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6] Arterial Wounds Flashcards

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1
Q

Aorta divides into?

A

R and L common iliac arteries

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2
Q

Common iliac divides into

A

Internal and external iliac arteries

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3
Q

Internal iliac artery supplies

A

Pelvis

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4
Q

External iliac artery becomes ? When it crosses ?

A

Femoral artery when it crosses inguinal ligament

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5
Q

Common femoral artery divides into

A

Superficial and deep femoral artery

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6
Q

What guides treatment for ulcers?

A

ABI

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7
Q

What’s the ABI scale??

NEED TO KNOW

A

0.9 to 1 = normal
0.75 to 0.9 = moderate disease
.5 to .75 = severe disease
Less than 0.5 = rest pain
Unreliable = diabetes

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8
Q

Deep femoral artery supplies muscles of

A

Thigh

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9
Q

Superficial femoral artery becomes

A

Popliteal artery

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10
Q

Superficial femoral artery is most common site of?

A

Atherosclerotic disease in LE

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11
Q

Popliteal artery goe smedial and divides below the knee to the 1st branch…

A

Anterior tib artery and tibioperoneal trunk

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12
Q

Tibioperoneal trunk divides into

A

Peroneal and posterior tibial arteries

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13
Q

Anterior tibial artery becomes

A

Dorsalis pedis artery

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14
Q

3 layers of the arterial wall

A

Adventitia
Media
Intima

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15
Q

Outer layer that has loose connective tissue

A

Adventitia

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16
Q

Middle layer that has elastic and muscular fibers that give strength, elasticity and contractibility

A

Media

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17
Q

Innermost layer- endothelial lining

A

Intima

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18
Q

Decreased circulation leading to ischemia and oxygen and nutrient deprivation

A

Arterial insufficiency

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19
Q

What happens in arterial insufficiency?

A

Cutaneous blood supply isnt enough and it leads to tissue death

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20
Q

You need enough arterial supply and venous return to?

A

Maintain oxygen and nutrition of the skin

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21
Q

Failure of artery supply or venous return can lead to ?

A

Wounds and healing wounds will be difficult

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22
Q

Will you do compression if they have arterial disease?

A

No

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23
Q

Characteristics of arterial ulcers?

6

A
  • Even wound margins
  • Pale, deep wound bed
  • Extreme pain
  • Minimal to no drainage
  • Gangrene/necrosis
  • Diminished or absent
    pulses
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24
Q

Appearance of arterial ulcers

A

Distinct borders, pale or yellow base, surrounding skin is pale or red If in dependent position and thin and shiny

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25
Not being quizzed on venous system but what should you know?
Theres a lot of veins goign back to the heart
26
Death of tissue in a part of body
Gangrene
27
Gangrene can be how big?
Small skin lesion or extend to entire limb
28
Gangrene initially appears how and then progresses how?
Initially pale then blue/grey then purple/black
29
Gangrene usually requires
Amputation
30
PVD is commonly associated with
Atherosclerotic disease
31
Tissue ischemia leads to
Necrosis
32
Most often, ulcers occur at?
Most distal sites
33
Color observation of limb
Pale Mottled (smears of color) Purplish Black
34
Temperature observation of limb
Cool or cold may indicate arterial insufficiency
35
Skin changes- when observing limb
Loss of hair Shiny Thick hair
36
Risk factors of arterial ulcers
``` HTN High cholesterol Diet/obese Exercise DM Family history Age Smoking ```
37
When smoking, one cigarette decreases circulation
30% for one hour
38
Rest pain is ?
Severe
39
What’s considered moderate pain?
Pain after walking up a few stairs or less than 50 yards
40
What’s considered mild pain?
Pain after walking 1-2 blocks
41
Physical exam of arterial ulcers
``` System screen Observe limbs ANKLE BRACHIAL INDEX Pulses/Doppler Capillary refill Rubor of dependency ```
42
- Calciphylaxis - Pyoderma gangrenosum Scleroderma - Venous insufficiency - Spider bites - trauma
Conditions that might mimic arterial leg ulcers
43
Slow, progressive, incurable multisystem disorder
Scleroderma
44
Involves skin and internal organs; | inflammatory, vascular and sclerotic changes
Scleroderma
45
Are venous ulcers on the feet or the legs?
LEGS
46
Scleroderma has ?
Proliferation of fibroblasts, excessive collagen production
47
Patients with arterial ulcers you want to leave their legs ?
Dangling
48
Patients with venous ulcers should have their legs
Elevated ?
49
How does scleroderma skin appear
Shiny and hard with loss of mobility
50
What lesions on the trunk with scleroderma?
Morphea
51
How do you perform ABI?
Take BOTH brachial BPs in supine. Put the cuff on the leg just above malleoli. Put the Doppler at 45 degree angle to the dorsalis pedis or post tib artery. Inflate cuff until Doppler is obliterated. Slowly deflate the cuff until doppler signal comes back and record this as the ankle systolic pressure. Divide ankle systolic by higher of the two brachial systolic pressures.
52
Behind the knee when knee is semiflexed
Popliteal artery
53
behind medial mallelolus. Supplies | posterior compartment of leg & plantar surface of foot
Posterior tib pulse
54
lateral to extensor hallicus longus.Supplies dorsal surface of the foot
Dorsalis pedis pulse
55
How would you describe pulses?
Weak Bounding Regular
56
Scale of pulses ?
``` 0 = no pulse 1+ = barely felt 2+ = diminished 3+ = normal pulse 4+ = bounding ```
57
Venous filling time
Pt in supine with foot elevated to 45-60 deg for 1 min, bring foot into dependent position and look at skin color changes
58
Less than 15 sec for venous filling time is
Normal
59
If venous filling time = 15 - 40 seconds
Moderate arterial insufficiency
60
More than 40 seconds for venous filling time
Severe ischemia
61
Rubor of dependency
Pt in supine and elevate their leg 60 degrees for 1 minute. Normal is when the pink decreases when returning back down. + would be pale appearance that turns to cherry red when lowered to dependent position.
62
Intervention for arterial ulcers
``` Local wound care Education about smoking Limb protection Refer to vascular surgeon Exercise of walking program ```
63
Do you debride gangrene?
NO
64
3 types of wound prognosis
Healable Maintenance Nonhealable (palliative)
65
maintain moisture and bacteria balance
Healable wound
66
(wound that could heal but ptfactors such as uncontrolled DM or smoking make healing less likely)
Maintenance wound
67
Two surgical interventions for arterial ulcers
Percutneous balloon angioplasty and femoropoploteal bypass graft
68
Percutaneous balloon angioplasty is used for
Short term segment stenosis
69
Femoropopliteal bypass graft is
The standard treatment

Integumentary (15 decks)

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