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CSB521 - PM1 > wk 2- vascular assessment > Flashcards

wk 2- vascular assessment Flashcards

1
Q

populations for CVD. who is at a higher risk?

A

-CVD is leading cause of illness and death in women in australia
-indigenous peoples are twice as likely to have CVD compared to non indigenous

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2
Q

What are the behavioural risk factors for CVD 4

A

smoking
poor diet
sedentary
alchohol consumption

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3
Q

what are the biomedical risk factors for CVD 4

A

high blood pressure
abnormal blood lipids
diabetes
overweight and obesity

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4
Q

what are the vessels of the vascular system 5

A

Arteries
Arterioles
Capillaries
Venules
Veins

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5
Q

arteries are

A

large and medium sized vessels that transport oxygenated blood to the tissues and organs

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6
Q

the 3 layers of arteries

A

Tunica Intima- inner layer, direct contact with blood

tunica media- thickest layer- controls vasodilation/constriction

tunica externa- outer layer

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7
Q

how are veins different to arteries (4)

A

thinner than arteries
carry deoxygenated blood back to the heart
lower pressure system
contain valves to prevent backflow of blood

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8
Q

how does the venous system get pumed back to the pulmonary system

A

through valves opening and closing and contracted skeletal muscle pushing the deoxygenated blood back up

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9
Q

when are instances that pressure within the capillaries changes? (2)

A

-lying, sitting and standing
-temperature changes

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10
Q

what system controls the vascular response

A

autonomic system

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11
Q

what is the lymphatic system

A

Where circulatory system meets the immune
system
* Not a closed system
* No pump so movement is slow
* A network of lymphatic vessels that move
lymph toward heart
* Lymph is derived from
interstitial fluid also contains
immune cells
-helps return plasma

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12
Q

FINAL EXAM - arteries of the lower limb!

A

aorta down to the peripheral arteries. anterior and posterior aspect. and what compartments/muscles they supply

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13
Q

cutaneous blood flow is important for what

A

identifying location of pain can indicate the true anatomical regions by cutaneous blood supply

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14
Q

FINAL EXAM- veins of the lower limb

A

overview of the veins draining the lower limb

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15
Q

Final Exam- lymphatics of the lower limb

A

!

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16
Q

anatomical variation in the foot for arteries and its %

A
  • Absent or very thin posterior tibial artery – 6.35%
  • Absent or very thin anterior tibial artery – 5.27%
  • Absent or very thin peroneal artery – 2.8-3.8%
  • Absent dorsalis pedis – 12%
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17
Q

two components to vascular assessment

A

-general assessment (subjective)
-peripheral assessment (objective)

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18
Q

general assessment includes (5) and give examples/ risk factors for these categories

A

-past history: surgery, myocardial infarctions (and age when- secondary question), cerebrovascular accidents, transient ischemic attacks

-current medication: antihypertensive, hyperlipidemia meds, anticoagulants

-symptoms: angina, breathlessness, lassitude, pallor

-observation: BMI, oedema, spoon shaped nails, smoking stains, fatty deposits in the skin, lack of circulation

-clinical tests: bp, hr, ecg, x rays, blood test

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19
Q

peripheral vascular disease can be what? 3

A

-arterial disease
-venous incompetence
-oedema (primary or secondary)

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20
Q

peripheral assessment includes what structures 3

A

-arterial
-venous
-lymphatic

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21
Q

principles of the peripheral assessment

A

anatomy
medical history
symptoms
observations
clinical tests

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22
Q

risk factors for peripheral vascular disease with patient history

A

family history
age
hypertension
dyslipidaemia
smoker
obesity
diabetes
medications- NSAIDS (heart attack risk), oral contaceptive (blood clots), CVD medications
signs and symtpoms- pain, cramping, oedema, numbness, etc

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23
Q

risk factors for peripheral vascular disease for social history (behavioural)

A

smoking
alcohol
psychosocial
socioeconomic
diet
weight
exercise

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24
Q

3 major signs of patient history (symptoms) to indicate peripheral arterial disease

A
  • intermittent claudication: pain on exertion (particular distance or time)

-rest pain: usually in calves at rest and eased by standing

-non-healing lesions

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25
Q

patient examination for peripheral assessment (2) and examples underneath these categories

A
  • Visual Inspection
    Skin appearance
    Hair growth
    Nail quality
    Colour
    oedema
    muscle bulk
  • Physical examination
    Temperature gradient - perfusion
    Pulse palpation
    Doppler assessments (rate, amplitude, phasic, shape, pressures)
26
Q

4 areas/ things to exam for the venous system

A
  1. varicose veins: locations and severeity
  2. oedema
  3. haemosiderin deposits
  4. telangiectasia
27
Q

history and examination for venous issues

A
  • Varicose pain
  • Busting pain
  • Aching
  • Oedema
  • Alleviated by elevation
  • Night cramps relieved by getting up
  • Unilateral* Peripheral cause
  • Symmetrical §Systemic cause
28
Q

what causes nighttime cramps

A

syptom of venous disease
blood in veins is high in waste products which can leak out to surrounding tissues causing painful muscle cramping and contractions

