Peripheral Vascular Disease

Question 1

1. what is the peripheral vascular system?
2. What are the structures?

Answer 1

1. all blood vessels outside of the heart
2. Aorta and its arterial branches (arterioles and capillaries)
   Vena Cava and its vein branches (venules and capillaries)

Question 2

what are the components of all blood vessels (4)?

Answer 2

1. Tunica externa (adventitia) (outer layer) provides structural support and shape to the vessel
2. tunica media (middle layer) elastic and muscular middle layer that regulates the internal diameter of the vessel
3. tunica intima (innermost layer) the endothelial lining that provides a frictionless pathway for the movement of blood
4. Lumen is the hallow passageway where the blood flows

Question 3

1. what type of blood do the arteries carry?
2. What is the composition of the arteries? what influences them?

Answer 3

1. oxygenated blood to organs and muscles
2. arteries are elastic and muscular and influenced by the ANS

Question 4

1. what are the muscular arteries?
2. what are the elastic arteries?

Answer 4

1. brachial, femoral, radial
2. those closest to the heart

Question 5

what percentage of total blood supply is in the arterial system?

Answer 5

10-15%

Question 6

1. what is the job of the arterioles?
2. What input do they respond to?
3. What do they play a role in?

Answer 6

1. The arterioles supply blood to the organs
2. They are primarily smooth muscles that respond to ANS input
3. Due to lack of elastin, they play a role in peripheral resistance (HTN)

Question 7

What is the job of the capillaries?

Answer 7

thin, single endothelial layer that allows for the exchange of oxygen and nutrients

Question 8

1. What are the venuoles and where do they receive blood from?
2. what is the job of the venuoles?
3. what can they NOT withstand?

Answer 8

1. the venuoles are small and receive blood from venous capillaries after sphincter
2. participate in the nutrient exchange process
3. can not withstand high pressure and can rupture

Question 9

1. where do the veins receive blood from?
2. What is the composition of veins and what is their job?
3. what % of total blood is in the venous system?
4. Describe the valves of the veins and blood flow

Answer 9

1. receive blood from the venuoles
2. The veins have similar anatomy to arteries but they accommodate much LESS pressure. Veins are thin walled and elastic. They have high capacitance meaning they accommodate large blood vol at low pressures.
3. 75% of blood is in the venous system
4. veins have one-way valves that maintain forward blood slow toward the heart against gravity

Question 10

Compare and contrast arteries and veins

Answer 10

1. Arteries have thicker walls, more smooth muscle, and a small lumen. Arteries maintain pressure throughout the system and appear rounder.
2. Veins have thinner walls, less smooth muscle, and a larger lumen. Veins return blood to the heart and lungs and appear more collapsible.

Question 11

What is peripheral vascular disease?

Answer 11

An umbrella term that encompasses diseases of the arterial, venous, and lymphatic systems.
Includes diseases of the aorta, PAD, venous diseases, Vasospasms

Question 12

What are the most common clinical conditions of the aorta?

Answer 12

Aneurysm, dissection, obstruction

Question 13

1. What type of trauma is the aorta commonly subjected to?
2. What happens to the composition of the aorta as we age?

Answer 13

1. The aorta is subject to mechanical trauma due to continuous exposure to high pulsatile pressure
2. The aorta has high elastin content in the tunica media which allows for significant distensibility (ability to stretch and expand).
   Systole= Expansion
   Diastole= recoil
   As we age, elastin degenerates and the aorta becomes stiffer which increases systolic BP

Question 14

1. what is a pseudoaneurysm?
2. what is the common cause?

Answer 14

1. A contained rupture of the vessel lumen that develops when blood leaks out of a hole in the intima and media layers and is contained by the adventitia. Very unstable and prone to rupture.
2. caused by infection, trauma, puncture such as cardiac cath

Question 15

1. What percentage of dilation is classified as an aneurysm?
2. What is considered a true aneurysm?

Answer 15

1. when increased by 50% compared with normal
2. dilation of all 3 layers of the aorta, creating a large bulge in the vessel wall

Question 16

what are the most common aneurysms?

Answer 16

abdominal is the most common followed by thoracic

Question 17

what are the causes/ conditions associated with aortic aneurysms?

