Term
| which ulcer accounts for 70-90% of all ulcers |
|
Definition
|
|
Term
| % of the population that is diagnosed with chronic venous insuffiency |
|
Definition
|
|
Term
| % of population that has venous ulcers |
|
Definition
|
|
Term
| the remaining 10-30% of ulcers, what % are d/t mixed venous/arterial insuffiency |
|
Definition
|
|
Term
| gender more at risk for ulceration |
|
Definition
|
|
Term
| indiviuals 65+ years old have how much of a greater risk to develop venous disease |
|
Definition
|
|
Term
| prevalence of ulcers on admission to SNF is what % |
|
Definition
|
|
Term
| what % of venous ulcers can be resolved through conservative measures? |
|
Definition
|
|
Term
| recurrence rate in venous ulcers |
|
Definition
|
|
Term
| main cause of ulcer recurrence |
|
Definition
|
|
Term
| venous insuffiency aka (3) |
|
Definition
| venous reflux disease, ulcerative venous disaease, venous stasis disease |
|
|
Term
| chronic venous insuffiency occurs when what happens to valves? |
|
Definition
| become incompetent and do not close either in the superficial, deep, or perforator system |
|
|
Term
|
Definition
|
|
Term
| deep system pressure as compared to the pressure in teh superficial veins |
|
Definition
| higher pressure in the deep system |
|
|
Term
| pressure at the arterioles as they transfer blood to the capillaries on the venous side |
|
Definition
|
|
Term
| which system of the venous system will malfunction first? |
|
Definition
|
|
Term
|
Definition
| blood back flows since valves do not close |
|
|
Term
| mm vital for venous return |
|
Definition
|
|
Term
| common problems with the calf mm pump include (6) |
|
Definition
| calf weakness, patient non ambulatory, decreased ankle ROM, OA, foot deformities, paralysis |
|
|
Term
| 3 deep veins located in the calf muscle |
|
Definition
| femoral, popliteal, tibial |
|
|
Term
| the deep veins run how to the arteries |
|
Definition
|
|
Term
| pressure in the deep veins as compared to the superficial veisn |
|
Definition
| deep veins have a higher pressure |
|
|
Term
| purpose of the deep veins |
|
Definition
| carry most of the blood back to the heart |
|
|
Term
| all medium and large veins have bicuspid valves. what is the role of these bicuspid valves? |
|
Definition
| prevent retrograde flow and venous HTN |
|
|
Term
|
Definition
| greater and lesser saphenous veins |
|
|
Term
| where are the superficial veins lcoated |
|
Definition
| in the subcutaneous tissues |
|
|
Term
| function of the superficial veins |
|
Definition
| drain the skin and subcutaenous tissues |
|
|
Term
| veins which are more susceptible to damage |
|
Definition
|
|
Term
| why are the superficial veins more susceptible to damage other than their superficial location |
|
Definition
| thinner adventitia layer (outer layer) |
|
|
Term
| how do the superficial layers assist in temperature regulation? |
|
Definition
|
|
Term
| purpose of the perforating veins |
|
Definition
| pierce the fascia connecting the superficial veins to the deep veins |
|
|
Term
| innermost layer of the vein |
|
Definition
|
|
Term
|
Definition
|
|
Term
| outermost layer of the vein |
|
Definition
|
|
Term
| which layer of the vein produces a heparin like enzyme the reduces the incidence of DVTs |
|
Definition
|
|
Term
| the tunica intima produces an enzyme that does what? |
|
Definition
| heparin like enzyme that reduces incidence of DVTs |
|
|
Term
| similarities between veins and arteries |
|
Definition
| layers are similar, however veins are thinner with less smooth muscle |
|
|
Term
| where is most of the body's blood volume |
|
Definition
|
|
Term
| the vein's bicuspid valves are easily damaged by (4) |
|
Definition
| trauma, DVTs, inflammation, venous distension |
|
|
Term
| damage to vein bicuspid valves leads to what |
|
Definition
|
|
Term
|
Definition
|
|
Term
| population which could be prime candidates for venous HTN |
|
Definition
| sedentary jobs, which allow infrequent walking or those who stand in one place for hours on end |
|
|
Term
| pressure in the veins increases from 15 mmHg to what with static standing? |
|
Definition
|
|
Term
|
Definition
| previous/Family Hx of DVT, immobility, recent surgery, 40+ y.o., hormone therapy, oral contraceptives, pregnancy/post partum, previous or current cancer, limb trauma and/or orthopedic procedures, coagulation abnormalities, obesity |
|
|
Term
|
Definition
| discoloraiton of the legs, calf or leg pain or tenderness, swelling of the leg/lower limb, warm skin, surface veins become more visible, leg fatigue |
|
|
Term
|
Definition
| immobilization, trauma, hypercoaguability |
|
|
Term
| what should you look for with Virchow's Triad |
