Week 2 Arterial Insufficiency Flashcards
what is AI and what is an example
decreased arterial blood flow either by arteriosclerosis (thickening and hardening) or atherosclerosis (lumen is encroached by fatty walls)
what is intermittent claudication
activity specific discomfort, that goes away within 1-5 minutes of stopping activity. you can repeat this and reproduce this
how can you differentiate intermittent claudication with spinal stenosis
AI: s/s relief with cessation of activity, and predictable with the same level of activity
SS: s/s relief with change of position
what is the etiology of the AI
ischemic rest pain, and burning when the leg is elevated, and relieved with dependency , ischemic ulcers and even gangrene
what are some potential risk factors
hyperlipidemia
hypertriglyceridemia, smoking, DM, HTN, Trauma (shoes, bites bump injury, burn, MVA), age, PAD, obesity
what does smoking cessation do to circulation and CAD risk
circulation improves within 4 weeks, and CAD risk decreases by 1/2 in 1 year.
how does normal DM affect AI
you may not feel the pain associated with AI because of neuropathy
AI: how does the skin look
dry, withered, shiny, taut, thin
how is the skin temp with AI
cooler
Hair?
no
how does the limb surrounding look
pale and dusky, with pallor with elevation and rubor with dependency
AI and sensation?
decreased
muscles and AI
atrophy, and weakness, and claw toes from weak intrinsics
nails and AI:
brittle and yellow, hard and thick
do you have edema with AI
not usually
what are the 6 tests you can do with your clinical vascular exam
palpation for temp and pulses capillary refill rubor of dependency claudication time ABI venous filling rate
what is the pain pattern associated with AI
increased with elevation, and exertion (walking) numb, tingling, cold ache with exertion worse at night wakes with pain needs rests when walking
what is increasing pain indicative of
capsular consult, and meds, education, lifestyle modifications, revascularization.
what are two factors that might lead to amputation
uncontrolled pain and poor QOL
TF: in neuropathy with DM, you will always get pain
false the neuropathy can mask it
where are AI wounds usually found
below the ankle, not he foot, heel, met heads, tips of the toes and in bunion areas. sometimes superior to the lateral malleolus or on the anterior leg
what is the presentation of an AI wound
shallow then deep
punched out look
usually round
drainage of an AI wound
minimal to none, usually dry and hard
what is the tissue like in an AI wound
black or brown eschar
pale granulation tissue or a mix
dry gangrene (drainage, odor, demarcation)
mummification, and no drainage, and hard, little to no odor and clear demarcation
what is the wet gangrene like (drainage, odor, demarcation)
drainage, odor, flactuance/edema, erythema, less clear demarcation
what do you do for dry gangrene
protect and off load and monitor for conversion to wet and wait for it to auto amputate
what do you do for wet gangrene
urgent referral and vascular surgeon.
what do you do if you think they have AI
- MD refer for vascular testing, and cardiac workup
- PT education about the disease and self care
- safe, graded exercise
what kinds of things do you teach the patient about self care
- skin care and protection (checking shoes, keeping them warm)
- hot water bottle at the groin for gentle warming (warmth vasodilator and can bring blood in)
- behavior modification (smoking, diet, exercise, meds)
- sleep (positioning)
- wound management (protection, off-loading and care)