Answer 17

1. medical degeneration: marfans, elher-danlos, loeys- dietz, aortic valve problems, genetics
2. atherosclerosis
3. infections
4. vasculitis
5. trauma or aortic dissection

Question 18

what are the main causes of descending aortic and abdominal aneurysms? (4)

Answer 18

1. atherosclerosis; commonly seen in older male with hx of smoking, HTN, dyslipedemia, and caucasian
2. genetic predisposition
3. vessel inflammation
4. weakened tunica media due to infection from salmonella, staphylococci, streptococci, TB, or syphillis

Question 19

what is the clinical presentation of aortic/ abdominal aneurysms? (4)

Answer 19

1. Most patients are asymptomatic but can sometimes feel a pulsatile mass or sensation in the abdomen
2. feeling of another organ (kidney or intestine) being constricted or pressed
3. non-specific back pain, nausea, abdominal pain, pain in the flanks that radiates to the legs
4. general malaise if due to infection, weight loss if due to inflammation

Question 20

What is the presentation of a thoracic aneurysm?

Answer 20

Often asymptomatic but when they are symptomatic there is compression of neighboring structures such as the trachea, main bronchus, and esophagus.
Can present with cough, dysphagia, and hoarseness due to the recurrent laryngeal nerve

Question 21

what is the clinical presentation of an aneurysm of the ascending aorta?

Answer 21

aortic regurgitation and symptoms of CHF

Question 22

1. What is the common presentation of slow leaks (aneurysms)?
2. What is the common presentation of a rupture?

Answer 22

1. diffuse, deep belly pain, GI symptoms, bloating, cramping
2. hypovolemia, hypotension, deep pain in the back or abdomen, vomiting, diaphoresis, loss of consciousness

Question 23

what are risk factors for rupture?

Answer 23

Increasing size
Rapid expansion
Tobacco use
Increased or uncontrolled HTN
Cardiac or renal transplant COPD (increased intrathoracic pressure)
Female (decreased tensile strength and increased wall stress)
Recent surgery (stress on the body)

Question 24

What is required for diagnosis of a aortic aneurysm?

Answer 24

imaging, screening (men 65-75 who have hx of smoking), abdominal palpation (mainly reliable with large AAA)

Question 25

1. what is the treatment for a unruptured aneurysm? 2. what is the treatment for a rupture aneurysm?

Answer 25

1. manage underlying disease process and risk factors, repair surgically or endovascularly 2. emergent surgery, survival rate is <50%

Question 26

What is an aortic dissection? Where is it most common?

Answer 26

A tear in the intima and media that spreads along the artery causing blood to flow in between the layers of the blood vessel which can lead to an aortic rupture. Most commonly happens in the thoracic aorta. It is life threatening.

Question 27

what are risk factors for aortic dissection?

Answer 27

atherosclerosis, blunt trauma to the chest, and HTN

Question 28

What is the common presentation of an aortic dissection?

Answer 28

- Sudden onset of chest or back pain with a tearing or ripping sensation that can radiate to the shoulder, jaw, arm, and neck. - Signs of hypoperfusion like dizziness or syncope - nausea and vomiting - rapid and weak pulse

Question 29

what is the most common cause of PAD?

Answer 29

atherosclerosis

Question 30

what are risk factors for PAD?

Answer 30

1. CAD/ atherosclerosis 2. advanced age 3. hypercholesterolemia 4. smoking 5. HTN 6. diabetes 7. overweight 8. family HX

Question 31

What patients are at an increased risk of PAD? (table 3)

Answer 31

1. age >65 2. age 50-64 with risk factors for atherosclerosis such as DM, hx smoking, hyperlipidemia, HTN, family hx 3. age <50 with DM and 1 risk factor for atherosclerosis 4. people with known atherosclerosis in another vascular bed (coronary, carotid, subclavian, renal, mesenteric stenosis, AAA) 5. AAA

Question 32

what hx findings are suggestive of PAD? (table 4)

Answer 32

1. claudication 2. non joint related exertional LE symptoms 3. impaired walking function 4. ischemic resting pain

Question 33

what findings on physical examination are suggestive of PAD? (table 4)

Answer 33

1. abnormal LE pulse examination 2. vascular bruit 3. nonhealing LE wound 4. LE gangrene 5. elevated pallor and dependent rubor

Question 34

1. What is the pathophysiology of PAD? 2. What happens to the blood vessels?

Answer 34

1. Similar to CAD, there is a mismatch of the demands of the organs and muscles and the supply of O2 due to a atherosclerotic stenosis of the peripheral arteries. 2. There is reduced diameter of the blood vessels which leads to ischemia

Question 35

Describe pathophysiology of PAD and exercising muscle

Answer 35

- During exercise skeletal muscles metabolism produces adenosine which acts to dilate arterioles to increase blood flow to the muscles. Obstructed arteries cant respond to the vasodilating stimuli which means blood flow becomes limited leading to ischemia.

