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Integ > VI > Flashcards

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
Q

what is one of the biggest predictors of VI ulceration? sequalae associated?

A

previous VI ulceration

81% recurrence rate
local tissue hypoxia / malnutrition
scar tissue induced skin breakdown

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26
Q

risk factors of VI ulcer

A

calf muscle pump failure
trauma (edema)
previous VI ulcer
> age
obesity
diabetes

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27
Q

diabetes risk factors for VI ulcer

A

increased risk of microvascular disease and impaired immune response
impaired wound healing (hyperglycemia contraindicates healing)

28
Q

what is the gold standard for examining veins? any other alternatives?

A

venogram - expensive and invasive
Ultrasound instead
- noninvasive, 95% sensitive and specific

29
Q

difference in significance of proximal vs distal DVT

A

distal DVT - <20% of them embolize
proximal DVT - 50% of them embolize

30
Q

compression contraindication score on ABI

A

<0.5

31
Q

what is the Trendelenburg Test

A

supine with leg at 45° elevation for a minute
- look for venous distension

32
Q

significant times associated with trendelenburg test? what is indicated by each?

A

time to venous distension:

with tourniquet - <20 sec
–> deep / perforating vein

without - <10 sec
–> superficial vein

33
Q

what to identify during Doppler Ultrasound

A

presence/absence of sound
intensity of sound
lack of spontaneous sounds

34
Q

what is the reflux test?

A

using a doppler

  • squeeze proximal to doppler, if a sound is detected then back flow is indicated
35
Q

how are VI ulcers classified

A

depth
etiology
CEAP

36
Q

what is CEAP?

A

clinical etiology anatomy and physiology classification

37
Q

CEAP scores

A

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
Q

what is the significance of a C1-2 or 3 progression

A

C1 to 2 = into larger veins, more torturous

C2 to 3 = higher pressure in venous column

39
Q

some symptoms associated with C4b classification

A

lipodermatosclerosis
- fibrin and proteins into interstitium
- dry / crusty skin
- champagne leg

40
Q

symptoms associated with CS

A

leg achiness
heaviness
tightness
pain due to venous dysfunction

41
Q

Etiology criteria of CEAP

A

Ec - congenital
Ep - primary
Es - secondary (other DVT)

42
Q

anatomy criteria of CEAP

A

As - superficial
Ad - deep
Ap - perforating

43
Q

pathophysiology of CEAP criteria

A

Pr - reflux
Po - obstruction

44
Q

5PT method includes

A

Pain
Position
Presentation
Periwound
Pulses
Temperature

45
Q

difference in pain between VI and AI

A

V - mild to moderate, decrease with elevation or compression

A - severe, increased with elevation

46
Q

difference in positioning between VI and AI

A

V - medial malleolus, medial lower leg, area of truama

A - distal toes, dorsal foot, area of trauma

47
Q

difference in wound presentation between VI and AI

A

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
Q

difference in periwound and extrinsic tissue between VI and AI

A

V - edema, cellulitis/dermatitis, hemosiderin deposition, lipodermatosclerosis

A - shiny/dry skin, loss of hair growth, thickened yellow nails, pale/dusky/cyanotic

49
Q

difference in pulses between VI and AI

A

V - normal or decreased due to edema

A - decreased or absent

50
Q

difference in temperature between VI and AI

A

V - normal to mild warmth

A - decresed

51
Q

healing time for full-thickness venous ulcers

A

avg - 8 weeks
smaller - 5 to 7
larger - 10 to 16

52
Q

cut off time in healing of VI ulcer

A

> 4 weeks without any healing –> refer

53
Q

define full-thickness venous ulcer

A

through epi and dermis, but not through hypo

54
Q

precautions of VI procedural interventions

A

concamitant arterial disease
allergic reaction/sensitivity
inappropriate whirlpool use

55
Q

why may using a whirlpool not be the best treatment of VI ulcer

A

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
Q

when to refer if assessing a VI

A

> 3 on DVT criteria
failure to progress
wound culture/infection
bone or capsule exposure

57
Q

local wound care technique

A

protect periwound skin
address wound bed
enhance venous return
patient/caregiver education

58
Q

contraindications of compression therapy

A

ABI <0.7
acute infection
pulmonary edema
congestive heart failure
DVT

59
Q

difference between short and long stretch compression bandages

A

short = higher working pressure, lower resting pressure

long = lower working pressure, higher resting pressure

60
Q

what patient ability would a paste bandage be indicated for

A

ability to ambulate
- nonelastic compression

61
Q

laplace’s law

A

enough pressure to reduce edema without causing ischemia

62
Q

layers and their roles of short-stretch compression bandages

A

inner = absorb excess drainage, padding

middle = drainage

outer = increased compression

63
Q

therapeutic exercises to be used

A

range of motion and strengthening
- focus on ankle plantarflexors

aerobic exercise

gait and mobility training

64
Q

gold standard for assessing DVT

A

venogram

65
Q

what do doppler ultrasounds test

A

venous flow
vascular volume
valve competency

Integ (12 decks)

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