|
Definition
|
|
Term
| inflammatory thrombosis of superficial normal vein d/t infection or trauma from needles or trauma to a varicose vein |
|
Definition
|
|
Term
| sign of superficial phlebitis |
|
Definition
| linear painful erythematous cord |
|
|
Term
|
Definition
|
|
Term
| is homan's sign a good test? |
|
Definition
|
|
Term
| how is the homan's sign test performed? |
|
Definition
| ankle is passively dorsiflexed with knee extended |
|
|
Term
| what would the S/S be for a (+) homan's sign |
|
Definition
| pain with test movement, tenderness with deep palpation of gastrocnemius |
|
|
Term
| a (+) homan's sign can be found with what other conditions? |
|
Definition
| superficial phlebitis, musculoskeletal injuries (achilles tendonitis) |
|
|
Term
| the 2nd pump of the body, the first being the calf |
|
Definition
|
|
Term
| durign inspiration what happens to the diaphragm |
|
Definition
| depresses into the abdominal space |
|
|
Term
| during inspiration what is the pressure in the thorax |
|
Definition
|
|
Term
| during inspiraiton what is the pressure in the abdomen |
|
Definition
|
|
Term
| the greater the inspiration teh greater the |
|
Definition
|
|
Term
| risk factors for ulceration (6) |
|
Definition
| vein dysfunction, calf mm pump failure, trauma, previous venous ulcer, advanced age, diabetes |
|
|
Term
| chronic venous ulcers are thoguht to be initaited by what |
|
Definition
| minor trauma to an edematous leg |
|
|
Term
| what kind of trauma can cause a venous ulcer |
|
Definition
| benign trauma to leg with VI such as brush against a thorn bush, scratching a dry/itchy leg |
|
|
Term
| once a break in skin integrity occurs, the likelihood of delayed wound healing is increased in the presence of VI because of what |
|
Definition
| decreased O2 concentration |
|
|
Term
| recurrence rate for venous ulcers are as high as what? |
|
Definition
|
|
Term
| reasons ulcers recur in the same location (4) |
|
Definition
same reason as previous (local hypoxiema, malnutrition)
consider vascular consult/closure procedure
scare tissue from previous ulceration has less tensile strength and elasticity than the original healthy tissue
precipitating factors not addressed (edema) |
|
|
Term
| the wound will not heal if the A1C is above what level |
|
Definition
|
|
Term
| diabetic normal a1c is between what |
|
Definition
|
|
Term
| diabetes impairs what phase of wound healing? |
|
Definition
|
|
Term
| s/s of venous disease (7) |
|
Definition
| pain, spider veins, varicose veins, leg heaviness/fatigue, swelling, hemosiderine staining, lipodermatosclerosis |
|
|
Term
| conversion of skin into thinck, hard tissue by teh deposition of lipids and fibrous tissue (inverted chapagne bottle sign) |
|
Definition
|
|
Term
| conversion of skin into thinck, hard tissue by teh deposition of lipids and fibrous tissue (inverted chapagne bottle sign) |
|
Definition
|
|
Term
| apperance and characteristics of the venous ulcer (6) |
|
Definition
| shallow, irregular borders, weepy (mild to profuse exudate), gaiter area, beefy red, fibrin possible, surrounding skin with hemosiderine staining, lipodermatosclerosis, edema, eczema |
|
|
Term
| venous refill times: if normal |
|
Definition
|
|
Term
| venous refill times: if mild disease present |
|
Definition
|
|
Term
| venous refill times: moderate disease present |
|
Definition
|
|
Term
| venous refill times: if severe disease prsent |
|
Definition
|
|
Term
| screening for CVI: gold standard |
|
Definition
| color flow doppler ultrasound |
|
|
Term
| screening for CVI: con of a color flow doppler ultrasound |
|
Definition
|
|
Term
| screening for CVI: 2nd best test |
|
Definition
| quantitative photoplethysmogrpahy |
|
|
Term
| screening for CVI: tests screen for what? |
|
Definition
| reflux, thrombus, venous wall status as well as locations of obstructions |
|
|
Term
| prolbme with a doppler ultrasound of veins |
|
Definition
| more subjective than a doppler exam of arteries |
|
|
Term
| 3 parts of a doppler ultrasound |
|
Definition
| resting test, augmentation test, reflux test |
|
|
Term
| why is the doppler ultrasound test subjective |
|
Definition
| clinician interprets sound intensity changes |
|
|
Term
| procedure for doppler ultrasound resting test |
|
Definition
| pt supine. Gel over large vein with probe at 45 degree angle. Normally, veins should have spontaneous sounds |
|
|
Term
| procedure for doppler ultrasound augmentation test |
|
Definition
| apply pressure in form of a quick squeeze distal to probe placement. In healthy veins, this should enhance the doppler signal |
|
|
Term