Question 36

what are the adaptations to chronic ischemia? (PAD)

Answer 36

- changes to muscle fiber metabolism and skeletal muscle degeneration = LE weakness - ischemic changes in the arteries can lead to ischemic symptoms at rest that are similar to angina

Question 37

What arteries are commonly affected with PAD?

Answer 37

1. aorta & iliac (butt, hip, thigh, calve pain) femoral & popliteal (calve pain) tibioperoneal, brachiocephalic & subclavian & axillary (arm pain)

Question 38

What is the clinical presentation/ common symptoms of PAD? (10)

Answer 38

1. intermittent claudication which leads to buttock, hip, thigh, and calf pain (only in 1/3 of patients) (1/3 patients asymptomatic) (can be atypical such as leg pain carry on which means that they are able to keep exercising) 2. symptoms distal to the stenotic artery 3. if chronic ischemia --> ulceration, infection, skin necrosis 4. diminished or absent pulses distal to stenosis 5. muscle atrophy 6. pallor and reduced temperature upon elevation 7. shiny taut skin with hair loss and thick and brittle toe nails 8. wounds, gangrene, necrosis of the foot and digits 9. reduced sensation 10. DM

Question 39

What are the grades of the ACSM Intermittent Claudication Scale (PVD pain)

Answer 39

Grade 1: definite discomfort or pain but only initially or modest levels Grade 2: moderate discomfort or pain from which the patients attention can be diverted by conversation Grade 3: intense pain from which the patients attention can not be diverted Grade 4: Excruciating and unbearable pain

Question 40

what is the ankle brachial index?

Answer 40

An ankle brachial index (ABI) is a non-invasive test that measures the ratio of blood pressure in the ankle to the blood pressure in the arm. It's used to assess vascular health and determine if there's resistance to blood flow in the lower extremities.

Question 41

What are each ABI measurements indicative of?

Answer 41

>1.10: no possible symptoms, normal clinical presentation 0.5-1.0: claudication, pain in the calf with ambulation 0.2-0.5: critical limb ischemia, atrophic changes with resting pain and wounds <0.2: severe ischemia, gangrene and severe necrosis

Question 42

What are the pulse grades?

Answer 42

Grade 0: absent, no pulse Grade 1+: diminished barely palpable Grade 2+: brisk, expected Grade 3+: full and normal Grade 4+: bounding and strong

Question 43

1. what is critical limb ischemia? 2. what are the phases?

Answer 43

1. A progression of PAD in which circulation cannot meet rising metabolic demands. 2. -1st critical phase is when collateral circulation cannot meet the needs of metabolic demand = Limited blood supply will shunt to muscles and skin with wound will be compromised -2nd critical phase is when pain is experienced with exercise increasing muscle O2 demand - 3rd critical phase is seen with resting pain, non-healing wounds subject to infection, risk for gangrene

Question 44

1. What is an acute cold leg? 2. what is the likely cause? 3. what is the clinical presentation? 4. how is it treated? 5. what are the 6 P's?

Answer 44

1. A vascular emergency due to acute arterial occlusion = risk of limb loss 2. Due to in situ thrombotic occlusion most often in the femoral artery or from an embolism 3. sudden onset of cold, paleness, pulseless, painful, parasthesia, paralytic leg 4. treated with revascularization via embolectomy, interarterial thrombolysis, angioplasty, bypass surgery 5. pain, paralysis, pulselessness, perishingly cold, pallor, paresthesia

Question 45

what are the ACSM guidelines for PAD?

Answer 45

- aerobic activity 3-5 times per week at RPE of 12-16 for 20-60mins per session - Walking speed should be at a pace to elicit claudication symptoms within 3-5 min., once they reach mod. severity (level 3-5) then continue interval, ideally 35-50 min. - resistance exercise 2x/week with emphasis in major muscle groups (LE) - flexibility 2-3x/wk (static, dynamic, PNF)

Question 46

What were the results from the study regarding supervised exercise and PAD

Answer 46

- stenting or supervised exercise are equally beneficial for patients with PAD and moderate to severe claudication - Supervised exercise or stent surgery provides biological benefits aiding in improvement of limb strength, efficiency and performance …. And benefits remained up to a year following the supervised exercise phase

Question 47

What are options for surgical interventions for PAD?

