Wound Care: Arterial Insufficiency Flashcards
arterial insufficiency is also know as…
peripheral artery disease, lower extremity arterial disease
T or F: diabetes is a large risk factor for PVD
T
T or F: smoking after revascularization results in a 3 fold risk in graft failure
T
T or F: smoking cessation even if after surgery restores graft patency to that of non-smokers
T
Are whites of African Americans at greater risk of PAD?
African Americans
*also more likely to undergo amputation
T or F: elevating legs relieves pain from PAD
F: it makes it worse
arterial insufficiency
significant narrowing of arteries distal to the arch of the aorta
most common cause of arterial insufficiency
atherosclerosis
symptoms of PAD
- intermittent claudication
- rest pain
- non-healing wounds
- gangrene
intermittent claudication
pain in the leg muscles that occurs during exercise and is relieved by rest
Only ___ of PAD patients have intermittent claudication
1/3
purpura
purple spots or blotches due to inadequate blood supply
how to diagnose PAD (4)
1 - ABI
2 - MRA
3 - Photoplethysmography
4 - Transcutaneous oxygen pressures
MRA
magnetic resonance angiography (looks at arteries)
_____ ABI = higher rate of CV events
lower
PT interventions for prevention of PAD ulceration
- ambulation
- skin protection
- lifestyle modification
common wound locations from PAD
1 - between toes or on tips
2 - over phalangeal heads
3 - over lateral malleolus
4 - areas exposed to repeated trauma
5 - mid-tibia
typical appearance of PAD wound
- punches out appearance of wound edges
- dry, pale, necrotic
- usually small, may be deep
How to classify PAD ulceration
thickness of skin loss (partial, full, subcutaneous)
T or F: if you suspect PAD, you should refer to a vascular surgeon
T
*esp if pt has rest pain, ischemia, and gangrene
treatment for PAD ulcers
- exercise
- revascularization
- hydrate wound
- debride if able or protect
- smoking cessation
- patient education
The main goal as far as exercise for PAD is increasing what?
walking distance
frequency and duration of exercise program for PAD
- walking 3-5 times a week for 35-50 minutes
- walking to near maximal pain
- do this for 6 months or more
Do topical or systemic antibiotics work better for PAD ulcers?
topical, because they don’t have enough blood supply for systemic antibiotics to work
adjunctive therapies for PAD ulcers (2)
1 - hyperbaric oxygen therapy
2 - intermittent pneumatic compression (flip it to go proximal to distal)
what do veins depend on for blood flow back up the the heart
muscle pump/movement
one-way valves
what kind of veins do you often see with chronic venous insufficiency?
spider veins
what are the most common ulcers of the LE?
venous insufficiency ulcers
Are women or men at greater risk of venous insufficiency?
women
diagnosis of VI?
1 - doppler
2 - duplex ultrasound
tests and measures for VI
- homan’s sign
- ABI
- trendelenberg
- doppler ultrasound
- venous filling time
symptoms of VI
ache
pain
tightness
skin irritation
heaviness
muscle cramps
itching
ankle edema
T or F: the dependent position makes VI pain worse
T
arterial ulcers tend to be _____ while venous ulcers tend to be _______
lateral
medial
PT prevention for VI ulcers
- pneumatic compression
- ace wraps
- compression garments
- e-stim
- gait
- LE exercises
- aquatics
- breathing exercises
- skin care
venous disease classification
C = clinical classification
E = etiology
A = anatomy
P = pathophysiology
T or F: VI ulcers have a huge amount of drainage
T
what kind of dressing do you want for VI?
something to absorb moisture
T or F: in patient’s with VI they only need to wear compression for a short period of time
F: it is something they will need to wear for the rest of their life
PT management of VI ulcers
- local wound care
- therex
- elevation
- compression
- patient education
If VI is not managed it will progress to ________
lymphedema
components of lymphatic system
lymph
collecting ducts
lymph nodes
which system has higher water content? lymphatic or venous?
venous
*lymph is high in protein
lymph motility
- muscle contraction
- respiration
- arterial propulsion
- intrinsic contractions
T or F: the lymphatic system has a central pump
F
what does the lymph system empty into?
subclavian vein
lymphedema
abnormal accumulation of protein rich fluid in the interstitial space
most common cause of lymphedema in the US
surgery (breast cancer, prostate cancer, gun shot wounds, seatbelt injuries)
if you have had lymph nodes removed you are automatically at stage ___ of lymphedema classification
0, no s/s but pt is at risk
stage one lymphedema
no fibrosis, pits on pressure, elevation reduces edema
stage 2 lymphedema
moderate fibrosis, no pitting edema, no edema reduction with elevation
stage 3 lymphedema
substantial fibrosis, no pitting edema, no edema reduction with elevation, trophic changes with skin
T or F: people at risk of lymphedema should avoid any lifting with involved extremity
F: just avoid heavy lifting
4 components to lymphedema therapy
1 - manual lymph drainage
2 - compression
3 - skin care
4- decongestive exercises
stemmer sign
can you pinch skin of second toe?
3 phases of lymphedema therapy
1 - decongestion
2 - transition (to self/caregiver techniques)
3 - maintenance
T or F: manual lymph drainage is massage
F: you are not getting into the muscles! you don’t need a lot of pressure
For manual lymph drainage work ______ to _____ first
proximal to distal, to open up the channels
*then you can work distal to proximal to move the fluid to functioning lymph nodes
Pts with lymphedema should use a ____ pH lotion (low or high?)
low, to prevent skin from drying
resting pressure
pressure constantly exerted by compression alone when the muscles are resting
working pressure
pressure actively exerted by the muscles from within the limb against the wraps
the working pressure is ______ if compression gives less
higher
for lymphedema patients you want to use _____ stretch bandages
short
T or F: short stretch bandages are the same as ACE wraps
F
how long can you leave short stretch bandages on
24h
wrap short stretch bandages _____- to ________
distal to proximal
* in a circumferential pattern using padding
for these two types of compression, patients need to be mobile
ace wraps (long stretch)
Unna’s boots
edema is a _______, lymphedema is a ______
symptom, disease
*currently no cure for lymphedema