29
Q

CEAP - seven clinical classes of chronic venous disorders. physical examination for veins

A

chronic venous disorders can be divided into seven clinical classes C0 to
C6 with specific signs:
C0: No visible or palpable signs of venous disease
C1: Telangiectasis (spider veins) or reticular veins
C2: Varicose veins
C3: Edema
C4: Skin changes (pigmentation, eczema, induration)
C5: Healed venous ulcer
C6: Active venous ulcer

30
Q

clinical assessment of oedema (4)

A
  1. Press firmly with your thumb or index finger for at least 2 seconds on each extremity
    1.Over the dorsum of the foot
    2.Behind the medial malleolus
    3.Lower calf above the medial malleolus
    4.Record indention recovery time in seconds

scoring system is based off the mm of indention

31
Q

risk factors for impaired venous return (8)

A

Age
* Family history
* Female gender
* History of DVT in legs
* Obesity
* Pregnancy
* Sitting or standing long
periods
* Tall height

32
Q

symptoms of impaired venous return (6)

A
  • Dull aching, heaviness,
    cramping, pain, warmth
  • Itching and Swelling
  • Redness of ankles & legs
  • Haemosiderin desposits
  • Varicose veins
  • Ulcers and impaired healing
    at the ankles or legs
33
Q

venous insufficiency and compression therapy key things to remember

A

Compression therapy can be very helpful for those with venous
insufficiency – you MUST check the ABPI BEFORE making this
recommendation!
It must be above 0.8 for safe recommendation of compression

34
Q

what is deep vein thrombosis

A

Blood clot in the deep veins
Most commonly in thigh or calf
Medical emergency

35
Q

risk factors for deep vein thrombosis (7)

A

Risk factors:
* Prolonged bed rest
* Inactivity (travel)
* Major surgery
* Injury (fracture)
* Illness
* Oral contraceptive pill
* Pregnancy or recently
post-partum

36
Q

symptoms and complications for deep vein thrombosis (DVT)

A

Symptoms
* None
* Dull aching, heaviness, cramping,
pain, warmth
* Swelling
* Shortness of breath
* dizziness

Complications
* Pulmonary embolism (clot
breaks off, lodges in the lung)
* Valve damage
* Vessel damage
* Long term oedema

37
Q

why is DVT more common on the left side?

A

iliac artery sits around and puts pressure on the left

38
Q

examples of DVT differential diagnosis (6)

A

*Phlebitis
*Cellulitis
*Acute ischaemia
*Baker’s cyst rupture
*Muscle tears
*Tendon, tears, partial rupture

39
Q

transport through the lymphatic system is done by?

A

Lymphatic system has no central pump
* Lymph transportation influenced by
–Pressure of tissue fluids
–Valves of lymphatic vessels
–Contraction of smooth muscle in lymphatic
vessel walls
–Pressure on vessels from surrounding
skeletal muscles
–Pulsations of adjacent arteries
–Auxiliary respiratory pump

40
Q

what are the main lymph nodes and ducts for podaitrists

A
  • Popliteal nodes – drain
    lower leg and knee
  • Inguinal nodes – drain legs,
    external genitalia, lower
    abdominal wall
41
Q

what is venous hypertension

A

superficial or deep will increase the intra-luminal hydrostatic pressure at the venous end so it resists the colloid osmotic pressure and reduces the ability of pulling fluid back into the capillaries

this causes oedema

42
Q

what is the stemmers sign?

A

lymphoedema, inability to pinch the skin of the proximal phalanx of the second or third toe

43
Q

what is lymphoedema

A

Interstitial oedema of the extremities
due to a failure of the Lymphatic
System
Protein rich fluid – this attracts more
fluid
Fibroblast proliferation, thickening of
tissues

begins off as soft swelling, develops into firmer condition. induced risk of bacterial infection due to increased levels of protein

44
Q

treatment of lymphoedema

A

Compression (minimum 30mmHg)
*Elevation
*Exercise
*Lose weight
*Pneumatic night pumps
*Surgery

45
Q

what is PAD

A

poor blood(arterial) circulation to the lower leg and foot
* Generally due to atherosclerosis

46
Q

what should you look for in patient history (medical history and symptoms) to raise suspicion of PAD (7)

A

Medical history
* MI
* CVA’s (Stroke)
* TIA’s
* Coronary or Femoral-Popliteal Bypass
* Medications

Symptoms
* Pain- site, duration, cramps, rest pain, etc
-disease in the aortoiliac vessels causes butt/thigh symptoms
-disease in femoral/popliteal regions will give calf pain
-Ischaemic pain may be lacking due to diabetic neuropathy

47
Q

differential diagnosis for PAD 7

A
  • Arthropathy
  • Spinal stenosis (pseudoclaudication) * Diabetic neuropathy
  • Deep vein thrombosis
  • Venous claudication
  • Buerger’s disease
  • Compartment syndrome
48
Q

the 4 categories of PAD

A

asymptomatic
claudication
critical limb ischemia
acute limb ischemia

49
Q

when should adults without known history of CVD have an assessment?

