Unit 1 - Peripheral Vascular Disease

Question 1

Edema is defined as

Answer 1

either a generalized or local swelling in which there is an excessive amount of fluid in tissue

Question 2

This can involve any of the tissues in the body, for example;

Answer 2

cerebral edema or pulmonary edema

Question 3

Localized edema may occur as part of the body’s normal

Answer 3

normal response to injury or trauma in a lower limb.

Question 4

Localized edema may occur as part of the body’s normal response to injury or trauma in a lower limb. This type of edema resolves when?

Answer 4

as the injury resolves

Question 5

dependent edema

Is characterized by…?
3 causes

Answer 5

Characterized by being
Temporary/transient

prolonged standing,

prolonged lack of motion to stimulate venous and lymphatic fluid return

the effects of gravity

Someone may have swollen legs after standing for an unusually long period, but the swelling will abate after the legs are elevated.

Question 6

When does dependent edema resolve?

Answer 6

when the conditions that brought it on are removed

Question 7

dependent edema

Someone may have swollen legs after…
But…
Typically…

Answer 7

Someone may have swollen legs after standing for an unusually long period,

but the swelling will abate after the legs are elevated.

Typically, the person sleeps and the edema is gone in the morning.

Question 8

Dependent edema is usually not cause for concern as…

Answer 8

it may be attributed to a particular set of circumstances and resolves easily

Question 9

Lower limb edema that develops without a visible cause and does not resolve easily with leg elevation may be due to?

Answer 9

a systemic disease

Question 10

5 Systemic Diseases

that can lead to lower limb edema

Answer 10

Cardiac Disease Heart Failure
Hepatic Disease
Renal Disease
Inflammatory Disease
Malnutrition or Starvation

Question 11

Cardiac Disease Heart Failure is a condition where…

Answer 11

the heart no longer exerts the strength necessary to effectively return all the blood from the extremities

Question 12

Cardiac Disease Heart Failure is a condition where the heart no longer exerts the strength necessary to effectively return all the blood from the extremities.

This results in…

Answer 12

excess pooling of blood in the lower limbs assisted by gravity

Question 13

Cardiac Disease Heart Failure

Excess pooling of blood in the lower limbs assisted by gravity does what?

Answer 13

increases the pressure in the veins and capillaries of the legs

Question 14

Cardiac Disease Heart Failure

Excess pooling of blood in the lower limbs assisted by gravity increases the pressure in the veins and capillaries of the legs.

This increased pressure…

Answer 14

makes it more difficult for fluid to move from the interstitial compartment into the capillaries and so it remains in the interstitial space causing edema

Question 15

Hepatic or Liver Disease may effect the production of?

Answer 15

plasma proteins

Question 16

Hepatic or Liver Disease may effect the production of plasma proteins.

These large plasma proteins do what?

Answer 16

provide a large part of the osmotic pressure that draws fluid from the interstitial space into the capillaries and bloodstream

Question 17

Hepatic or Liver Disease may effect the production of plasma proteins.

These large plasma proteins provide a large part of the osmotic pressure that draws fluid from the interstitial space into the capillaries and bloodstream.

When the number of these proteins is decreased, what happens?

Answer 17

the osmotic pressure of the blood is decreased and more fluid is left behind in the interstitial space

Question 18

Renal Disease results in?

Answer 18

fluid and electrolyte imbalances

Question 19

Renal Disease results in fluid and electrolyte imbalances, particularly?

Answer 19

sodium retention

Question 20

Renal Disease results in fluid and electrolyte imbalances, particularly sodium retention.

Sodium retention may result in? (2)

Answer 20

edema

excessive loss of protein from the body through proteinuria

Question 21

Malnutrition or starvation results in?

Answer 21

inadequate protein intake

Question 22

Malnutrition or starvation results in inadequate protein intake.

Inadequate protein intake will result in?

Answer 22

fewer plasma proteins being produced

Question 23

Malnutrition or starvation could include? (2)

Answer 23

any malabsorption disease
such as

Celiac Disease
or
Inflammatory Bowel Disease

Question 24

Inflammatory Disease may cause edema when?

example?

Answer 24

an immune response triggers

the release of chemical toxins,

increased local blood flow

and

influx of white blood cells mistakenly against the body’s own tissue

E.g. = RA

Question 25

Inflammatory edema is usually? (4)

Answer 25

Red Warm Tender Non-pitting

Question 26

When inflammatory edema is chronic there may be evidence of?