Answer 47

1. Angioplasty with or without a stent: claudication is generally improved right away and aids in healing of distal wounds, exercise can resume 72 hrs post 2. Bypass surgery: harvest a vein from another part of the leg (aortobifemoral, iliofemoral, femoral); symptoms resolve, OOB day 1, encourage regular physical activity once wounds heal and limit lifting for 6wks 3. Femoral popliteal bypass: used for critical limb ischemia, OOB walking day 1, resume physical activity once wounds heal, and monitor the limb through healing

Question 48

What are the different types of venous disorders?

Answer 48

- varicose veins - DVT -PE - chronic venous insufficiency

Question 49

Compare and contrast superficial and deep veins

Answer 49

- superficial veins carry approximately 10-15% of blood in the LE's which drain into communicating veins and flow into deep veins - deep veins lie inside the muscle and carry 85-90% of blood back to the heart

Question 50

what are risk factors for venous disorders?

Answer 50

Prior history of blood clot Family history Obesity Pregnancy Prolonged standing History of ankle injury or immobility Trauma, illness, surgery Lifestyle

Question 51

What is the clinical presentation for venous disorders?

Answer 51

-Edema generally in LE’s -Fatigue -Heaviness feeling in LE’s -Hemosiderin staining -Warmth on palpation -Ulcers/wounds are commonly found on the LE above the ankle -Frequent infections

Question 52

1. what are varicose veins? 2. what veins are the most common? 3. what is the most common cause?

Answer 52

1. dilated tortuous superficial veins 2. saphenous and tributaries 3. intrinsic weakness of the vessel wall, volume overload, congenital weakness, incompetent valves, chronic backflow

Question 53

what are risk factors for varicose veins?

Answer 53

Females 2-3x more likely than men Pregnancy Obesity Family history Prolonged standing History of infection

Question 54

what are common symptoms for patients with varicose veins?

Answer 54

heaviness, dull ache, bulging veins, may see a local hematoma small venuoles rupture

Question 55

what are the stages of varicose veins?

Answer 55

Normal veins Stage 1: spider veins or reticular veins Stage 2: varicose veins or venous nodes Stage 3: edema of the lower leg Stage 4: varicose eczema or trophic ulcer

Question 56

What is the route of management for varicose veins? (4)

Answer 56

1. Conservative: compression hose, elevating feet, managing edema, avoiding prolonged standing 2. Sclerotherapy – localized IV injection of irritating chemical to fibrose veins 3. Endovenous thermal ablation – use laser or radiofrequency to deliver heat to obliterate varicose saphenous veins 4. Surgical – vein ligation and removal

Question 57

what is the pathogenesis for VTE?

Answer 57

Virchow’s Triad: Venous stasis, Vascular Injury, Hypercoagulability ---> coagulation cascade (5-6weeks)--> decreased or mechanically altered blood flow (LE) - can commonly develop weeks after discharge

Question 58

what are risk factors for DVT?

Answer 58

Post-operative Obesity Pregnancy and post partum period Heart failure or respiratory failure Tobacco use Use of oral contraceptives Cancer and chemotherapy Prolonged airline, car or train travel Trauma Diabetes, HTN, CVA, SCI Varicose veins Increasing age

Question 59

what causes increased risk for UE DVT?

Answer 59

Central Venous Catheters, PICC lines and pacemaker insertions

Question 60

What are signs and symptoms of LE DVT?

Answer 60

- Unilateral Edema - Tenderness and pain in leg (especially calf Warmth and erythema) -Low-grade fever - Cognitive changes in elderly

Question 61

How is DVT diagnosed?

Answer 61

1. Serum d-Dimer: Blood test that measures degradation of fibrin 2. Doppler US 95% sensitive for proximal veins, 75% sensitive for calf veins 3. MRI and contrast venography

Question 62

What are the items of the Wells Clinical Prediction Rule for DVT? What is the score interpretation?

Answer 62

1. active cancer (within 6 months) 2. paralysis, paresis, or immobile LE 3. bedridden for more than 3 days because of surgery (within 12 weeks) 4. localized tenderness along distribution of deep veins 5. entire leg swollen 6. unilateral calf swelling of >3cm 7. unilateral pitting edema 8. collateral superficial veins 9. previously documented DVT Risk interpretation: 2 pts or more = DVT likely

Question 63

what is the clinical prediction rule for UE DVT

Answer 63

- venous material in subclavian or jugular vein or pacemaker: +1 - localized arm pain: +1 -unilateral pitting edema: +1 - alternative diagnosis: -1

Question 64

what should not be used for DVT?

