Lecture 6: vascular disorders

Question 1

Question 2

Question 3

this is wrong, its diuretics first

Question 4

Question 5

Question 6

Occlusive peripheral artery disease - so the peripheral arteries are occluded
* common in individuals >70, smokers, diabetes, metabolic syndrome (obesity, t2d, hypertension)
* Results in occlusion, thrombus formation, ischemia (cutting bf off = ischemia) –> results in necrosis of tissue

Question 7

Occlusive peripheral artery disease symptoms not common until how much of a blockage?

Answer 7

70%

Question 8

KNOW: People who have aneurysms are likely to have occlusive peripheral artery disease

Question 9

What does occlusive peripheral artery disease start has (s/s)
* What happens to feet w/ elevation?
* name some trophic changes that happen as this disease progresses
* name some symptoms when this disease gets serious
* Tx

Answer 9

Starts w/ intermittent claudication

Leads to trophic changes such as: Hair loss, muscle atrophy, cool feet, skin/nail changes, pallor with elevation

SEVERE = nocturnal/resting pain, skin ulcers, gangrene

Tx:
* lifestyle modifications, exercise training
* RX - statins (helpful w/ maintaing BF), antihypertensives, antithrombotics, and prostaglandins
* Revascularization - stents, thromboembolectomy - take out dvt
* bypass grafts (fempop = most common, take part of femoral vein, and bypass part of artery thats impacted, to reestablish BF)

note: impact can dislodge a stent, and cause pooling at the ends of the bypass

Question 10

Occlusive Peripheral Artery Disease:
* NOTE: most people w/ this have CAD and possibly cerebrovascular disease (artery stuff is systemic)
* Screen for AAA - pt in supine, palpate deeply next to belly button - do it slow, looking for abnormal pulsing (large pulse)
* Vital signs and REP w/ EX
* Pt education - proper foot care, hygiene, daily inspection

Question 11

Aortic aneurysm:
* disruption of which layer of the artery?
* more common in what sex?
* s/s?

Answer 11

Destruction of the media and elastic tissues from aging, HTN (shear forces), or obstructive lesions
* arterial intima is torn, blood accumulates in the medial layers of the vessel
* so intima tears and outer layers are being pushed out by the blood

2-3 times more common in males

s/s = back pain, groin pain, abdominal discomfort, pain radiating to buttocks or legs
* thoracoabdominal AA will cause epigastric pain

note more common in lower aortia than high

Question 12

what kind of aneurysm is this

Answer 12

fuseaform
* expansion of entire thing
* encompass entire diameter of vessel
* this is way more likely to result in death - more serious

Question 13

Berry aneurysm

Question 14

risk factors for aneurysm / complications

Question 15

Aortic Aneurysm:
* Tx includes frequent monitoring and surgical repeair (put a stent in, don’t try and bypass)
* Refer - monitor closely if cardiac risk factors and complaints of back, neck, or abdominal pain
* Patient education on the reduction of risks

Question 16

diabetes type 2

Question 17

Cerebrovascular disease
* vascular disease the affects heart and brain - very linked when it comes to BF (direct vasculature that connects them)
* cerebrovascular ischemia: slow progression leads to collateral circulation development - transient ischemic attacks lead to a stroke if not treated (ischemia = slowing losing Bf through carotids)
* cerebrovascular accident = stroke

so if were going to treat someone for a stroke, were also going to treat them for a heart issue - they’re linked

Interal carotid –> middle cerebral artery

strokes typically on left because of where its thrown coming out of the heart

TIA = warning sign = some occlusion –> squeezing in, opening back up etc…
* turns into a stroke

circle of willis = prevents strokes from being really severe

slower occlusion happens = better chance circle of willis takes over
* lets the circle of willis compensate

Question 18

TPA - tissue plasma activator - get this is they’re quick enough and its an ischemic stroke
* 10% mortality risk
* can make it convert from ischemic –> hemorhagic

Question 19

What is thrombophlebitis
* s/s

Answer 19

inflammation of the vessel wall –> thrombus formation –> scarring

NOTE: DVT sometimes asymptomatic until PE develops
* so it has to get pretty bad before symptoms
* often dont notice until that pulmonary emblism

look like little black snakes

S/s:
* LE: dull ache, tightness/pain in the calf, TTP, swelling - might say tightness / acheing in leg - palpating might show you that that tissue is rock solid
* UE: pain, swelling, cyanosis

Tx: anticoagulants, thrombolytic therapy, thrombectomy (surgical removal), vena cava filter placement (come down from superior, –> inferior vena cava and sit there and collect blood clots, will actually cause you to develop clots around top part of filter)

Question 20

going to tell you how likely it is for them to have a DVT

used to just squeeze calf to test, however can lead to embolism

Question 21

so keep them moving

do ROM if you cant get them moving

Question 22

Question 23

what disease results from incompetent valves, inadequate muscle action, or venous obstruction

Answer 23

venous insufficiency

Question 24

risk factors for venous insufficiency

Answer 24

advanced age, genetics, obesity, prolonged standing, sedentary lifestyle, smoking, female hormones

this staining is a classif cisng of chronic venous insufficiency

Question 25

what may result from chronic venous stasis (incompetence) * comes w/ chronic LE edema, itchiness, scaly appearance, skin ulceration, and hemosiderin staining

Answer 25

DVT | this staining is a classif cisng of chronic venous insufficiency

Question 26

Do people w/ venous insufficnecy have lots of pain

Answer 26

No

Question 27

KNOW: venous ulcers = hard to heal

Question 28

What are varicose veins indicitive of?

Answer 28

Venous insufficiency these are elongated, dilated, tortuous superficial veins * often caused by obesity, pregnancy, ascities | do not have adequate valve function = backflow = expands

Question 29

they're immobilized for a long period of time position where you're not using muscles = no m pump action might have been a turnicit applied, so weve lost BF and now were rebounding which has a tendency to break clots off

Question 30

Vascular examination * skin color, texture, and tempt * Peripheral pulses with doppler/ABI * Capillary refill * Rubor of dependency - w/ legs hanging down leg w/ poor BF turns bright red - will see significant color change from one side to another. If legs turn white = artial issue, blood isnt getting to tissue * Venous filling time * Claudication time test * Wells criteria * Pitting edema - squeeze extremeity and your finger shape will stay in that area * Circumferential measures - be consistent and these should be great

Question 31

Question 32

normal ankle brachial index

Answer 32

Question 33

what is stemmer sign for pitting edema

Answer 33

negative - pinch and lift skin positive (lymphedema) - can't separate skin - probs have lymphedema (not just pitting edema, but the lymphatic system is very involved)

Question 34

needs to be at a constant speed when pain starts thats when you stop test and mark it for intermittent claudication also have them do that subjective report at the bottom

Question 35

for edema elevate for edema arterial occlusion = dont elevate as much (blood wont be able to get in) and not above lvl of heart