Answer 26

simultaneous tissue destruction and repair

Question 27

Diagnosis of the underlying systemic disease causing the edema is made by the client’s physician and may include...

Answer 27

bloodwork EKG x-rays ultrasonography of the heart, liver, kidneys Referral to specialists for further testing with CT MRI nuclear scanning

Question 28

Clinical Symptoms of Systemic Edema: Systemic causes of edema will usually result in?

Answer 28

a symmetrical distribution of edema for example; both legs, both eyes with periorbital edema, or both hands or feet

Question 29

Clinical Symptoms of Systemic Edema: Edema may? (3)

Answer 29

be pitting or non-pitting be indurated (Hardened, usually used with reference to soft tissues becoming extremely firm but not as hard as bone.) extend from the toes to knees or start at the ankles and extend upwards

Question 30

Clinical Symptoms of Systemic Edema: Onset may be...

Answer 30

slow and gradual over many months or relatively sudden over hours, days or several weeks

Question 31

Clinical Symptoms of Systemic Edema: The more rapid the onset...

Answer 31

the more cause for serious concern and the more pressing the need for treatment

Question 32

Goals and Treatments for Systemic Edema: Goals and treatment for edema from systemic disease needs to focus on...?   edema caused by systemic disease will not resolve until the underlying cause is specifically treated.  Treatment with compression stockings does not begin until diagnosis.

Answer 32

accurate and timely diagnosis of the underlying cause

Question 33

Goals and Treatments for Systemic Edema: Once cause is established...?

Answer 33

a medical plan of treatment can be pursued by the client and doctor to treat and manage the symptoms of the underlying disease

Question 34

Goals and Treatments for Systemic Edema: Once cause is established, a medical plan of treatment can be pursued by the client and doctor to treat and manage the symptoms of the underlying disease; this will prevent...?

Answer 34

further complications of skin damage and/or infection

Question 35

Lymphatic Disorders causing Edema The Lymphatic System: Describe.

Answer 35

``` lymphatic system is a web-like system of lymph capillaries, vessels, valves and nodes ``` ``` that transport lymph fluid containing water, proteins, nutrients and white blood cells throughout our body tissues ```

Question 36

Lymphatic Disorders causing Edema The Lymphatic System is a web-like system of lymph capillaries, vessels, valves and nodes that transport lymph fluid containing water, proteins, nutrients and white blood cells throughout our body tissues. It then...?

Answer 36

returns the lymph fluid to our vascular system via the thoracic duct into the left subclavian vein and the right lymphatic duct into the right subclavian vein

Question 37

Lymphatic Disorders causing Edema What is the function of the lymphatic system? (2)

Answer 37

to remove foreign material from our tissues after delivering fluid and nutrients to those tissues to work with the circulatory system to absorb digested fats from the small intestine

Question 38

Lymphedema etiology: (5)

Answer 38

anything that results in injury, destruction or blockage of the lymphatic system can lead to lymphedema by blocking or impeding the return of lymph fluid to the vascular system injury to lymphatic vessels from trauma, surgery or radiation chronic hereditary disease called Milroy’s disease parasitic infection found in tropical climates called lymphatic filariasis venous obstruction results in an increase in capillary pressure and this in turn leads to the increased production of tissue fluid

Question 39

Medical Diagnosis of Lymphedema: Usually diagnosed by? What else may be used and why? What is rarely used and why?

Answer 39

history and physical exam alone lab tests to exclude other systemic causes lymphangiography due to risk of complications

Question 40

Clinical Symptoms and Complications of Lymphedema: In the early stage? But with time? Eventually?

Answer 40

there is pitting edema that relieves with elevation the edema becomes non-pitting and does not relieve with elevation Eventually the swollen tissue becomes hardened and fibrotic and may have and “orange peel” appearance to the skin

Question 41

Clinical Symptoms and Complications of Lymphedema: With prolonged lymph stasis, what happens?

Answer 41

toxins remain in the tissue and inflammation (called lymphangitis) and infection are common complications Lymph stasis - A stoppage or slowdown in the flow of blood or other body fluid, such as lymph.

Question 42

lymphangitis

Answer 42

an infection of the lymph vessels that carry lymphatic fluid throughout the body

Question 43

Signs of lymphangitis

Answer 43

the appearance of pain, warmth and red streaking along the track of the lymph vessels

Question 44

There is no cure for lymphedema Treatment is aimed at?

Answer 44

the prevention of complications of skin breakdown and infection

Question 45

There is no cure for lymphedema Treatment is aimed at the prevention of complications of skin breakdown and infection. Through? (3)

Answer 45

reduction of swelling containment of swelling additional support measures

Question 46

Lymphedema treatment Reduction of swelling (2)

Answer 46

pneumatic extremity pumps manual lymph drainage or complete decongestive therapy

Question 47

Lymphedema treatment Containment of swelling (3)

Answer 47

short stretch bandages (e.g. Comprilan) reusable fabric devices with adjustable straps (e.g. Circ-Aid, Reid Sleeves) custom compression garments (e.g. Jobst)

Question 48

Lymphedema treatment Additional support measures (4)

Answer 48

healthy diet and weight control exercise is important in stimulating lymphatic fluid return careful skin and nail care drugs may be used to control infection diuretics are rarely used

Question 49

Thrombophlebitis Deep vein thrombosis

Answer 49

Thrombophlebitis (throm-boe-fluh-BY-tis) is an inflammatory process that causes a blood clot to form and block one or more veins, usually in your legs. The affected vein might be near the surface of your skin (superficial thrombophlebitis) or deep within a muscle (deep vein thrombosis, or DVT). Deep vein thrombosis (DVT) is a blood clot (thrombus) in a deep vein, usually in the legs. Clots can form in superficial veins and in deep veins. Blood clots with inflammation in superficial veins (called superficial thrombophlebitis or phlebitis) rarely cause serious problems.

Question 50

Thrombophlebitis etiology Usually two of three following factors are present:

Answer 50

venous stasis or slowing of venous return endothelial injury creating site for formation of clot alteration in blood clotting mechanism

Question 51

Clinical Symptoms of Thrombophlebitis: Usually? 

Answer 51

one limb only

Question 52

Clinical Symptoms of Thrombophlebitis: Superficial thrombophlebitis WARTS

Answer 52

