Term
| What are the THREE main risk factors for PAD? |
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Definition
| SMOKING!! DIABETES, HYPERLIPIDEMIA |
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Term
| What two ethnic groups are at highest risk for PAD? |
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Definition
| African American and Hispanic |
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Term
| What are 6 other risk factors for PAD? |
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Definition
| Chronic Kidney disease, sedentary lifestyle, sress, Hyper-homo-cystein-emia (venous disease), Metabolic Syndrome, Elevated C-reactive pr- |
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Term
| What are 4 important risk factors in order of highest to lowest that clinicians should consider in add to ABI to assess risk for developing PAD? |
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Definition
| #1 Diabetes, #2 Smoking, #3 Hypertension, #4 Total Cholesterol (10mg/dL) |
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Term
| What is the PAD progression? |
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Definition
| Intermittent claudication-->Rest Pain-->Ulceration-->Gangrene-->Limb Loss |
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Term
| How is Intermittent Claudication characterized? |
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Definition
| Muscle ache/cramp caused by walking a specific distance which is CONSISTANT day to day--> relieved by rest-->walk-pain-rest-relief over and over again... |
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Term
| What are the sites of Intermittant Claudication? |
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Definition
| Pain is always one joint level below the blockage, if the WHOLE LEG hurts you have multi blockages. Calf (superficial femoral artery), buttock & thigh (aorto-iliac), foot (tibial and peroneal (ankle) arteries) |
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Term
| HEART FAILURE -- what are the compensatory mechanisms that the heart undergoes which lead to HF? |
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Definition
| Ventricular dilation, ventricular hypertrophy, neurohormonal responses (ADH, aldosterone), SNS activation |
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Term
| What are the signs and symptoms of PAD? |
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Definition
| Dry scaly skin, hair loss, unilateral dependent rubor (purplish reddish when leg is hanging), blanching w elevation (takes longer than 40s to return), poor nail growth |
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Term
| What are the defining characteristics of ARTERIAL ULCER? |
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Definition
| Well demarcated, deep and punched out (circular). DIFFICULT TO HEAL, needs sloughing |
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Term
| What is a Neuropathic ulcer? |
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Definition
| Caused by not being able to sensory loss in the lower extremities like skin lesions common in diabetics. Has some arterial component to the pathology. |
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Term
| What are the pros/cons of treating ulcers w/ moisture retentive HYDROGELS? |
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Definition
| (esp sm arterial wounds) Provides moist wound environment, gentle autolysis (cleans up the wound) and can impregnate on nugauze for tunneling, are soothing. CONS-- needs secondary dressing, NOT absorbant, can cause maceration--some pt say they burn. |
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Term
| What are the pros/cons of treating ulcers w/ moisture retentive HYDROCOLLOIDS? |
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Definition
| Provides moist wound surface, autolysis, protection CONS--only absorb light exudate and can be occlusive, may cause stripping |
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Term
| What are the pros/cons of treating ulcers w/ absorptive FOAM dressings? |
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Definition
| Absorptive, may or may not need secondary bandage to adhere, decreases frequency of changes CONS: Expensive |
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Term
| What is ankle brachial index? |
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Definition
| SBP ANKLE/SBP ARM =~ 1 or greater LEFT and RIGHT ankle values use the highest value of either arm; can use higher value of dosal pedalis or posterial tibial value for either leg |
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Term
| What is the diagnostic significance of a ABI score in either ankle of <0.9? |
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Definition
| ABI < 0.9 is diagnostic of PAD! |
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Term
| What is the absolute UPPER LIMIT for ABI? Claudication? Gangrene? |
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Definition
| 1.25 (above this is a false reading); <0.9, <0.35 |
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Term
| What are the main PAD diagnostic tests? |
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Definition
| Duplex ultrasound usually first test, ABI |
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Term
| What are the hallmarks of UE arterial disease? how do you check for it? |
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Definition
| Arm fatigue/pain with exertion, difficulty hold/grasp obj, difficulty DRIVING -- take bilateral brachial BP, if there is a discrepancy >20 mmHg, Unilateral coolness/pallor, increased cap refill time you probably have UE Arterial Disease |
