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VI Flashcards

1
Q

compare the pressure of blood moving through arteries vs veins
- why is this important

A

arteries - higher pressure, blood propelled through vessels

veins - lower pressure, blood must be pushed back toward heart

veins with less pressure are likely to back up and cause venous insufficiency

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2
Q

differences in vein vs artery structure

A

veins are
- thinner
- have less smooth muscle
- less connective tissue support
- lack of compliance with increased pressure

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3
Q

what is a capacitance vessel? what is the significance of that?

A

storage vessels holding 75% of blood volume

when SNS stimulates veins, blood rushes back to heart and decreases peripheral pressure

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4
Q

what causes venous insufficiency structurally

A

valves lose their ability to prevent retrograde flow and back up occurs

  • can be paired with dilation and cause tortuous flow of blood
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5
Q

types of veins

A

deep
perforating
superficial

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6
Q

deep vein examples and significance

A

femoral, popliteal, tibial
carry 80-90% of blood back to heart

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7
Q

role of perforating veins

A

connect deep and superficial veins

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8
Q

job of superficial veins

A

drain skin / subcutaneous tissue
collect from the dermis
temperature regulation

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9
Q

where are superficial veins and what are some examples of them?

A

above the deep fascia
greater and lesser saphenous

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10
Q

cut off for venous HTN

A

> 90mmHg

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11
Q

what plays a major role in venous return? what are methods to overcome it

A

gravity

respiratory and calf pump

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12
Q

explain the respiratory pump

A

diaphragm contraction of a deep breath allows for the thoracic cage pressure to decrease

with the decrease, the pressure within veins and lymphatic vessels becomes higher than the thoracic cage

blood and lymph flows to the thoracic cage in response

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13
Q

what can cause venous HTN

A

degradation of valves

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14
Q

what causes venous insufficiency

A

vein dysfunction
calf muscle pump failure
- combination of both

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15
Q

what vein is associated with the calf pump

A

greater saphenous
- incompetence of this vein occurs in 25-50% of all VI ulcers

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16
Q

spider veins is also called

A

telangiectasia

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17
Q

conditions predictive of VI ulcer? where are each found

A

spider veins - superficial
tortuous varicose - deep

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18
Q

what is the fibrin cuff theory

A

as a thin vein stretches over time:

fibrinogen and large proteins move into the interstitial space

once there, they firm up and create a band around the vessel like a tourniquet

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19
Q

what is the white blood cell trapping theory

A

when blood becomes stagnant, WBC factors begin the inflammation process behind valves when trapped

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20
Q
A
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21
Q

vein dysfunction causes

A

venous hypertension and is associated with superficial and perforating veins

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22
Q

what causes vein valve damage

A

thrombus / blood clot
distended vessel diameter
varicose veins

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23
Q

what causes calf muscle pump failure

A

calf weakness/paralysis
decreased dorsiflexion
prolonged standing
incompetent valves

