Term
| 4 Major risk factors associated w/ arterial insufficiency |
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Definition
1. Smoking
2. Diabetes
3. HTN
4. Genetic Predisposition |
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Term
| Describe pressures that contribute to fluid and nutrient exchange between blood vessels and tissues. |
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Definition
Capillary Hydrostatic Pressure > Interstitial Hydrostatic Pressure --> Flow out of capillary, into interstitium.
Capillary Oncotic (protein) Pressure < Interstitial Oncotic Pressure --> Flow into capillary from interstitium.
The equilibrium of these pressures regulates fluid flow between vessels and surrounding tissue. |
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Term
| How does smoking impact arterial insufficiency? (8 major ways) |
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Definition
1. Inc. endothelial cell damage and dysfunction --> easier for cell to take up lipids.
2. Inc. risk for high cholesterol
3. Inc. Blood lipids
4. Inc. platelet adhesiveness
5. Inc HR &BP
6. Dec Bld flow to extremities
7. Dec. HDL
8. Dec. O2 Transport |
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Term
| How does diabetes impact arterial sufficiency? |
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Definition
| Poorly controlled insulin levels can lead to micro & macrovascular disease due to the constant fluctuation ofglucose levels in the blood. |
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Term
| How does HTN affect arterial sufficiency? |
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Definition
| It causes traumatic damage to the vessel walls resulting in arteriosclerosis, which negatively impacts arterial sufficiency. |
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Term
| How do acute and chronic arterial insufficiency differ in terms of causative events? |
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Definition
Acute: Thrombus, Embolus, vasospasm (sudden)
Chronic: Atherosclerosis (occurring over time) |
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Term
How do acute and chronic arterial insufficiency differ in terms of symptoms?
Acute (5)
Chronic (8) |
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Definition
Acute: Pain, Pallor, Loss of pulse, paresthesia, Paralysis.
Chronic: Intermittent claudication,
Dec. Pedal pulses, (+)ve Rubor of Dependency, Trophic Changes, Temp changes, Dec. ability to respond to change, Ulcerations secondary to ischemia, Gangrene. |
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Term
| What changes occur with arteriosclerosis obliterans? |
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Definition
Decr. Elasticity
Thickening
Hardening of the artery |
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Term
| Describe the process of atherosclerosis. |
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Definition
| Trauma --> Inc. permeability of vessel to lipids --> lipids enter intima layer of vessel --> macrophages consume lipids and form foam cells --> foam cells combine to make a fatty streak --> streak causes inflammatory response --> inc. production of fibrin --> fibrous cap --> cap splits as in inc in size --> platelet adherence to necrotic leaking material --> occlusive plaque which decreases the size of the lumen. |
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Term
| Describe the pathology that leads to venous stasis. |
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Definition
| Varicosities, venous dilation, or valve insufficiency is a result of persistant increases in BP (HTN). This leads to decreased venous return, thus pooling in the LEs. |
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Term
| Describe the pathology of arterial ulcers. |
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Definition
| Blood flow is decreased, tissue becomes ischemic. Prolonged ischemia --> necrosis --> ulceration. |
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Term
| Describe the pathology of venous ulcers. |
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Definition
| Venous pooling -> decreased nutrition delivered to tissues & decr. waste removal --> necrosis. |
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Term
| Signs & Symptoms of arterial insufficiency. (4) |
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Definition
1. Intermittent Claudication
2. Decr. Pulses
3. Trophic Changes (decr. hair growth, thick nails)
4. Delayed capillary refill |
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Term
| Signs & symptoms of venous insufficiency. (2) |
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Definition
1. Swelling ("Heavy" LEs, relief w/ elevation)
2. Cellulitis (infection - redness of limb) |
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Term
| Signs and symptoms associated w/ arterial ulcers. (8) |
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Definition
1. Round
2. Defined Edges
3. Deep
4. Localized edema around edge of wound
5. May have exposed tendons
6. Pale yellow exudate if there's no infection.
7. Usually on foot
8. Arterial insufficiency symptoms |
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Term
| Signs & symptoms of venous ulcers. (6) |
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Definition
1. Irregular shape
2. Shallow
3. Edema in large area surrounding ulcer (generalized, not local)
4. Usually wet (dry is atypical)
5. Found on lower leg, not usually on the foot.
6. Venous insufficiency symptoms. |
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Term
| Describe the appropriate treatment strategy for arterial ulcers |
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Definition
Avoid: Compression bandages, sensitizing topical meds, LE elevation.
Do: Keep head elevated. Avoid excessive muscular activity. Remove pressure. Gentle exercises for claudication.