| procedure for doppler ultrasound for reflux test |
|
Definition
| apply pressure (quick squeeze) proximal to probe placement. In healthy veins sound will disappear. When compression released, resting signal returns |
|
|
Term
| Classification of CVI: abbreviation |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
| etiology (primary, secondary, congential) |
|
|
Term
|
Definition
| anatomic distribution (deep, superficial, perforator) |
|
|
Term
|
Definition
| pathophysilogy (reflux, obstruction, both) |
|
|
Term
| Classification of CVI: Clincal Presentation Class 0 |
|
Definition
| no signs of venous disease |
|
|
Term
| Classification of CVI: Clincal Presentation Class 1 |
|
Definition
| spider veins (telangiectases) |
|
|
Term
| Classification of CVI: Clincal Presentation Class 2 |
|
Definition
|
|
Term
| Classification of CVI: Clincal Presentation Class 3 |
|
Definition
|
|
Term
| Classification of CVI: Clincal Presentation Class 4 |
|
Definition
|
|
Term
| Classification of CVI: Clincal Presentation Class 5 |
|
Definition
|
|
Term
| Classification of CVI: Clincal Presentation Class 6 |
|
Definition
|
|
Term
| Classification of CVI: C3 Ep As Pr |
|
Definition
| clinical (edema), etiology (primary), anatomic distribution (superficial), pathophysiology (refulx) |
|
|
Term
| nonsurgical treatment of CVI |
|
Definition
|
|
Term
| types of compression for nonsurgical treatment of CVI |
|
Definition
| compression stockings, multilayer compression wraps, elevation and exercise, pneumatic pumps |
|
|
Term
|
Definition
| increases interstital pressure reversing the fluid leak out of the capillary bed and forces it back into the blood stream |
|
|
Term
| short or long stretch for VI |
|
Definition
|
|
Term
| short or long stretch for lymphedema |
|
Definition
|
|
Term
| studies indicate that what type of compression is similar to short stretch in their outcomes in regards to VI |
|
Definition
|
|
Term
| external compression compensates for what regarding skin |
|
Definition
| decreased elasticity in skin and vessels |
|
|
Term
| external compression keeps fluid from collecting where |
|
Definition
|
|
Term
| compression with the addition of muscular activity promotes what |
|
Definition
| venous and lymphatic return |
|
|
Term
| Compression stockings pressure: class 1 |
|
Definition
|
|
Term
| Compression stockings pressure: class 2 |
|
Definition
|
|
Term
| Compression stockings pressure: class 3 |
|
Definition
|
|
Term
| Compression stockings pressure: class 4 |
|
Definition
|
|
Term
| Compression stockings pressure: where is it measured |
|
Definition
|
|
Term
| Compression stockings pressure: what happens to the pressure as you move proximal from the ankle |
|
Definition
|
|
Term
| there should not be any of this in a venous wound |
|
Definition
|
|
Term
| presence of slough in a venous wound would indicate what |
|
Definition
| lots of bacteria, or it is actually arterial insuffiency |
|
|
Term
| are ace wraps good for VI? |
|
Definition
|
|
Term
| dr aaron recommends what type of stretch for VI |
|
Definition
|
|
Term
| considerations for choosing a compression garment |
|
Definition
| cost/insurance coverage, compression class, pt compliance, appearance (cosmetics), custom/off the shelf, material (long/short stretch), skin condition, donning/doffing |
|
|
Term
| Short or long stretch: cotton fibers with interlocking weave |
|
Definition
|
|
Term
| Short or long stretch: polyblend fibers |
|
Definition
|
|
Term
| Short or long stretch: allows approximately 60% extensibility of original length |
|
Definition
|
|
Term
| Short or long stretch: allows for more than 140% extensibility of original length |
|
Definition
|
|
Term
| Short or long stretch: comprilan, rosidal K, porelast |
|
Definition
|
|
Term
| Short or long stretch: ace, four flex, profore, surepress, cetopress |
|
Definition
|
|
Term
| if the pressure is 40 mmHG at the ankle, it will graduate to what at the knee? |
|
Definition
|
|
Term
| new compression design that enhances lymphatic drainage and minimizes the tourniquet effect of other types of compression |
|
Definition
|
|
Term
| circaid juxta fit: Low ______ pressure, high _______ pressure |
|
Definition
|
|
Term
| indications of pneumatic pumps (4) |
|
Definition
| primary/secondary lymphedema, CVI, DVT prophylaxis |
|
|
Term
| contraindications of pneumatic pumps (6) |
|
Definition
| CHF, DVT, PE episodes, untreated infection/cellulitis, lymphangiosarcoma, AI (ABI <.5 or <.6 depends on study) |
|
|
Term
| if an ABI is greater than 1 with diminished/absent pulses what would it mean? |
|
Definition
| vasculitis and is an urgent referral |
|
|
Term
