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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
Q

causes of chronic venous insufficiency

A

Venous hypertension
Swelling & ulceration
Varicose ulcer

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26
Q

thrombophlebitis

A

Saphenous veins often associated with varicosities

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27
Q

DVT

A

Thrombus forms in vein
Secondary inflammation

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28
Q

symptoms of thrombophlebitis

A

Localized inflammation vein wall + secondary thrombosis
Pain / tender / red / swollen
Rest / elevation / analgesics / NSAID

29
Q

Signs of DVT

A

Risk - post op / immobilisation
Pain / swelling / red area calf
Positive Honan’s sign
US / Venogram

30
Q

Rx of DVT

A

prevent PE / anti-coagulated / elastic stockings / heparin

31
Q

Vascular examination methods

A

Doppler US
Abdominal US
Ankle pressures
Exercise testing
Arteriography
Ambulatory pressure monitoring
Angiography

32
Q

Angioplasty

A

Insert small catheter with balloon advanced through vessel to site of blockage then inflated

33
Q

Bypass Graft

A

Vein (often saphenous vein) graft from other part
of body / artificial material
used to create a detour
around the blocked artery

34
Q

Endarterectomy

A

Area of blockage identified
Incision / Opening of vessel
Diseased segment or atherosclerotic plaque removed

35
Q

indications of endarterectomy removed

A

Symptomatic plaque throwing emboli
Critical stenosis

36
Q

causes of amputation

A

PVD e.g. atherosclerosis
Diabetes
Trauma, compound fracture, cold frostbite
Tumour
Osteosarcoma
Chondrosarcoma
Fibrosarcoma
Severe burns / blast injury, compression injury
Congenital limb deficiency

37
Q

surgical considerations

A

UL - preservation of elbow joint
LL - preservation of knee joint
Greater success with functional prosthetic use

38
Q

pre operative assessment

A

Physical domains
Psychological considerations
Social aspects

39
Q

physio pre-operation

A

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
Q

what psychological issues may patient face with amputation

A

impact
Response to loss
Motivation
Depression 30%
Psychological morbidity
Social isolation

adjustment
Loss / illness behaviour
Past medical Hx
Cause
PTSD
family/social support

41
Q

Post op complications

A

Wound breakdown
Infection
Pressure areas
Stump oedema
Pain

42
Q

physio post op amputation

A

Prevention of contractures & wound management a priority
Mobility / strengthening 2 - 3 days
Acceptance of limb – all members of MDT

43
Q

what possible physio interventions for post op amputation

A

Chest physiotherapy
Movement
Stretching & positioning
Strengthening
Bed mobility
Transfers & appropriate aids
Balance & mobility
Falls prevention

44
Q

LL amputation physio active movements

A

Hip - flexion / extension / adduction / abduction
Static quadriceps
Knee flexion
Bed mobility
Bridging / rolling / moving up down bed / sit forward / use of UL

45
Q

prevention method for ll contractures post op below knee amputation

A

Active extension
Care with dressings
Avoid trauma
Pain may  flexion
Passive ROM
Extended position
Stump board

46
Q

prevention method for ll contractures post op ABOVE knee amputation

A

Monitor hip flexion & abduction
Encourage hip extension / adduction
Neutral hip position
Minimise prolonged sitting
Prone lying

47
Q

Physio role for wheelchair use in post op amputation

A

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
Q

cause of residual limb oedema

A

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
Q

Consequences of residual limb oedema

A

delayed healing = infection = scar tissue = fitting difficultie s
fitting difficulties = pressure points = residual limb breakdown

50
Q

Residual limb oedema - management

A

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
Q

Implementation exercise programme for primary amputee

A

RO wound drain
Therapy environment
Adequate analgesia
Rehabilitation
EARLY referral to prosthetic dept.

52
Q

Implementation exercise programme for Established amputee

A

Residual limb breakdown
Surgical revision
Fracture
Recurrence tumour
Other medical conditions
Social problems

53
Q

management of a present contracture

A

Positioning
Stretching
Active movement
Pain management
Ice & mobilisation
US
Serial splinting

54
Q

gait re-ed for amputation

A

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
Q

types of prosthetic construction

A

Cosmetic
Endoskeletal
Exoskeletal

55
Q

Construction temporary prosthesis

A

Thigh corset
Suspension
Knee joint
Socket
Base
Checks

56
Q

Components of prosthesis

A

Prosthetic socket
Auxillary suspension
Prosthetic joints
Interjoint segments
LL - base / foot to contact floor
UL - hand / other terminal device
Cosmetic covering

57
Q

components of prosthetic socket

A

Shape
Suspension
Materials
Check socket
Liners & socks

58
Q

prosthetic referral considerations

A

Motivation / participate in rehab
Level of mobility
Independent transfers
Independent ADL / self -care
Dexterity
Eyesight
Cognition
Social support / Accommodation
QoL

59
Q

what is followed after prosthetic fitting

A

Rehabilitation
Gait re-education with physiotherapist
Modifications to prosthesis / adjustments
Final finish & Cosmesis
Final limb
Fully rehabilitated
Discharge
Follow up as necessary

60
Q

patient advice for prosthesis

A

Care of residual limb
Hygiene / stump socks
Prevent complications
Periods spent not wearing prosthesis
Back care
Footwear
General health & weight

61
Q

describe hindquarter level of LL prosthesis

A

Whole pelvis intact
Tolerance in standing
Support for abdominal / pelvic contents
Total tissue contact socket
Shoulder strap
Hip & knee joint

62
Q

transfemoral, prosthesis

A

13cm - to knee joint
Suspension Rigid Pelvic Band
Knee + foot component

63
Q

types of knee disarticulation

A

Gritti-stokes
Transcondylar
Supracondylar

64
Q

transtibial level prosthesis

A

Patellar Tendon Bearing socket
Foot component

65
Q

what is symes prosthesis

A

Disarticulation of ankle
Heel pad preserved

66
Q

mid tarsal chopart prosthesis

A

partial foot amputation
Disarticulation between talus / calcaneus proximally & navicular / cuboid distally

67
Q

transmetatarsal lisfranc

A

Shoe filler
Partial foot prosthesis

68
Q

causes of upper limb amputation

A

Trauma
RTA, Industrial / agricultural accident
Disease
Malignancy / Embolism / Vascular
Congenital limb deficiency

Physiotherapy Across Lifespan II (8 decks)

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