Surgery Options: Bypass graft, amputation, arterial reconstruction, angioplacty, sympatectomy (to incr. blood to skin, but not to muscle). |
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Term
| Describe the appropriate treatment strategy for venous ulcers |
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Definition
Do: Use compression bandages/stockings/unna boot, elevate, use antimicrobials.
Surgery Options: Excision, grafting, closure by secondary intention
For acute thromboses: bed rest & anticoagulants. |
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Term
| What is intermittent claudication, and what causes it? |
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Definition
Severe pain in the LE that occurs w/ activity and subsides w/ rest.
Caused by inadequate arterial blood supply to exercising muscles. (ABI=.5-.8) |
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Term
| Describe treatment for intermittent claudication. |
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Definition
| Exercise to stimulate angiogenesis and build more blood vessels. |
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Term
| How is an ABI calculated? |
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Definition
| Systolic BP @ dorsal pedis artery over systolic BP @ brachial artery. |
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Term
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Definition
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Term
What does it mean if the ABI = 0.75 - 0.94?
What should you do about it? |
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Definition
| There is mild arterial insufficiency and intermittent claudication. It should be monitored to make sure it doesn't get worse. |
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Term
What does it mean if the ABI > 1.2?
In what patient populations is would this reading be common? |
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Definition
It is falsely elevated, combined w/ intermittent claudication.
Common in pts w/ diabetes and arterial disease. |
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Term
What does it mean if ABI = 0.5 - 0.74?
How do you treat this situation? |
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Definition
The patient may have intermittent claudication, moderate arterial disease and resting pain.
Exercise to increase arterial neogensis. |
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Term
What does it mean if ABI , 0.5?
What is the treatment for this situation? |
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Definition
Resting pain and ischemic neuritis may be present.
Surgery is needed: bypass graft or endaterectomy. |
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Term
| How does venous stasis contribute to the formation of a venous ulcer? |
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Definition
| The pooling blood lies stagnant in the LEs, and makes it difficult for fluid exchange to occur. Decreased venous return causes anoxia and cell death, which promotes development of an ulcer. |
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Term
VOCAB: Organic Arterial Insufficiency
ie: _______, _________ |
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Definition
| Structural problem leading to closure of a vessel. ie: thrombus, embolus |
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Term
VOCAB: Functional Arterial Insufficiency
ie:_____________ |
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Definition
| Impairment in the function of a vessel ie: Raynaud's (vasospasm) |
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Term
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Definition
| Thickenin and hardening of the arterial wall |
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Term
| What would you want to document in the chart of a patient you examined who has intermittent claudication? (5major things) |
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Definition
1. Pulses (femoral, popliteal, dorsal pedis AND malleolar.) Compare bilaterally if you can.
2. Chances in the physical exam after walking.
3. Cladication time: How far she can walk before onsite of pain.
4. Trophic Chances
5. Capillary refill time |
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Term
| In what position would you have the patient while you measured their ABI? |
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Definition
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Term
| A patient c/o pain when legs are elevated, when she exercises, especially when it's hot out. He has night pain as well. Based on these symptoms, what would you suspect is the problem? |
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Definition
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Term
| You visit a patient in the hospital, and her feet are sticking out from under the blanket. You notice a wound between her first and second toe. It is round, and fairly deep. You also notice her toenails are very thick and yellowed. What type of ulcer does |
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Definition
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Term
| One of your patients tells you that she had a sympathectomy 3 months ago. Why would she have had this done, and how would it have helped her problem? |
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Definition
| She has an incompetent arterial system. The sympathectomy will allow for increased blood flow to the skin, for more adequate circulation to that area(because the symp system can't constrict the arteries). This will decrease her risk for wounds, and will decrease healing time should a would develop. |
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Term
| VOCAB: Valve incompetence |
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Definition
| Inability of the venous valves to close, leading to venous reflux. |
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Term
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Definition
| backflow of blood in the veins. Occurse b/c excess edema in the vein spreads the venous walls so far apart that the valve flaps cannot contact each other. |
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Term
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Definition
| Brownish purple discoloration due to the breakdown of RBCs. Seen in pts w/ venous insufficiency. |
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Term
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Definition
| Destruction of cutaneous lymph channles or obstruction of lymphatic patterns. It's an infection and causes redness of the limb. |
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Term
| What is an Unna boot? What is it used for? |
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Definition
An inelastic bandage impregnated w/ zinc oxide.
Used for venous ulcers. Also enhances re-epithelialization and decreases inflammation and bacterial growth. |
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