| ABI: what angle should the doppler probe be held at |
|
Definition
|
|
Term
| ABI: don't pump the cuff past what |
|
Definition
|
|
Term
|
Definition
|
|
Term
| ABI: normal value and compression |
|
Definition
|
|
Term
| ABI: mild arterial insuffieincy |
|
Definition
|
|
Term
| ABI: mild arterial insuffiency and compression |
|
Definition
|
|
Term
| ABI: moderate insuffiency |
|
Definition
|
|
Term
| ABI: moderate arterial insuffiency and compression |
|
Definition
| contraindicated (ok to use light compression ABI .6-.8) |
|
|
Term
| ABI: severe arterial insuffiency |
|
Definition
|
|
Term
| ABI: severe arterial insuffiency and compression |
|
Definition
| absolutely contraindicate |
|
|
Term
| ABI: >1.2 indicative of what |
|
Definition
| calcified vessles if diabetic (medical calcific stenosis) |
|
|
Term
| ABI: when would intermitten claudication appear |
|
Definition
| moderate arterial insuffiency |
|
|
Term
| ABI: when would resting pain occur |
|
Definition
|
|
Term
| ABI: when would tissue loss occur? |
|
Definition
|
|
Term
| when should a toe brachial index be used? |
|
Definition
| when calcific stenosis gives a falsely elevated ABI |
|
|
Term
|
Definition
|
|
Term
|
Definition
| segmental digital plethysmography |
|
|
Term
| Surgical Interventiosn for CVI: (6) |
|
Definition
| stripping, sclerotherapy, stab phlebectomy, subfascial endoscopic perforator srugery, closure procedure (radio frequency ablation), Linton procedure |
|
|
Term
| Surgical Interventiosn for CVI: manually pulls the vein out, out dated, significant tissue damage |
|
Definition
|
|
Term
| Surgical Interventiosn for CVI: injection of a caustic agent into the vein causing necrosis and scar formation |
|
Definition
|
|
Term
| Surgical Interventiosn for CVI: uses a series of small incisions to remove large varicosities |
|
Definition
|
|
Term
| Surgical Interventiosn for CVI: entry to the perforator with a CO2 ballon used to collapse the vein |
|
Definition
| subfascial endoscopic perforator surgery |
|
|
Term
| Surgical Interventiosn for CVI: a catheter is inserted into the vein. Once in place it is withrawn wht the simulataneous application of ultrasonic RF energy thereby closing the vein |
|
Definition
| closure procedure/radio frequency ablation |
|
|
Term
| Surgical Interventiosn for CVI: incised entire leg and removed the vein |
|
Definition
|
|
Term
| What does the lymphatic system consist of? (6) |
|
Definition
| organs, bone marrow, lymph nodes, spleen, thymus, and ducts |
|
|
Term
| Function of the lymphatic system simple |
|
Definition
| recirculate interstitial fluid back to the tissues |
|
|
Term
| function of the lymphatic system (more complicated definition) (3) |
|
Definition
| returns interstitial fluids to the bloodstream, produce T cells and B cells to fight infection/disease, transprots lipids from the intestines to the blood |
|
|
Term
| WHere are the superfiical lymphatics located |
|
Definition
|
|
Term
| Where are teh deeper lymphatics lcoated |
|
Definition
| in the subcutaneous tissue |
|
|
Term
|
Definition
| fluid and protein that has been squeezed out of teh blood (blood plasma) |
|
|
Term
| How is lymph drained from the tissue |
|
Definition
| microscopic blind-ended vessels called lymph capillaries |
|
|
Term
| Are they lymph capillaries pressurzied? |
|
Definition
|
|
Term
| How does lymphatic fluid drain? |
|
Definition
| easily under normal circumstances by peristalsis from muscle activity (both smooth mm and skeletal mm) |
|
|
Term
| What is lymphedema caused by (3) |
|
Definition
| blockage of lymph channels, damage to lymph vessels or node (d/t surgery, radiation, or trauma), or congenital anomalies |
|
|
Term
|
Definition
|
|
Term
| lymphedema caused by blockage of lymph channels, damage to lymph vessels or nodes d/t surgery, radiation, or trauma |
|
Definition
|
|
Term
|
Definition
| inability to pinch a fold of skin at the base of the 2nd toe. sign of lymphedema |
|
|
Term
| staging lymphedema: grade 1 (edema descriptor) |
|
Definition
|
|
Term
| staging lymphedema: grade 2 (edema descriptor) |
|
Definition
|
|
Term
| staging lymphedema: grade 3a (edema descriptor) |
|
Definition
|
|
Term
| staging lymphedema: grade 3b (edema descriptor) |
|
Definition
|
|
Term
| staging lymphedema: grade 4 (edema descriptor) |
|
Definition
|
|
Term
| staging lymphedema: which grade has two substages |
|
Definition
|
|
Term
| staging lymphedema: grade 1 (physical appearance) |
|
Definition
| involves distal parts such as a forearm or hand or a lower leg and foot. THe difference in circumference is less than 4 cm and other tissue changes are not yet present |
|
|
Term