``` Warmth Affected site induration Redness Tenderness Swelling ```

Question 53

Clinical Symptoms of Thrombophlebitis: Deep vein thrombosis or DVT

Answer 53

Symptoms may vary from none to severe pain swelling of affected limb cyanosis of affected limb fever and chills

Question 54

Diagnosis of Thrombophlebitis: (4)

Answer 54

Venous duplex ultrasound imaging uses sound waves to produce images of the veins. It is commonly used to search for blood clots, especially in the veins of the leg – a condition often referred to as deep vein thrombosis. Ultrasound does not use ionizing radiation and has no known harmful effects. A Doppler ultrasound study may be part of a venous ultrasound examination. Venography a procedure in which an x-ray of the veins, a venogram, is taken after a special dye is injected into the bone marrow or veins. The dye has to be injected constantly via a catheter, making it an invasive procedure. Impedance plethysmography evaluates the velocity of blood flow through the veins (a non-invasive medical test that measures small changes in electrical resistance of the chest, calf or other regions of the body. These measurements reflect blood volume changes, and can indirectly indicate the presence or absence of venous thrombosis.) ``` Coagulation bloodwork Prothrombin time (PT or PT-INR) Platelet count Thrombin time Bleeding time ```

Question 55

Goals for Thrombophlebitis: (3)

Answer 55

to prevent pulmonary embolus from DVT to restore effective venous return to limit damage to the valves of the deep and perforating veins

Question 56

To prevent pulmonary embolus from DVT r/t surgery, what can be given? When? To who?

Answer 56

sub-cutaneous low molecular weight heparin pre and post-op to those at most risk

Question 57

Treatments for Thrombophlebitis: (3)

Answer 57

use of anti-embolism stockings (TEDs) for non-ambulatory clients before, during and immediately post-surgery to prevent pooling of blood in lower limbs during prolonged immobility thrombolytic and anticoagulation therapy as needed thrombectomy surgery in cases of severe compromise of circulation

Question 58

Chronic Venous Insufficiency Etiology 3 main causes

Answer 58

1. failure of the calf muscle pump 2. venous reflux from damaged or incompetent valves 3. obstruction of venous return or outflow

Question 59

Calf muscle pump

Answer 59

When walking, the calf-muscle-pump contracts allowing the blood to flow proximally towards the heart. Blood flow from the superficial veins to the deeper veins occurs when the pressure decreases. In fully functional vessel valves, retrograde blood flow is prevented as the leg muscles relax. The calf muscle pump is made up of all the muscles in the legs, but the motors that provide the power for the pump are the calf muscles -- these are made up of two basic movers -- they are Soleus which is primarily used for standing upright, and Gastrocnemius used for running and jumping. As muscles move, they increase and decrease pressure of the vessel walls (the veins) which have one-way valves in them which open to let blood pass through them and close to prevent the blood flowing back toward the feet.