Answer 64

Homan’s sign should NOT be relied upon (passive squeezing of calf with ankle DF)

Question 65

what are treatments for DVT?

Answer 65

1. Compression stockings – anti-embolic stocking, sequential compression device (SCD) 2. Anti-coagulation medications: IV heparin, Oral warfarin (Coumadin) 3. 1st DVT diagnosis – usually on RX for 3 mos. If cannot anti-coagulate patient then IVC filter is considered

Question 66

what are the guidelines for mobilizing patients with DVT?

Answer 66

1. If the patient is not on anticoagulants and has a known DVT AND does not have an IVC filter, check with medical team 2. If the patient is anticoagulated: If on Coumadin (warfarin) – check INR levels (International Normalized Ratio) <1.1 in healthy normal NOT on Coumadin 2-5 therapeutic range when on Coumadin >4.5 risk of hemorrhage <2 increased risk of clot 3. Avoid consuming large amounts of green leafy vegetables with vitamin K (kale, spinach, Brussel sprouts, broccoli); green tea; cranberry juice, alcohol

Question 67

what is the guideline for mobilizing a patient with a DVT who is on unfractionated heparin?

Answer 67

< 24 hours: no mobility 24-48 hours: consult medical team > 48 hours: mobilize

Question 68

what is the guideline for mobilizing a patient with a DVT who is on low molecular weight heparin?

Answer 68

< 3 hours: no mobility 3-5 hours: check with physician > 5 hours: mobilize

Question 69

what is an IVC filter for DVT management?

Answer 69

1. Prevent embolism of DVT from traveling to lungs 2. Placed in Inferior Vena Cava by interventional radiologist or cardiologist 3. Placed above the level of a diagnosed clot

Question 70

What does HASBLED score stand for? What HAS-BLED score is concerning?

Answer 70

Hypertension, abnormal renal and liver function, stroke, bleeding, labile INR, elderly, drug or alcohol usage If the HASBLED score is >4 = stop anticoagulation

Question 71

what is post thrombotic syndrome?

Answer 71

Permanent damage to the valves of the veins and reflux of blood in the venous system ---> Leads to venous hypertension that reduces muscle perfusion, increases tissue permeability * associated with high morbidity and lower QOL

Question 72

what are signs and symptoms of post thrombotic syndrome?

Answer 72

chronic aching arm or leg pain, intractable edema, limb heaviness, and leg ulcers, skin changes, and heaviness of the limb affected by DVT

Question 73

1. what is a pulmonary embolism? 2. when are they common?

Answer 73

1. Clot, most often from DVT, breaks off dislodges and travels through the vena cava, right heart to the lungs and lodges in a part of the pulmonary vasculature --> Can be fatal (40% fatality rate if left untreated) 2. Common, especially after surgery, trauma prolonged immobility

Question 74

1. what is the presentation of a PE? 2. what is the common course of treatment?

Answer 74

1. dyspnea, pleuritic chest pain, hemoptysis, cough, syncope, tachypnea 2. anticoagulation and thrombolytic therapy

Question 75

What is the Wells Clinical Prediction rule for PE?

Answer 75

1. clinical symptoms of DVT (3) 2. other dx less likely than PE (3) 3. HR >100 (1.5) 4. immobilization or surgery within past 4 weeks (1.5) 5. previous DVT or PE (1.5) 6. hemoptysis (1) 7. Malignancy (1)

Question 76

1. what is chronic venous insufficiency? 2. what is it associated with?

Answer 76

1. Valve incompetence or venous obstruction leads to extravasion (leaking) of edema into surrounding tissues 2. Associated with varicose veins, edema, skin inflammations and hyperpigmentation and ulcerations

Question 77

what is the typical course of treatment for chronic venous insufficiency?

Answer 77

1. Treat the edema 2. Diuretics 3. Antibiotics (when infection present) 4. Compression – ACE vs. custom stocking 5. Dressing changes: Unna boot, Dressing materials Chronic wounds that are constantly infected puts patient @ risk for sepsis, multiple hospitalizations, reduced quality of life

Question 78

what will be common in the hx of someone with venous insufficiency?

Answer 78

May report chronic edema issues Slow healing h/o infection(s) h/o varicose veins

Question 79

what is common in the hx of someone with arterial insufficiency?

Answer 79

Aching or cramping of distal limbs Poor wound healing Limited mobility

Question 80

what are the grades of the pitting edema scale?