| staging lymphedema: grade 2 (physical appearance) |
|
Definition
| lymphedema involves an entire limb or corresponding quadrant of the trunk. Difference in circumference is more than 4 but less than 6 cm. TIssue changes such as pitting are apparent |
|
|
Term
| staging lymphedema: grade 3a (physical appearance) |
|
Definition
| lymphedema is present in on elimb and its associated trunk quadrant. The difference in circumference is greater than 6 cm. Significant skin alterations such as cornification, fistulas, and or cysts can be present |
|
|
Term
| staging lymphedema: grade 3b (physical appearance) |
|
Definition
| same as 3a, but two or more extremities are affected |
|
|
Term
| staging lymphedema: grade 4 (physical appearance) |
|
Definition
| aka elephantitis. THe affected extremities are huge d/t almost complete blockage of the lymph channels. Elephantiasis my also affect the head and face |
|
|
Term
|
Definition
| address lymphedema asap for best results. network with manual therapists who specialize in lymphatic drainage and mgmt. initiate compression. |
|
|
Term
| lipedema is frequently mistaken for what (2) |
|
Definition
|
|
Term
|
Definition
| pathological disorder of adipose tissue resulting in progressive migration and expansion of fat cells in the lower body |
|
|
Term
| characteristics of lipedema: (6) |
|
Definition
| familial, females predominantly affected, can appear in thin or obese individuals, normal size upper body with symmetric and bilateral expansion of fat from waist to just above malleoli. fat can not be lost with diet and exercise. easy bruising |
|
|
Term
|
Definition
| primarily puberty, pregnancy, peri menopause, other hormonal changes (hysterectomy etc) |
|
|
Term
| secondary side effects of lipedema |
|
Definition
| eventual interference of lymphatic flow by accumulation of adipose and secnodary lymphedema frequently develops as a result |
|
|
Term
| syndrome associated with lipodema |
|
Definition
| suaven trousers syndrome. feet spared with overlapping tissue over the malleoli |
|
|
Term
| differential dx: pain CVI |
|
Definition
|
|
Term
| differential dx: pain lymphedema |
|
Definition
|
|
Term
| differential dx: pain lipedema |
|
Definition
|
|
Term
| differential dx: dorsum of foot involved cvi |
|
Definition
|
|
Term
| differential dx: dorsum of foot involved lymphedema |
|
Definition
|
|
Term
| differential dx: dorsum of foot involved |
|
Definition
|
|
Term
| differential dx: decreased swelling over night cvi |
|
Definition
|
|
Term
| differential dx: decreased swelling overnight lymphedema |
|
Definition
|
|
Term
| differential dx: decreased swelling over night lipedema |
|
Definition
|
|
Term
| differential dx: stemmer sign CVI |
|
Definition
|
|
Term
| differential dx: stemmer sign lymphedema |
|
Definition
|
|
Term
| differential dx: stemmer sign lipedema |
|
Definition
|
|
Term
| differential dx: reccurent infections CVI |
|
Definition
|
|
Term
| differential dx: recurrent infections lymphedema |
|
Definition
|
|
Term
| differential dx: recurrent infections lipedema |
|
Definition
|
|
Term
| differential dx: easy bruising CVI |
|
Definition
|
|
Term
| differential dx: easy bruising lymphedema |
|
Definition
|
|
Term
| differential dx: easy bruising lipedema |
|
Definition
|
|
Term
| other causes of LE edema (8) |
|
Definition
| DVT, CHF, neoplasm, radiation, infection, pulmonary HTN, systemic diseases, meds |
|
|
Term
| LE edema can be d/t infection with which bacteria being more common |
|
Definition
| strep gram most often, erysipela |
|
|
Term
| which meds could cause LE edema |
|
Definition
| calcium channel blockers, steroids, tamoxifen |
|
|
Term
|
Definition
| peripheral vascular disease (PVD), peripheral arterial disease (PAD) |
|
|
Term
| most common etiology of arterial disease |
|
Definition
|
|
Term
| conditions most commonly associated with arteriosclerosis (6) |
|
Definition
| hyperlipidemia, HTN, obesity, diabetes, CAD, CHF |
|
|
Term
| signs of peripheral arterial occlusive disease (8) |
|
Definition
| thin, atrophic skin (shiny hairless), hypertrophic nails, muscle wasting, dependent rubor, pallor and pain with elevation, hanging foot sign, exercise induced pain (intermitten claudication), absent or diminished pulses |
|
|
Term
| characteristics of arterial wounds (6) |
|
Definition
well defined round borders "cookie cutter" appearance
dry with minimal to no exudate
pale in color
usually full thickness
painful
located at the tips of toes, lateral foot, and gaiter area |
|
|
Term
|
Definition
| pulselessness, pallor, poikilothermia, pain, paralysis, paresthesias |
|
|
Term
|
Definition
| inability to regulate body temp usually d/t a vital body part not getting flow |
