Test 3: Pathologies Related to the Knee Flashcards
(45 cards)
what is deep vein thrombosis
partial or complete occlusion of a vein by a clot
etiology of DVT
50% is unknown
other half involve conditions that have at least 2 of the following: venous stasis, hypercoagulability, or damage to the venous wall
conditions that may be more likely to produce DVT
prior DVT
hx of cancer/CHF/lupus
major infection/sx/trauma
chemotherapy
immobility
pregnancy
use of oral contraceptives/hormone therapy
genetic clotting disorder (i.e. Willebrand)
>60 years old
incidence and prevalence of DVT
3rd most common cardiovascular disease
most common in deep LE veins
most preventable cause of hospital related deaths
most common cause of readmissions and death after THA/TKA
common veins that develop DVT
popliteal
femoral
tibial
peroneal
pathogenesis of DVT
greater exposure of platelets and clitting factors to a damaged venous wall
fibrin, leukocytes, and erythrocytes adhere and form thrombosis
what could be done to prevent/treat DVT
early and regular exercise
anticoagulants
compression socks
intermittent pneumatic compression devices
avoid SAD
eliminate persistent smoking/drinking
caution with early and regular exercise for DVT
as a prevention it is great
be cautious/wait for anticoagulant therapy to take effect to avoid a PE from motion with treatment if a clot is already present; DO NOT WANT TO MOVE CLOT
what might be included in pt history if they have DVT
50% of individuals are asymptomatic in early stages
typically a gradual onset of a dull ache/tightness/calf pain
CDR for DVT include what factors
edema; possibly pitting in 70% of pts
increase calf girth
calf pain/tenderness in 50% of pts; worse with walking; relief lessens as condition worsens
possible redness/warmth
PT implications for DVT
referral to MD per CDR
urgent referral if <17% with less than 2 CDRs
emergency if 75% and 3 or more CDRs
do not want to miss
may lead to pulmonary embolism
etiology/pathogenesis of Pulmonary Embolism
DVT that moves and lodges into the smaller artery supplying the lungs
S&S of pulmonary embolism
often non specific… “the great masqueraders”
SOB/wheezing/rapid breathing may be only symptom
pleuritic chest pain; sudden/sharp chest pain that can be exacerbated by:
-deep inhale
-cough
-mechanical pain may occur due to lung fascia attachment to ribs/thoracic vertebrae (i.e. trunk, UE, or rib motion)
other/possibly less common S&S of pulmonary embolism
blood with cough
painful breathing at rest
fainting
tachycardia and palpitations
referral for PE
urgent of <2/6
emergency if greater than or equal to 2/6
what is peripheral artery disease
ischemia leading to symptoms in the most distal area from the blocked artery; most often on calf
where is peripheral artery disease most common
most often in LEs
risk factors for peripheral artery disease
over 45
family hx of MI or sudden death before 55
recent or current smoker
physical inactivity
metabolic syndrome
pathogenesis of peripheral artery disease
artherosclerosis or plaque build up in aa that also promotes vascular constriction thus further limiting circulation
symptoms begin once 50% of a is narrow
S&S of intermittent claudication with peripheral artery disease
LE pain; most often in calf with similar amount of activity and elevated positions
can be uni or bilateral depending on where blockage is
relief with rest and dependent position
often described as cramping but may be weakness/pressure/aching
S&S of peripheral artery disease distal to the ischemic area
loss of pulses
TTP
muscle atrophy/weakness
loss of hair
cool/bluish skin
bruit on auscultation
possible necrosis/wound
how might pain act in the presence of severe ischemia
pain at rest
can cause sleep interruptions
steps for ankle brachial test
take BP at posterior tibial a and brachial a (on both sides)
just looking at the ratio of the ankle systolic/brachial systolic
concerning levels for ankle brachial test
less than 0.9 is bad
the lower the worse the dieases
over 1.4 may indicate poorly compressed vv due to hardened aa from artherosclerosis
