Arterial Injuries - Class 4

Question 1

arterial ulcers are d/t

Answer 1

arterial insufficiency of large and small vessels

Question 2

how do arterial ulcers present

Answer 2

gangrene

Question 3

gangrene

Answer 3

dry, dark, cold and mummified

wet gangrene = infection

Question 4

when does ulceration occur –> gangrene

Answer 4

when gangrene is sloughed off or debrided

Question 5

where do arterial ulcers usually occur

Answer 5

toes

interdigital spaces

foot

lateral malleolus

Question 6

arterial ulcer wound base

Answer 6

dry

deep

pale

Question 7

arterial ulcers will have

Answer 7

necrotic, lacking granulating tissue

wound edges usually rough and steep

Question 8

surrounding skin of arterial ulcers

Answer 8

may be cyanotic or gangrenous

demarcation of viable and nonviable tissues

Question 9

arterial ulcers are

Answer 9

very painful to pt

Question 10

acute arterial ulcers

Answer 10

thrombosis

Question 11

chronic arterial ulcers

Answer 11

arteriosclerosis obliterans

Question 12

arterial insufficiency presents w/

Answer 12

intermittent claudication

pain and pallor on elevation

rubor on dependency

trophic changes of skin

decreased pulses

slow nail growth

Question 13

predisposing factors of arterial insufficiency

Answer 13

smoking

DM

hyperlipoproteinemia

hypertension

advancing age

Question 14

those with atherosclerosis –>arterial insufficiency

Answer 14

60-70% of pts have at least 2 RFs

Question 15

how is arterial insufficiency dx

Answer 15

angiogram

arterial dopler

Question 16

rubor of dependency

Answer 16

assesses arterial flow by evaluating skin color during elevation and dependency

Question 17

venous filling time

Answer 17

assesses arterial flow by evaluating time for veins to refill after emptying

Question 18

capillary refill

Answer 18

assesses patency of the capillaries in small vessel dz

Question 19

arterial doppler

Answer 19

assesses relative flow of blood

movement of blood cells
–>causes shift in signal frequency which is audible to the examiner

Question 20

arterial doppler –> normal

Answer 20

sound pulsatile

Question 21

pulse volume recording

Answer 21

used w/ arterial doppler

visualize waveforms of segmental pressures at different sites of the extremity

Question 22

pulse volume recording asseses

Answer 22

the site of blockage

Question 23

ankle/brachial index

Answer 23

detects and quantifies arterial dz

can determine tx course of action

Question 24

ABI ratio

Answer 24

systolic pressure of posterior tibial artery to brachial artery

Question 25

< 0.5 ABI

Answer 25

tissue necrosis

Question 26

0.5-0.8 ABI

Answer 26

ischemic rest pain

Question 27

0.8-1.0 ABI

Answer 27

minimal sxs

Question 28

> 1.0 ABI

Answer 28

no arterial occlusive dz

Question 29

medical therapy for arterial insufficiency

Answer 29

reducing RFS for dz and resultant MI, stroke and vascular death improving sxs

Question 30

improving sxs

Answer 30

stop smoking control of DM anti-platelet therapy trental --> reduces blood viscosity pletal walking exercise program

Question 31

indications for surgical therapy --> arterial insufficiency

Answer 31

progressive and limiting intermittent claudication rest pain gangrene

Question 32

conservative management

Answer 32

bed rest (for acute occlusion) limb protection is paramount decreased --> NWB when ambulating if ulcerative local wound care skin protection reflexive vasodilation light exercise

Question 33

bed rest

Answer 33

avoid excessive muscular activity HOB raised slightly for increased perfusion to feet

Question 34

local wound care

Answer 34

determine ABI sharps, enzymatic debridement if indicated moisture wound dressings (hydrogels) cultures --> antibiotics if infected

Question 35

skin protection

Answer 35

w/ petrolatum bases moisturizers

Question 36

light exercise

Answer 36

preulcerative pt

Question 37

surgical management

Answer 37

vascular studies imaging cultures surgery

Question 38

vascular studies

Answer 38

dopplers ABI angiogram MRA tcPO2

Question 39

imaging

Answer 39

xrays CT scans bone scans MRIs

Question 40

surgery

Answer 40

angioplasties/stents bypass surgeries serial debridement amputations