Question 60

Chronic Venous Insufficiency Etiology 1. failure of the calf muscle pump What do calf muscles do? During which phases of the gait cycle?

Answer 60

Squeeze deep veins Open valves Push blood toward the heart Heel strike Foot flat Heel off

Question 61

Chronic Venous Insufficiency Etiology 1. failure of the calf muscle pump What happens when the calf muscle relaxes? During which phase of the gait cycle is the calf relaxed?

Answer 61

valves close preventing backflow of blood in the veins between the toe off and next heel strike phase of the gait cycle

Question 62

Chronic Venous Insufficiency Etiology 1. failure of the calf muscle pump The calf muscle pump fails to function unless...? What does the calf muscle pump need to be activated?

Answer 62

normal walking motion has dorsiflexion at the ankle of > 90 degrees needs seven steps to be activated

Question 63

Chronic Venous Insufficiency Etiology 1. failure of the calf muscle pump What will not activate the calf muscle pump effectively?

Answer 63

immobility paralysis a weak shuffling gait

Question 64

Chronic Venous Insufficiency Etiology (3) 2. venous reflux from damaged or incompetent valves

Answer 64

inherited acquired with occupations that involve prolonged standing in one place damage of DVT trauma infection

Question 65

Chronic Venous Insufficiency Etiology 3. obstruction of venous return or outflow T POMP

Answer 65

thrombosis prolonged sitting obesity malignancy pregnancy

Question 66

Chronic Venous Insufficiency Etiology 3 main causes

Answer 66

1. failure of the calf muscle pump 2. venous reflux from damaged or incompetent valves 3. obstruction of venous return or outflow

Question 67

Clinical SIGNS of Chronic Venous Insufficiency: (3)

Answer 67

hemostasis leading to hemosiderin staining chronic induration of tissue and eventual fibrosis dermatitis Stasis dermatitis is a long-term condition that causes inflammation, ulcers, and itchy skin on the lower legs. It often occurs in people who have underlying conditions that affect blood flow in the legs, such as chronic venous insufficiency, varicose veins, deep vein thrombosis (DVT), and congestive heart failure.

Question 68

Complications of Chronic Venous Insufficiency: V OR CC

Answer 68

venous stasis ulcers obstruction of microcirculation with delayed healing recurrent thrombosis chronic edema eventually not relieved with elevation cellulitis

Question 69

Medical Diagnosis of Chronic Venous Insufficiency:

Answer 69

Venous duplex ultrasound imaging uses sound waves to produce images of the veins. It is commonly used to search for blood clots, especially in the veins of the leg – a condition often referred to as deep vein thrombosis. Ultrasound does not use ionizing radiation and has no known harmful effects. A Doppler ultrasound study may be part of a venous ultrasound examination. Impedance plethysmography evaluates the velocity of blood flow through the veins (a non-invasive medical test that measures small changes in electrical resistance of the chest, calf or other regions of the body. These measurements reflect blood volume changes, and can indirectly indicate the presence or absence of venous thrombosis.)

Question 70

Goals for Chronic Venous Insufficiency:

Answer 70

restore intact skin prevent further ulceration, thrombosis, dermatitis or infection

Question 71

Treatment for Chronic Venous Insufficiency: (4)

Answer 71

compression therapy infectious disease consultation dermatology consultation vascular surgery consultation

Question 72

Treatment for Chronic Venous Insufficiency: Compression therapy What must first be evaluated prior to initiation of compression therapy? How is this evaluated?

Answer 72

arterial flow -- is it adequate enough to use compression therapy?! ankle brachial pressure indices (ABPI) The ankle brachial index, or ABI, is a simple test that compares the blood pressure in the upper and lower limbs. Health care providers calculate ABI by dividing the blood pressure in an artery of the ankle by the blood pressure in an artery of the arm.

Question 73

Treatment for Chronic Venous Insufficiency: Compression therapy -- 3 types

Answer 73

pneumatic extremity pumps compression dressings compression garments or hosiery

Question 74

Treatment for Chronic Venous Insufficiency: Compression therapy -- once started...?

Answer 74

compression therapy once started, is for life!

Question 75

Treatment for Chronic Venous Insufficiency: infectious disease consultation can help manage?

Answer 75

difficult cellulitis and wound care issues

Question 76

Treatment for Chronic Venous Insufficiency: dermatology consultation is helpful for?