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24
Q

edema can result in

A

local tissue hypoxia

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25
what is one of the biggest predictors of VI ulceration? sequalae associated?
previous VI ulceration 81% recurrence rate local tissue hypoxia / malnutrition scar tissue induced skin breakdown
26
risk factors of VI ulcer
calf muscle pump failure trauma (edema) previous VI ulcer > age obesity diabetes
27
diabetes risk factors for VI ulcer
increased risk of microvascular disease and impaired immune response impaired wound healing (hyperglycemia contraindicates healing)
28
what is the gold standard for examining veins? any other alternatives?
venogram - expensive and invasive Ultrasound instead - noninvasive, 95% sensitive and specific
29
difference in significance of proximal vs distal DVT
distal DVT - <20% of them embolize proximal DVT - 50% of them embolize
30
compression contraindication score on ABI
<0.5
31
what is the Trendelenburg Test
supine with leg at 45° elevation for a minute - look for venous distension
32
significant times associated with trendelenburg test? what is indicated by each?
time to venous distension: with tourniquet - <20 sec --> deep / perforating vein without - <10 sec --> superficial vein
33
what to identify during Doppler Ultrasound
presence/absence of sound intensity of sound lack of spontaneous sounds
34
what is the reflux test?
using a doppler - squeeze proximal to doppler, if a sound is detected then back flow is indicated
35
how are VI ulcers classified
depth etiology CEAP
36
what is CEAP?
clinical etiology anatomy and physiology classification
37
CEAP scores
C0 - asymptomatic C1 - spider veins <3mm C2 - varicose veins >/=3mm C3 - leg edema C4 - skin and subcutaneous changes C4a - hemosiderin C4b - lipodermatosclerosis C5 - healed venous ulcer C6 - current venous ulcer CS - symptomatic
38
what is the significance of a C1-2 or 3 progression
C1 to 2 = into larger veins, more torturous C2 to 3 = higher pressure in venous column
39
some symptoms associated with C4b classification
lipodermatosclerosis - fibrin and proteins into interstitium - dry / crusty skin - champagne leg
40
symptoms associated with CS
leg achiness heaviness tightness pain due to venous dysfunction
41
Etiology criteria of CEAP
Ec - congenital Ep - primary Es - secondary (other DVT)
42
anatomy criteria of CEAP
As - superficial Ad - deep Ap - perforating
43
pathophysiology of CEAP criteria
Pr - reflux Po - obstruction
44
5PT method includes
Pain Position Presentation Periwound Pulses Temperature
45
difference in pain between VI and AI
V - mild to moderate, decrease with elevation or compression A - severe, increased with elevation
46
difference in positioning between VI and AI
V - medial malleolus, medial lower leg, area of truama A - distal toes, dorsal foot, area of trauma
47
difference in wound presentation between VI and AI
V - irregular shape, red/ruddy wound bed, fibrous yellow or glossy coating, copious drainage A - regular shape, pale granulation tissue, black eschar/gangrene, dry
48
difference in periwound and extrinsic tissue between VI and AI
V - edema, cellulitis/dermatitis, hemosiderin deposition, lipodermatosclerosis A - shiny/dry skin, loss of hair growth, thickened yellow nails, pale/dusky/cyanotic
49
difference in pulses between VI and AI
V - normal or decreased due to edema A - decreased or absent
50
difference in temperature between VI and AI
V - normal to mild warmth A - decresed
51
healing time for full-thickness venous ulcers
avg - 8 weeks smaller - 5 to 7 larger - 10 to 16
52
cut off time in healing of VI ulcer
>4 weeks without any healing --> refer
53
define full-thickness venous ulcer
through epi and dermis, but not through hypo
54
precautions of VI procedural interventions
concamitant arterial disease allergic reaction/sensitivity inappropriate whirlpool use
55
why may using a whirlpool not be the best treatment of VI ulcer
warm water will cause vasodilation, greater likelihood of edema gravity will allow for edema and pulmonary HTN to occur increased moisture on the wound will not help an already wet wound
56
when to refer if assessing a VI
>3 on DVT criteria failure to progress wound culture/infection bone or capsule exposure
57
local wound care technique
protect periwound skin address wound bed enhance venous return patient/caregiver education
58
contraindications of compression therapy
ABI <0.7 acute infection pulmonary edema congestive heart failure DVT
59
difference between short and long stretch compression bandages
short = higher working pressure, lower resting pressure long = lower working pressure, higher resting pressure
60
what patient ability would a paste bandage be indicated for
ability to ambulate - nonelastic compression
61
laplace's law
enough pressure to reduce edema without causing ischemia
62
layers and their roles of short-stretch compression bandages
inner = absorb excess drainage, padding middle = drainage outer = increased compression
63
therapeutic exercises to be used
range of motion and strengthening - focus on ankle plantarflexors aerobic exercise gait and mobility training
64
gold standard for assessing DVT
venogram
65
what do doppler ultrasounds test
venous flow vascular volume valve competency

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