A

all adults aged 45+
aboriginal and torres strait islander people ages 35+

50
Q

the 6 P’s to the acute limb ischaemia pathway

A
  • Pulseless
  • Pain (constant, exacerbated by movement)
  • Pallor – cyanotic blotches (non-blanching – caplillary bed thrombosis)
  • Parathesia – 1-3 hours after onset (sensory nerve ischaemia – loss of light touch)
  • Paralysis – motor nerve damage (6 hours) – without collateral flow – loss of toe and ankle
  • Perishing cold (Poikiothermia) – ambient room temperature
  • “waterhammer” pulse – above the stenosis
51
Q

interpretting different colours
white, blue, blue with central cyanosis, hazy blue. red, brown , black

A

white- White. Pale (pallor)
Cold (to conserve heat), anaemia, chillblains, raynaud’s phenomenon, cardiac failure, insufficient arterial supply, occlusion (precursor to gangrene)

Blue (peripheral)
(deoxygenation) Cold, chillblains, raynauds phenomenon, venous status

Blue with central cyanosis
Cardiac, respiratory failure

Hazy blue
Infection, necrosis, bruising

Red
Heat, exercise, extreme cold (cold-induced vasodilation), inflammation, infection (cellulitis), chillblains, raynaud’s phenomenon. Dusky red (severe vascular deficiency)

Brown
Haemosiderin deposits, necrosis, melanoma, gangrene

black
bruising, nercosis, melanoma, gangrene

52
Q

clinical assessments include what for vascular system (7)

A
  • Pulses (macrovascular)
  • Capillary refill time / Sub-capillary venous plexus filling time (SVPFT)
  • Elevation dependency test (Buerger’s test)
  • Perfusion (temperature)
  • Doppler waveform
  • Systolic pressures
  • Segmental pressures
    ØAnkle brachial index (ABI)
    ØToe pressure index (TPI)
53
Q

minimal vascular assessment includes 7 things

A
  1. history of modifiable and non modifiable risk factors
  2. palpation of foot pulses
  3. skin, temp
    4 intermittent claudication and ischaemic rest pain indentified
  4. differential diagnosis of common leg symptoms
  5. identification of arterial ulceration/severity
  6. identify venous disease, oedema, lympheodema
54
Q

where can u pulse palpate?

A

Dorsalis pedis (Absent in approximately 12% of
population)
Anterior tibial
Posterior tibial (Absent in approximately 2%)
Popliteal
Femoral

55
Q

how do you report results from pulses

A

Pulses
Grading (0-4) (Merriman et.al.) 0 = no pulse
1 = feeble pulse
2 = normal pulse
3 = bounding pulse
4 = aneurysmal (rare below popliteal artery)
Rhythm Regular
Irregular
Rate (beats per minute)
< 1 year old (100-120 bpm) Adult (65-80 bpm)
Athlete (<50 bpm)

56
Q

capillary refill time Sub-capillary venous plexus filling time (SVPFT) clinical assessment

A
  • Raise digit to heart level
  • Milk venous blood
  • Press hard for several seconds
  • Release and record time for colour to return
  • <3-5 seconds (adequate)
  • > 5 seconds (delayed)
  • > 10 seconds (significant disease)
57
Q

perfusion clinical assessment

A

The temperature gradient of the skin is checked using the back of the hands and gently moving them from the pre-tibial region of the leg distally over the dorsum of the foot to the toes while keeping in contact with the person’s skin. An asymmetric gradient may indicate either unilateral ischaemia on the colder side or unilateral inflammatory response such as Charcot osteoarthropathy or infection on the warmer side.

58
Q

what is Raynaud’s phenomenon

A

a hyperactivation of the sympathetic nervous system causing extreme vasoconstriction of the peripheral blood vessels, leading to tissue hypoxia. it is common in a range of auto immune diseases.

59
Q

the elevation dependency test (buergers test)

A
  • Elevate the leg to 60 degrees and hold for 1 minute
  • Record the time to pallor of the sole of the foot
  • Grading
    Ø 0 = no/mild pallor in 60 seconds Ø 1 = definite pallor in 60 seconds Ø 2 = pallor <60 seconds
    Ø 3 = pallor <30 seconds
    Ø 4 = pallor at rest
  • Dependency
    Ø Record time for foot to return to normal colour after lowering the limb
    § 10-15 seconds = adequate
    § 15-25 seconds = inadequate supply § 40+ seconds = severe ischemia
60
Q

doppler ultrasound clinical assessment

A

Pulse examination

Audible pulse waveform which reflects the character and velocity of
the pulse

In normal vasoconstricted state, normal arterial pulses forms 3 clear sounds

Triphasic response
First sound is the loudest and of a higher pitch – ventricular bolus from
the heart

The second and third sounds are the diastolic sounds due to the reversal of flow caused by the elastic distension in the arteries and final forward flow as the arteries rebound

Loss of reverse flow or dampening of waveform can indicate disease u Frequency and amplitude

CSB521 - PM1 (10 decks)

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