Answer 80

1+: indentation barely visible 2+: slight indentation that returns to normal in 15 seconds 3+: deeper indentation that returns to normal in 30 seconds 4+: indentation that lasts greater than 30 seconds

Question 81

what are the characteristics of a venous wound?

Answer 81

1. Location: Venous wounds tend to be above malleoli 2. History of the wound: Venous wounds tend to be more insidious in onset, preceded by skin color and texture changes 3. Appearance: Uneven edges, shallow depth, Chronic wounds may have rolled edges, Minimal eschar, Surrounding skin shiny, warm or scaly 4. Drainage: Serous, unless infection is present 5. Pain: Not typically painful in regard to the wound but dull, ache of chronic venous insufficiency Most common wounds – 80-90% of all ulcers

Question 82

what are the characteristics of arterial wounds?

Answer 82

1. Location: Arterial wounds occur most often on the foot, in between or at the tips of the toes, at pressure points from foot wear, on the heels and around lateral malleolus 2. Size and shape: Most likely round, with a “punched out” appearance. They may range in size from small to large, with well-defined edges. 3. Color: Often occur yellow, brown or black in color. Skin may also appear pale and non-granulating. 4. Appearance: Arterial ulcers are often deep, but may also appear shallow in early stages. Skin surrounding the wound is often thin, smooth, taut and dry. Loss of hair on the leg is also common. 5. Exudate: Unlike venous ulcers, arterial ulcers are often dry due to minimal drainage. 6. Pain level: Reportedly very painful. Elevating the leg can increase this pain. 7. Other distinguishing characteristics: -Toenails often appear brittle, yellow, deformed, thick and dry. -A patient’s pulse may be indistinguishable around the site of the wound. -The area around the wound is likely cool or cold to the touch due to minimal blood circulation.

Question 83

1. what is cellulitis? 2. what are common causes? 3. what are symptoms

Answer 83

1. NOT a vascular disorder but can be confused for a developing venous wound, Bacterial (Staphylococcus aureus or Streptococcus) skin infection of dermis or subcutaneous tissue 2. Breaks in skin, splinters, bug bites, incisions, IV sites 3. Symptoms: Red area of skin that tends to expand, Swelling, Tenderness, Pain, Warmth, occasional open wounds, Fever, Red spots, Blisters, Skin dimpling

Question 84

what is Raynauds disease and the common symptoms?

Answer 84

Intermittently affects small arteries and arterioles – decreased blood supply to distal extremity Symptoms: Cold fingers/toes Color changes to skin in response to cold or stress Numbness/tingling in fingers or toes Stinging/throbbing pain when warming or stress relieved Ulcers can occur on tips of fingers/toes (severe cases

Question 85

what are 5 treatments for Raynaud's disease?

Answer 85

1. stop smoking 2. avoid caffeine 3. avoid medications that cause tightening of blood vessels 4. keep the body warm, avoid exposure to cold 5. wear comfortable and roomy shoes and wool socks

Question 86

1. what is Buergers disease? 2. what are the common symptoms 3. what is the treatment course

Answer 86

1. Inflammation and thrombosis of small & medium sized veins and arteries that is commonly associated with smoking. Common in males age 20-40’s with Onset distal to proximal in extremities 2. Temperature and color variance in hands/feet, pain in hands/feet can be severe (arch of foot), painful sores or ulcers hands/feet, pain during walking in LE 3. Smoking cessation, pain management, improve circulation through surgery that restores blood flow

Question 87

what are the skin characteristics, pain levels, exudate, pulses, wound characteristics, and common sites for arterial wounds?

Answer 87

1. Skin characteristics: Shiny, dry, cool/cold, loss of hair, rubor with dependent positioning, pallor in elevation 2. Pain: Positive for pain due to ischemia 3. Exudate: Not observable, dry 4. Pulses: Can be absent or diminished 5. Common sites: Toes, feet, distal to malleoli 6. wound characteristics: small, defined borders, punched out, deep, tunneling, dry, necrotic tissue

Question 88

what are the skin characteristics, pain levels, exudate, pulses, wound characteristics, and common sites for venous wounds?

Answer 88

1. Skin characteristics: Warm, pigmentation, mottling, thickened, rough skin, changes in appearance of skin after wound healing 2. Pain: Wounds generally minimally painful 3. Exudate: oozing 4. Pulses: normal 5. Common sites: above malleoli, distal 1/3 of lower leg 6. wound characteristics: Uneven borders, shallow, drainage, can be large