemoral, prosthesis
13cm - to knee joint Suspension Rigid Pelvic Band Knee + foot component
63
types of knee disarticulation
Gritti-stokes Transcondylar Supracondylar
64
transtibial level prosthesis
Patellar Tendon Bearing socket Foot component
65
what is symes prosthesis
Disarticulation of ankle Heel pad preserved
66
mid tarsal chopart prosthesis
partial foot amputation Disarticulation between talus / calcaneus proximally & navicular / cuboid distally
67
transmetatarsal lisfranc
Shoe filler Partial foot prosthesis
68
causes of upper limb amputation
Trauma RTA, Industrial / agricultural accident Disease Malignancy / Embolism / Vascular Congenital limb deficiency

Physiotherapy Across Lifespan II (8 decks)

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