- intermittent claudication - rest pain - non-healing wounds - gangrene

Wound Care: Arterial Insufficiency Flashcards by Catherine McDowell

arterial insufficiency is also know as…

peripheral artery disease, lower extremity arterial disease

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T or F: diabetes is a large risk factor for PVD

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T or F: smoking after revascularization results in a 3 fold risk in graft failure

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T or F: smoking cessation even if after surgery restores graft patency to that of non-smokers

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Are whites of African Americans at greater risk of PAD?

African Americans
*also more likely to undergo amputation

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T or F: elevating legs relieves pain from PAD

F: it makes it worse

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arterial insufficiency

significant narrowing of arteries distal to the arch of the aorta

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most common cause of arterial insufficiency

atherosclerosis

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symptoms of PAD

intermittent claudication
rest pain
non-healing wounds
gangrene

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intermittent claudication

pain in the leg muscles that occurs during exercise and is relieved by rest

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Only ___ of PAD patients have intermittent claudication

1/3

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purpura

purple spots or blotches due to inadequate blood supply

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how to diagnose PAD (4)

1 - ABI
2 - MRA
3 - Photoplethysmography
4 - Transcutaneous oxygen pressures

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MRA

magnetic resonance angiography (looks at arteries)

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_____ ABI = higher rate of CV events

lower

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PT interventions for prevention of PAD ulceration

ambulation
skin protection
lifestyle modification

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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

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typical appearance of PAD wound

punches out appearance of wound edges
dry, pale, necrotic
usually small, may be deep

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How to classify PAD ulceration

thickness of skin loss (partial, full, subcutaneous)

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T or F: if you suspect PAD, you should refer to a vascular surgeon

T
*esp if pt has rest pain, ischemia, and gangrene

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treatment for PAD ulcers

exercise
revascularization
hydrate wound
debride if able or protect
smoking cessation
patient education

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The main goal as far as exercise for PAD is increasing what?

walking distance

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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

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Do topical or systemic antibiotics work better for PAD ulcers?

topical, because they don’t have enough blood supply for systemic antibiotics to work

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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

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

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

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

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