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Term
| What are the Treatment goals for PAD? |
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Definition
| Minimize risk of MI and STROKE by quit smoking, HTN management, lower cholesterol <100 LDL or <70 LDL for high risk. |
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Term
| What antithrombotics are used to treat PAD? |
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Definition
| Aspirin, Ticlopidine, Clopidogrel (Plavix),Effient, Coumadin |
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Term
| What treatments can relieve claudication symptoms? |
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Definition
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Term
| What are the six P's of Acute Arterial Occlusion? |
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Definition
| Pain, Pallor, Pulseless, Parathesia, Paralysis, Poikilothermia (equal to environmental temp w/ no temp control) |
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Term
| How do you treat arterial occlusion? |
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Definition
| Anticoag (IV Heparin), embolectomy/thrombectomy, thrombolytic agents |
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Term
| What are perforating veins for in the venous system? |
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Definition
| They connect the superficial and deep venous system through the deep facia. |
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Term
| Where in the LE are DVT's likely to occur? What special sinuses in the calves help move blood up to the heart when you walk? |
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Definition
| In the illeo-femoral and in the calf, (especially the SOLEAL SINUSES) |
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Term
| What are the benefits of the musculovenous pump? |
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Definition
| Lowers venous pressure, reduces venous volume, moves blood back to heart |
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Term
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Definition
| It is MULTIFACTORIAL however, stasis is the main cause. |
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Term
| What is VIRCHOW's triad of RISKS for DVT? |
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Definition
| Stasis, Hypercoagulability, endothelial injury |
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Term
| What are risk factors that increase COAGULOPATHY which is one of the risk factors in Virchow's Triad for DVT? |
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Definition
| Pregnancy, cancer, oral contraceptives, hormone replacement therapy, Protien defficiency (C, S, Antithrombin III), polycythemia |
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Term
| How significant are CALF DVT's? |
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Definition
| Usually superficial and very low risk of PE, usually they move to deep veins w/o treatment and swelling is minimal |
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Term
| What are the signs and symptoms of DVT? What are the S/Sx of Illeo-femoral DVT? |
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Definition
| Edema, pain (dull, tight OR throb), tender to palpation, warmth, palpable cord (superficial system)--TOTAL leg swelling, SEVERE pain, CYANOSIS |
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Term
| What is the Treatment for DVT? |
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Definition
| PREVENT thrombus propagation with ANTICOAG therapy (heparin IV/coumadin), reduce PE risk, promote recanalization (reopening of the vein), preserve valve fxn, avoid post thrombotic syndrome. |
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Term
| What is thrombophlebitis? how is it different from DVT's? |
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Definition
| Inflammatory condition limited to superficial veins and is NOT a clot, DVT's are lacking an inflammatory component. |
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Term
| How do you treat Thrombophlebitis? |
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Definition
| Elevation, warm/moist heat, anti inflammatory meds, analgesic |
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Term
| What is post thrombotic syndrome? |
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Definition
| Incompetence of the distal deep veins, failure of calf muscle pump and ambulatory venous HTN. |
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Term
| If you have brown itchy ankles and GATOR DISTRIBUTION, itching, weeping and scaling what do you have? |
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Definition
| Chronic Venous Insufficiency |
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Term
| What is the treatment for Chronic Venous Insufficiency? |
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Definition
| Elevate leg, TED hose, sleep w FOB elevated, avoid tight garments |
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Term
| How are venous ulcers characterized? |
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Definition
| Lower third of the calf/gaitor area, pre-tibial region, pitting edema and pain alleviated by ELEVATION, GRANULATION TISSUE and WEEPING/exudate |
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Term
| how do you treat a venous ulcer? |
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Definition
| Debridement (surgical or mesh dressings ALGINATES), Calcium Alginate absorbs exudate and stops bleeding |
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