|
|
Term
| pain from PAOD is from exercise induced muscular ischemia and can manifest where |
|
Definition
| calf, thigh, gluteal region |
|
|
Term
| Literature supports what exercise program for muscular ischemia |
|
Definition
| 30 min, 3x/wk for at lesat 6 months at an 8/10 VAS |
|
|
Term
| PAOS could be confused with these other 2 conditions |
|
Definition
| blood clot, herniated disc w radiculopathy |
|
|
Term
| what is a LEA (lower extremity arterial study) able to diagnose |
|
Definition
| disease at multiple levels using doppler wave and pulse volume recording |
|
|
Term
| What is a laser doppler able to do |
|
Definition
| measures blood flow to the skin, penetrates 1-2 mm below the surface |
|
|
Term
| With a laser doppler: a skin perfusion >= to what indicates a 90% changes that wound healing will occur |
|
Definition
|
|
Term
| Duplex scan combines what 2 procedures |
|
Definition
| arterial doppler with color flow analysis |
|
|
Term
| Duple scan combines arterial doppler with color flow analysis to do what? |
|
Definition
| evaluate multiple arteries |
|
|
Term
| Transcutaneous Oxygen (TcpO2) measures what? |
|
Definition
| oxygen as it diffuses across the skin from capillary beds |
|
|
Term
| What TcpO2 pressure will the wound not heal |
|
Definition
|
|
Term
| What TcpO2 pressure should the wound heal |
|
Definition
|
|
Term
| Effects of Tissue Ischemia: Decreased (6) |
|
Definition
metabolism
neutrophil function (ability to fight bacteria)
RNA/DNA production
collagen production
nitric oxide production
angiogenesis |
|
|
Term
| end result of tissue ischemia |
|
Definition
| non-healing wound environment |
|
|
Term
| other causes of tissue ischemia (6) |
|
Definition
| smoking, anemia, radiation, vasculitis, edema, severly impaired cardiac function |
|
|
Term
| how much did 1 cigarette decrease O2 flow and for how long |
|
Definition
|
|
Term
| what kill the blood supply to the cells with radiation |
|
Definition
| obliterative endocarditis |
|
|
Term
| optiuons for tx of ischemia (4) |
|
Definition
| minimally invasive procedures, angioplasty, thrombolytics, stents/baloons, VEGF (molecular level therapy) |
|
|
Term
| what is the role of VEGF( vascular endothelial growth factor) |
|
Definition
| signals 4 proteins responsible for vascular/angiogenesis. Enhances micro vascular permeability |
|
|
Term
| what is the specfic procedure for the angioplasty option |
|
Definition
| percutaneous transluminal coronary angioplasty (PTCA, baloon compression of plaque) |
|
|
Term
| surgical alternative for ischemia (5) |
|
Definition
bypass grafts
reconstructions
gortex graft (ePTFE)
reverse saphenous vein, lesser saphenous vein
amputation |
|
|
Term
| by pass grafts could use what arteries (3) |
|
Definition
|
|
Term
|
Definition
|
|
Term
| how many Americans born after 2002 will be diagnosed positive for diabetes |
|
Definition
|
|
Term
| what percent of persons who are presently affected will develop a foot ulcer |
|
Definition
|
|
Term
| how many people are presently affected by diabetes |
|
Definition
|
|
Term
| how many people are yet undiagnosed with diabetes |
|
Definition
|
|
Term
| of those who are diagnosed with diabetes how many will undergo amputation |
|
Definition
|
|
Term
| what percentage of diabetic patietns demonstrate mild to severe neuropathy |
|
Definition
|
|
Term
| diabetes accounts for what percentage of all lower extremity amputations |
|
Definition
|
|
Term
| what percentage of diabetic foot ulcers will lead to amputation? |
|
Definition
|
|
Term
| most common co-morbidity associated with diabetes |
|
Definition
|
|
Term
| high blood sugars cause damage to what 2 structures |
|
Definition
| nerve (neuropathy) and artery damage |
|
|
Term
| arterial changes with diabetes occur in what types of vessels |
|
Definition
| both large and small vessels |
|
|
Term
| arterial changes d/t diabetes: large vessels: which arteries (2) |
|
Definition
| coronary aa, large lower extremity aa's |
|
|
Term
| arterial changes d/t diabetes: large vessels: identical in appearance to changes caused by what? |
|
Definition
|
|
Term
| arterial changes d/t diabetes: small vessels: which vessels (3) |
|
Definition
| arterioles, capillaries, venules |
|
|
Term
| arterial changes d/t diabetes: small vessels: damge is specific to diabetes with what structures being most vulnerable (2) |
|
Definition
|
|
Term
| what dysfunctional does high blood sugars lead to in the small vessels |
|
Definition
|
|
Term
| endothelial dysfunction in the small vessels as a result of high blood sugars |
|
Definition
