Mosby 15 Flashcards

Question

Venous Obstruction Symptoms

Answer 1

Constant pain Swelling and tenderness over the muscles Engorgement of superficial veins Erythema and/or cyanosis

Answer 2

thrombosis, varicose veins, or edema

Answer 3

Flex the patient’s knee slightly with one hand and, with the other, dorsiflex the foot. The complaint of calf pain with this procedure is a positive sign and may indicate venous thrombosis

Answer 4

1+ Slight pitting, no visible distortion, disappears rapidly 2+ A somewhat deeper pit than in 1+, but again no readily detectable distortion, and it disappears in 10 to 15 seconds 3+ Noticeably deep pit that may last more than a minute; the dependent extremity looks fuller and swollen 4+ Very deep pit that lasts as long as 2 to 5 minutes, and the dependent extremity is grossly distorted

Answer 5

Stand 10 times on toues Dependent position

Answer 6

**DESCRIPTION** An inflammatory disease of the branches of the aortic arch including the temporal arteries **PATHOPHYSIOLOGY** Inflammatory infiltrates develop in the thoracic aorta and neighboring arterial structures Arterial intimal thickening and thrombosis can lead to ischemia ofsupplied structures such as the masseter muscle, tongue, or optic nerve **SUBJECTIVE** Usually affects persons older than 50 years of age Flulike symptoms (e.g., low-grade fever, malaise, anorexia) may be accompanied by polymyalgia involving the hips and shoulders Headache in the temporal region on one or both sides, although the headache can occur in other regions Ocular symptoms, including loss of vision, are common Ischemia can also cause tongue pain and jaw claudication **OBJECTIVE** Area over the temporal artery can become red, swollen, tender, and nodular Temporal pulse may be variously strong, weak, or absent

Answer 7

**DESCRIPTION** An aneurysm is a localized dilation, generally defined as 1.5 times the diameter of the normal artery, caused by a weakness in the arterial wall **PATHOPHYSIOLOGY** Usually the result of atherosclerosis; with family history, tobacco use, and hypertension playing important roles Abdominal aneurysms are four times more common in men than in women **SUBJECTIVE** Generally asymptomatic until they dissect or compress an adjacent structure With dissection, the patient may describe a severe ripping pain **OBJECTIVE** Pulsatile swelling along the course of an artery Occurs most commonly in the aorta, although renal, femoral, and popliteal arteries are also common sites A thrill or bruit may be evident over the aneurysm

Answer 8

**DESCRIPTION** An arteriovenous fistula is a pathologic communication between an artery and a vein **PATHOPHYSIOLOGY** May be congenital or acquired Damage to vessels caused by catheterization is the most common acquired etiology If the fistula is large, there may be significant arterial-to-venous shunting of blood **SUBJECTIVE** Patients may present with lower extremity edema, varicose veins, or claudication due to ischemia If severe, high output cardiac failure can develop **OBJECTIVE** May result in an aneurysmal dilation A continuous bruit or thrill over the area of the fistula suggests its presence Edema or ischemia may develop in the involved extremity

Answer 9

**DESCRIPTION** Stenosis of the blood supply to the extremities by atherosclerotic plaques **PATHOPHYSIOLOGY** Most common cause is peripheral atherosclerosis Diabetes, hypertension, dyslipidemia, and tobacco use are all risk factors Can also be a result of vascular trauma, radiation therapy, or vasculitis **SUBJECTIVE** Intermittent claudication produces pain, ache, or cramp in the exercised muscle that is receiving an inadequate blood supply The amount of exercise necessary to cause the discomfort is predictable (e.g., occurring each time the same distance is walked) **OBJECTIVE** Limb appears healthy, but pulses are weak or absent Progressive stenosis results in severe ischemia, in which the foot or leg is painful at rest, is cold and numb, and has skin changes (e.g., dry and scaling, with poor hair and nail growth) Edema seldom accompanies this disorder, but ulceration is common in severe disease, and the muscles may atrophy

