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Modalities > Wound Care: Arterial Insufficiency > Flashcards

Wound Care: Arterial Insufficiency Flashcards

1
Q

arterial insufficiency is also know as…

A

peripheral artery disease, lower extremity arterial disease

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2
Q

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

A

T

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3
Q

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

A

T

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4
Q

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

A

T

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5
Q

Are whites of African Americans at greater risk of PAD?

A

African Americans
*also more likely to undergo amputation

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6
Q

T or F: elevating legs relieves pain from PAD

A

F: it makes it worse

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7
Q

arterial insufficiency

A

significant narrowing of arteries distal to the arch of the aorta

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8
Q

most common cause of arterial insufficiency

A

atherosclerosis

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9
Q

symptoms of PAD

A
  • intermittent claudication
  • rest pain
  • non-healing wounds
  • gangrene
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10
Q

intermittent claudication

A

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

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11
Q

Only ___ of PAD patients have intermittent claudication

A

1/3

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12
Q

purpura

A

purple spots or blotches due to inadequate blood supply

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13
Q

how to diagnose PAD (4)

A

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

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14
Q

MRA

A

magnetic resonance angiography (looks at arteries)

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15
Q

_____ ABI = higher rate of CV events

A

lower

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16
Q

PT interventions for prevention of PAD ulceration

A
  • ambulation
  • skin protection
  • lifestyle modification
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17
Q

common wound locations from PAD

A

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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18
Q

typical appearance of PAD wound

A
  • punches out appearance of wound edges
  • dry, pale, necrotic
  • usually small, may be deep
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19
Q

How to classify PAD ulceration

A

thickness of skin loss (partial, full, subcutaneous)

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20
Q

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

A

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

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21
Q

treatment for PAD ulcers

A
  • exercise
  • revascularization
  • hydrate wound
  • debride if able or protect
  • smoking cessation
  • patient education
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22
Q

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

A

walking distance

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23
Q

frequency and duration of exercise program for PAD

A
  • 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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24
Q

Do topical or systemic antibiotics work better for PAD ulcers?

A

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

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25
Q

adjunctive therapies for PAD ulcers (2)

A

1 - hyperbaric oxygen therapy
2 - intermittent pneumatic compression (flip it to go proximal to distal)

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26
Q

what do veins depend on for blood flow back up the the heart

A

muscle pump/movement
one-way valves

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27
Q

what kind of veins do you often see with chronic venous insufficiency?

A

spider veins

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28
Q

what are the most common ulcers of the LE?

A

venous insufficiency ulcers

29
Q

Are women or men at greater risk of venous insufficiency?

A

women

30
Q

diagnosis of VI?

A

1 - doppler
2 - duplex ultrasound

31
Q

tests and measures for VI

A
  • homan’s sign
  • ABI
  • trendelenberg
  • doppler ultrasound
  • venous filling time
32
Q

symptoms of VI

A

ache
pain
tightness
skin irritation
heaviness
muscle cramps
itching
ankle edema

33
Q

T or F: the dependent position makes VI pain worse

A

T

34
Q

arterial ulcers tend to be _____ while venous ulcers tend to be _______

A

lateral
medial

35
Q

PT prevention for VI ulcers

A
  • pneumatic compression
  • ace wraps
  • compression garments
  • e-stim
  • gait
  • LE exercises
  • aquatics
  • breathing exercises
  • skin care
36
Q

venous disease classification

A

C = clinical classification
E = etiology
A = anatomy
P = pathophysiology

37
Q

T or F: VI ulcers have a huge amount of drainage

A

T

38
Q

what kind of dressing do you want for VI?

A

something to absorb moisture

39
Q

T or F: in patient’s with VI they only need to wear compression for a short period of time

A

F: it is something they will need to wear for the rest of their life

40
Q

PT management of VI ulcers

A
  • local wound care
  • therex
  • elevation
  • compression
  • patient education
41
Q

If VI is not managed it will progress to ________

A

lymphedema

42
Q

components of lymphatic system

A

lymph
collecting ducts
lymph nodes

43
Q

which system has higher water content? lymphatic or venous?

A

venous
*lymph is high in protein

44
Q

lymph motility

A
  • muscle contraction
  • respiration
  • arterial propulsion
  • intrinsic contractions
45
Q

T or F: the lymphatic system has a central pump

A

F

46
Q

what does the lymph system empty into?

A

subclavian vein

47
Q

lymphedema

A

abnormal accumulation of protein rich fluid in the interstitial space

48
Q

most common cause of lymphedema in the US

A

surgery (breast cancer, prostate cancer, gun shot wounds, seatbelt injuries)

49
Q

if you have had lymph nodes removed you are automatically at stage ___ of lymphedema classification

A

0, no s/s but pt is at risk

50
Q

stage one lymphedema

A

no fibrosis, pits on pressure, elevation reduces edema

51
Q

stage 2 lymphedema

A

moderate fibrosis, no pitting edema, no edema reduction with elevation

52
Q

stage 3 lymphedema

A

substantial fibrosis, no pitting edema, no edema reduction with elevation, trophic changes with skin

53
Q

T or F: people at risk of lymphedema should avoid any lifting with involved extremity

A

F: just avoid heavy lifting

54
Q

4 components to lymphedema therapy

A

1 - manual lymph drainage
2 - compression
3 - skin care
4- decongestive exercises

55
Q

stemmer sign

A

can you pinch skin of second toe?

56
Q

3 phases of lymphedema therapy

A

1 - decongestion
2 - transition (to self/caregiver techniques)
3 - maintenance

57
Q

T or F: manual lymph drainage is massage

A

F: you are not getting into the muscles! you don’t need a lot of pressure

58
Q

For manual lymph drainage work ______ to _____ first

A

proximal to distal, to open up the channels
*then you can work distal to proximal to move the fluid to functioning lymph nodes

59
Q

Pts with lymphedema should use a ____ pH lotion (low or high?)

A

low, to prevent skin from drying

60
Q

resting pressure

A

pressure constantly exerted by compression alone when the muscles are resting

61
Q

working pressure

A

pressure actively exerted by the muscles from within the limb against the wraps

62
Q

the working pressure is ______ if compression gives less

A

higher

63
Q

for lymphedema patients you want to use _____ stretch bandages

A

short

64
Q

T or F: short stretch bandages are the same as ACE wraps

A

F

65
Q

how long can you leave short stretch bandages on

A

24h

66
Q

wrap short stretch bandages _____- to ________

A

distal to proximal
* in a circumferential pattern using padding

67
Q

for these two types of compression, patients need to be mobile

A

ace wraps (long stretch)
Unna’s boots

68
Q

edema is a _______, lymphedema is a ______

A

symptom, disease
*currently no cure for lymphedema

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