| vessels cant dilate in response to injury resulting in decreased bloow flow and O2/nutritional transport |
|
|
Term
| what reflex is affected in the small vessels as a result of high blood sugars |
|
Definition
|
|
Term
| precise etiology of the nerve-axon reflex |
|
Definition
|
|
Term
| most important side effect of small vessel disease |
|
Definition
| infection, one of the most common reasons for hospital admission for the diabetic patient and is a precursor for most amputations |
|
|
Term
| 3 causes of diabetic foot ulcerations |
|
Definition
| peripheral neuropathy, sensory loss, mechanical stres (foot deformities, tight shoes) |
|
|
Term
| 3 causes of foot ulcerations |
|
Definition
| peripheral neuropathy, sensory loss, mechanical stres (foot deformities, tight shoes) |
|
|
Term
| assessment of loss of protective sensation: what monofilament is used |
|
Definition
| semmes-weinstein 5.07 monofilament |
|
|
Term
| assessment of loss of protective sensation: how much pressure does the semmes weinsten 5.07 monofilament deliver |
|
Definition
|
|
Term
| assessment of loss of protective sensation: how often should the semmes weinsten 5.07 monofilament be tested? |
|
Definition
|
|
Term
| assessment of loss of protective sensation: what areas should not be tested for sensation |
|
Definition
|
|
Term
| assessment of loss of protective sensation: tuning fork at what frequency |
|
Definition
|
|
Term
| assessment of loss of protective sensation: absence of sensation when tested with a 128 Hz tuning fork indicates what |
|
Definition
| loss of protective sensation |
|
|
Term
|
Definition
| Lower Extremity Amputation Prevention |
|
|
Term
| what is the greatest risk for a diabetic foot ulcer |
|
Definition
|
|
Term
| what is the greatest risk for amputation |
|
Definition
|
|
Term
| assessment of loss of protective sensation: if a patient cannot sense a monofilament of 10 grams bending force at 3 or more areas tested, what does this indicate |
|
Definition
| the pt has a loss of protective sensation and are at a high risk for ulceration |
|
|
Term
| characteristics of diabetic foot ulcers: location (2) |
|
Definition
| plantar foot surface, over boney prominences |
|
|
Term
| characteristics of diabetic foot ulcers: appearance (3) |
|
Definition
| round, punched out in shape, minimal exudate, pale wound bed |
|
|
Term
| characteristics of diabetic foot ulcers: symptom |
|
Definition
|
|
Term
| characteristics of diabetic foot ulcers: other factors: skin condition |
|
Definition
|
|
Term
| characteristics of diabetic foot ulcers: other factors: what is the dry skin d/t? what does it result in? |
|
Definition
| autonomic neuroapthy. results in cracks and fissures |
|
|
Term
| characteristics of diabetic foot ulcers: other factors: hyperkeratosis |
|
Definition
| abnormal callus formation |
|
|
Term
| characteristics of diabetic foot ulcers: other factors: foot dysfunction |
|
Definition
| peronial nerve foot fdrop leads to equino verus and increased forefoot pressure, leads to foot deformities and muscle weakness |
|
|
Term
| characteristics of diabetic foot ulcers: other factors: tibial nerve damage results in what |
|
Definition
| calcaneo valgus and increased heel pressure |
|
|
Term
| mgmt of the diabetic foot: on the pt end (3) |
|
Definition
daily foot exams (use a mirror for limited mobility)
properly fitted shoes
keen skin moisturized, avoiding between toes |
|
|
Term
| mgmt of the diabetic foot: on the medical end |
|
Definition
| Podiatry visits to remove callus, trim nails |
|
|
Term
| mgmt of the diabetic foot: NEVER DO THIS |
|
Definition
| never soak, causes maceration and lead to infection |
|
|
Term
| how many shoes and instert will medicare cover in a year? |
|
Definition
| 1 pair of diabetic shoes, 3 pairs of inserts |
|
|
Term
| optimize healing for the diabetic pt: maintenance of normal blood sugars (2) |
|
Definition
|
|
Term
| optimize healing for the diabetic pt: trauma |
|
Definition
|
|
Term
| optimize healing for the diabetic pt: how many wounds will heal just by offloading pressure |
|
Definition
| 92% heal with offloading alone |
|
|
Term
| optimize healing for the diabetic pt: wound heailng basics (2) |
|
Definition
| reduce bioburden, moist wound healing |
|
|
Term
| irrigation with what PSI is neccessary to wash bacteria out without harming healthy tissue |
|
Definition
|
|
Term
| if there isn't the specific tool for irrigation, what can be MacGyver'd to create 8 psi of pressure |
|
Definition
| 35 mL syringe with 19 gauge angiocath or needle |
|
|
Term
| if the A1C is above what level, healing will be impossible |
|
Definition
|
|
Term
| if a wound is not healing, what provider needs to come in and take a look? |