Answer 10

**DESCRIPTION** This is the exaggerated spasm of the digital arterioles (occasionally in the nose and ears) usually in response to cold exposure **PATHOPHYSIOLOGY** Primary Raynaud phenomenon occurs most commonly in young, otherwise healthy individuals, most commonly women, with no evidence of underlying cause Secondary Raynaud phenomenon is associated with an underlying connective tissue disease such as scleroderma or systemic lupus erythematosus **SUBJECTIVE** Involved areas will feel cold and achy, which improves on rewarming In secondary Raynaud, there can be intense pain and digital ischemia with necrosis at the tips **OBJECTIVE** With primary Raynaud phenomenon, there is a triphasic demarcated skin pallor (white), cyanosis (blue), and reperfusion (red) within the extremities The vasospasm may last from minutes to less than an hour In secondary Raynaud, ulcers may appear on the tips of the digits and eventually the skin over the digits can appear smooth, shiny, and tight from loss of subcutaneous tissue

Answer 11

**DESCRIPTION** Atrial fibrillation can lead to clot formation within the atrium; if the clot is unstable, emboli may be dispersed throughout the arterial system **PATHOPHYSIOLOGY** Emboli can also be caused by atherosclerotic plaques, infectious material from fungal and bacterial endocarditis, and atrial myxomas **SUBJECTIVE** Pain is the most common symptom Paresthesias may also develop **OBJECTIVE** Occlusion of small arteries and necrosis of the tissue supplied by that vessel With endocarditis, you can see splinter hemorrhages in the nail beds

Answer 12

**DESCRIPTION** Thrombosis can occur suddenly or gradually and with varying severity of symptoms; it can be the result of trauma or prolonged immobilization **PATHOPHYSIOLOGY** Risk factors for venous thrombosis include prolonged immobilization, malignancy, trauma, use of birth control medication, and history of previous thrombosis **SUBJECTIVE** Tenderness along the iliac vessels or the femoral canal, in the popliteal space, or over the deep calf veins Deep vein thrombosis in the femoral and pelvic circulations may be asymptomatic Pulmonary embolism may occur without warning **OBJECTIVE** Swelling may be distinguished only by measuring and comparing the circumference of the upper and lower legs bilaterally There may be minimal ankle edema; low-grade fever; and tachycardia Homan sign can be helpful but is not absolutely reliable in suggesting deep vein thrombosis

Answer 13

**DESCRIPTION** Hypertension is one of the most common diseases in the world; it is often responsible for stroke, renal failure, and congestive heart failure **PATHOPHYSIOLOGY** Hypertension continues to be defined as a blood pressure consistently at 140/90 mm hg or higher For essential hypertension, the pathogenesis remains poorly understood **SUBJECTIVE DATA** Essential hypertension is asymptomatic unless it is malignant, where patients may present with headache, visual symptoms, or encephalopathy **OBJECTIVE DATA** In addition to checking the blood pressure, you should assess for any end-organ damage that may be present This includes papilledema and evidence of heart failure

Answer 14

**DESCRIPTION** The backflow of blood into the right atrium during systole; a mild degree of tricuspid regurgitation can be seen in up to 75% of the normal adult population **PATHOPHYSIOLOGY** Most commonly due to conditions that lead to dilation of the right ventricle (e.g., hypertension, pulmonary thrombosis) Less frequently it can also result from primary valvular disease **SUBJECTIVE** With mild to moderate tricuspid regurgitation, there are typically no symptoms With severe disease, you may see symptoms of right-sided heart failure such as ascites or peripheral edema **OBJECTIVE** The v wave is much more prominent and occurs earlier, often merging with the c wave (Fig. 15-20; see also Fig. 15-7) A holosystolic murmur in the tricuspid region, a pulsatile liver, and peripheral edema

Answer 15

**DESCRIPTION** This arrhythmia, seen more commonly in older adults, may result in decreased cardiac output and atrial thrombus formation with subsequent embolization **PATHOPHYSIOLOGY** Typically occurs in patients with some underlying heart disease that results in the atrial pathology such as enlargement or elevated pressures **SUBJECTIVE** While many episodes are asymptomatic, patients may describe palpitations, lightheadedness, or dyspnea **OBJECTIVE** The a wave is absent and the pulse is irregularly irregular There are only two venous pulsations for each arterial pulsation, and the time interval between v waves is variable

Answer 16

**DESCRIPTION** The accumulation of fluid within the pericardial space leading to compression and dysfunction of the heart chambers **PATHOPHYSIOLOGY** Pericardial fluid can accumulates from a number of etiologies (e.g., infection, malignancy, autoimmune disease) The pressure within this space increases such that it compresses the heart chambers, decreasing their volume, allowing less filling, and compromising cardiac output **SUBJECTIVE** The history will depend on the rapidity of the pericardial fluid collection; in acute settings, there may be sudden onset chest pain and dyspnea If more chronic in development, there may be the insidious development of symptoms of heart failure **OBJECTIVE** ``` The Y-descent is abolished and the JVP is markedly elevated (15 to 25 cm H2O) The JVP fails to fall with inspiration as it usually does and may actually increase (Kussmaul sign) Pulsus paradoxus (decrease in systolic blood pressure greater than 10 mm Hg with inspiration) may be present (see Box 15-5, Fig. 14-23) ```

Answer 17

**DESCRIPTION** Results from chronic inflammation and subsequent scarring of the pericardium **PATHOPHYSIOLOGY** Chronic inflammation leads to pericardial thickening and inelasticity This results in diminished cardiac filling and output **SUBJECTIVE** Symptoms of progressive cardiac insufficiency such as worsening of lower extremity edema or dyspnea **OBJECTIVE** The JVP is elevated, just as with cardiac tamponade, but there is a prominent Y-descent Signs of severe right heart failure such as ascites and severe peripheral edema (Fig. 15-21) may develop

Answer 18

**DESCRIPTION** Coarctation of the aorta is a stenosis seen most commonly in the descending aortic arch near the origin of the left subclavian artery and ligamentum arteriosum **SUBJECTIVE** Most patients are asymptomatic unless severe hypertension or vascular insufficiency develops In those settings, patients may develop symptoms of heart failure or vascular insufficiency of an involved upper extremity with activity **OBJECTIVE** Differences in systolic blood pressure readings when the radial and femoral pulses are palpated simultaneously

Answer 19

**DESCRIPTION** An acute vasculitic illness of uncertain cause affecting young males more often than females; the critical concern is cardiac involvement in which aneurysms of a coronary artery may develop **PATHOPHYSIOLOGY** The etiology of the vasculitis is unknown Immune-mediated blood vessel damage can result in both vascular stenosis and aneurysm formation **SUBJECTIVE** The symptoms are diffuse and typified by fever lasting a few days to several weeks The effects of a systemic vasculitic illness, such as weight loss, fatigue, myalgias, as well as arthritis, may develop **OBJECTIVE** Findings may include conjunctival injection, strawberry tongue, and edema of the hands and feet Lymphadenopathy and polymorphous nonvesicular rashes (Fig. 15-23)

Answer 20

**DESCRIPTION** Preeclampsia-eclampsia defines a syndrome specific to pregnancy; it is determined by hypertension that occurs after the 20th week of pregnancy and the presence of proteinuria; eclampsia is preeclampsia with seizures when no other cause for the seizures can be found **PATHOPHYSIOLOGY** Theorized to result from a combination of vascular and immunologic abnormalities within the uretoplacental circulation **SUBJECTIVE DATA** May be diagnosed without proteinuria if other systemic symptoms are present (e.g., visual changes, headache, abdominal pain, pulmonary edema **OBJECTIVE** Sustained elevation of the blood pressure (systolic \>160 mm Hg, diastolic \> 110 mm Hg)

Answer 21

**DESCRIPTION** This results from chronic venous insuffiency in which lack of venous flow leads to lower extremity venous hypertension **PATHOPHYSIOLOGY** Obstruction of venous flow may result from incompetent valves, obstruction of blood flow, or loss of the pumping effect of the leg muscles **SUBJECTIVE** Frequently asymptomatic in the early stages Patients may describe a leg heaviness and discomfort progressing to edema and ulceration **OBJECTVIE** Ulcers are generally found on the medial or lateral aspects of the lower limbs Induration, edema, and hyperpigmentation are common associated findings

Mosby 15 Flashcards

(45 cards)