|
Definition
|
|
Term
| Wagner Diabetic Ulcer Classification 0 |
|
Definition
|
|
Term
| Wagner Diabetic Ulcer Classification 1 |
|
Definition
|
|
Term
| Wagner Diabetic Ulcer Classification 2 |
|
Definition
|
|
Term
| Wagner Diabetic Ulcer Classification 3 |
|
Definition
|
|
Term
| Wagner Diabetic Ulcer Classification 4 |
|
Definition
|
|
Term
| Wagner Diabetic Ulcer Classification 5 |
|
Definition
|
|
Term
| Interventions Based on Wagner Diabetic Ulcer Classification: pre ulcer (3) |
|
Definition
| modify foot wear, limit activity, remove callus |
|
|
Term
| Interventions Based on Wagner Diabetic Ulcer Classification: superficial (4) |
|
Definition
| PWB, relief padding, remove callus, splint/cast |
|
|
Term
| Interventions Based on Wagner Diabetic Ulcer Classification: Deep (5) |
|
Definition
| PWB, culture, probe, x-ray, cast/splint |
|
|
Term
| Interventions Based on Wagner Diabetic Ulcer Classification: deep infected (7) |
|
Definition
| PWB, culture, probe, x-ray, cast/splint, surgical consult, antibiotics |
|
|
Term
| Interventions Based on Wagner Diabetic Ulcer Classification: dysvascular (4) |
|
Definition
| splint, pwb, vascular studies, vascular consult |
|
|
Term
| which bacteria is the most common in an infection of the diabetic foot |
|
Definition
|
|
Term
| what are 3 bacteria that are also involved in the infection of the diabetic foot? what are their gram resutls |
|
Definition
| E coli, pseudomonoas (gram-), proteus (gram -) |
|
|
Term
| objective of total contact casting |
|
Definition
| reduce pressure on the plantar surface of the foot by incresaing the weight bearing surface area |
|
|
Term
| 2 other benefits of total contact casting |
|
Definition
| immobilizes foot and ankle to facilitate healing, controls edema |
|
|
Term
| CROW orthosis is used for what |
|
Definition
| charcot restraint orthotic walker |
|
|
Term
| 5 contraindcations to total contact casting |
|
Definition
acute infections/osteomyelitis
tunneling
dermatitis
excessive swelling
patient adverse to casting |
|
|
Term
| nitric oxide is necessary for: -genesis (2) |
|
Definition
| angiogenesis, neurogenesis |
|
|
Term
| nitric oxide is necessary for: acids repair (2) |
|
Definition
|
|
Term
| nitric oxide is necessary for: amino acid that is a precursor to the production of nitric oxide |
|
Definition
|
|
Term
| nitric oxide is necessary for: (3) |
|
Definition
cell division and maturation
vasodilation; relaxing the smooth muscle cells lining vessel walls
collage synthesis |
|
|
Term
| additional therapeutic modalities (6) |
|
Definition
platelet derived growth factor (PDGF) aka Regranex
E stim
HBO
MIRE
Pulsed Lavage
Bio engineered tissue |
|
|
Term
| if a pt has a crow orthosis prescribe dthey will also need what? |
|
Definition
|
|
Term
| most important thing to do with a chronic wound |
|
Definition
|
|
Term
| if a pt with CHF has venous insuffiency ulcers bilaterally, what should you do in terms of wrapping the wound? |
|
Definition
| wrap one wound and let it heal before wrappign the other. wrapping bilaterally is dangerous |
|
|
Term
| when wrapping which nerve should be avoided and why? |
|
Definition
| avoid fibular nerve causes drop foot. wrap below fibular head |
|
|
Term
| if there is severe arterial insuffiency what is the assumption |
|
Definition
| they will most likely lose the limb |
|
|
Term
| when wrapping what is placed directly on the skin |
|
Definition
|
|
Term
| what are other types of wrap used for insuffiency wounds |
|
Definition
| gauze wrap, ace wrap, coban |
|
|
Term
| which is the only layer that is wrapped in a figure 8? |
|
Definition
|
|
Term
| what are the 4 layers of wound wrapping from inner most to superficial |
|
Definition
| cast padding, gauze wrap, ace wrap, coban |
|
|
Term
| How are the gauze wrap, cast wrap, and coban wrapped |
|
Definition
|
|
Term
| protocol for wrapping for moderate arterial insuffiency |
|
Definition
| only use 2 layers instead of all 4. see them everyday for the next 2 days assessing skin |
|
|
Term
| important note for surgical interventions for chronic venous insuffiency |
|
Definition
| only if there is 1 veins that is an issue |
|
|
Term
| calcium channel blockers can cause what issues in the legs (2) |
|
Definition
| swelling and clots in the legs |
|
|
Term
| how long is an ABI good for? |
|
Definition
|
|
Term
| if the gangrene is dry you must not let it get... |
|
Definition
|
|
Term
| an arterial clot and this nerve compression disorder present the same |
|
Definition
| sciatica, so always check the skin |
|
|
Term
| kidney disease discussed in class |
|
Definition
|
|