Answer 76

managing dermatitis

Question 77

Treatment for Chronic Venous Insufficiency: vascular surgery consultation can?

Answer 77

identify any possible surgical options

Question 78

Management of All Types of Edema Effects of Edema on the Lower Limb: What does prolonged edema do? It is therefore?

Answer 78

impairs the overall function of the skin as an organ a serious threat

Question 79

Management of All Types of Edema Effects of Edema on the Lower Limb: Prolonged edema impairs the overall function of the skin as an organ. Speak to the general condition of the skin (2)

Answer 79

epidermis thins, becomes more fragile and prone to injury from pressure and trauma the skin is less elastic and accommodating and thus prone to tearing or splitting

Question 80

Management of All Types of Edema Effects of Edema on the Lower Limb: Prolonged edema impairs the overall function of the skin as an organ. Speak to breaks in the skin (1)

Answer 80

any break in the skin becomes a portal of entry for microorganisms to enter and cause infection

Question 81

Management of All Types of Edema Effects of Edema on the Lower Limb: Prolonged edema impairs the overall function of the skin as an organ. Speak to lesion formation (1)

Answer 81

edema can cause formation of blisters that can become ulcerations

Question 82

Management of All Types of Edema Effects of Edema on the Lower Limb: Prolonged edema impairs the overall function of the skin as an organ. Speak to circulation (2)

Answer 82

edema impedes blood and lymph circulation and this leads to inadequate delivery of nutrients or antibiotics needed for tissue repair edema impedes the removal of waste and toxins from areas of injury and hence slows the healing process

Question 83

Management of All Types of Edema Effects of Edema on General Health and Mobility: SLID Pro

Answer 83

swelling around joints decreases ROM and hinders ability to perform ADLs less mobility in turn leads to less adequate venous return and this in turn leads to more edema increased weight associated with large amounts of edema expends more energy to carry around leading to fatigue decreased activity tolerance may seriously impair ability to manage ADL independently prolonged impaired mobility eventually negatively effects all body systems

Question 84

Effects of Edema on Common Foot Pathologies of Nails and Skin: Pressure points Feet Toes Infx (2)

Answer 84

edema makes any areas of increased pressure more prone to injury or skin breakdown e.g. corns or calluses foot edema increases the pressure of footwear on fragile skin edema to the toes makes it easier for the edge of the nail plate to pierce surrounding skin feet have indigenous bacterial flora and breaks in skin integrity lead to increased risk of infection from normal flora slowed healing makes it easier for infection to spread to surrounding tissue

Question 85

General Treatment for Managing Edema: PEACHY

Answer 85

protect fragile skin from damage and keep clean and moisturized elevation of effected limbs to improve venous return ambulation as soon as possible to activate the calf muscle pump change position or do ankle exercises to stimulate blood flow have to strongly encourage clients to persist with therapy that has been ordered you must direct any concerns that -- as a nurse -- you cannot answer back to their care provider in charge of the therapy

Question 86

Education for Managing Edema: Avoid (3) Any concerns?

Answer 86

AVOID restrictive clothing at waist, hips, groin, knees or ankles sitting or standing for long periods of time crossing legs, it reduces venous return by 15%

Question 87

Nursing Foot Care for Clients with Lower Limb Edema: Assessment Identify 1A EIOU ?s PQRSTU mnemonic

Answer 87

IDENTIFY 1ST AX -- is edema present? to what extent? edema caused by hx of systemic disease? if client on anticoagulants other health care providers involved e.g. doctor, home care or wound care nurse understanding client has of condition and any current treatments ?s onset, duration, what makes it better or worse? ``` Provoking/Paliation Quality/Quantity Region/Radiation Severity Timeframe (onset/duration) Understand pt's perception of problem ```

Question 88

Nursing Foot Care for Clients with Lower Limb Edema: Planning 3 things to plan

Answer 88

realistic goals for treatment in consultation WITH CLIENT and based on their preferences for treatment interventions including education and referrals WITH CLIENT foot care to not interfere with other treatments

Question 89

Nursing Foot Care for Clients with Lower Limb Edema: Intervention: In terms of medical supervision (4)

Answer 89

refer client to doctor if you identify persistent edema that has not been diagnosed monitor the presence and extent of edema at subsequent visits question the client about any changes refer client back to doctor if edema gets worse without adequate explanation

Question 90

Nursing Foot Care for Clients with Lower Limb Edema: Intervention: In terms of actual foot care (4)

Answer 90

exercise particular caution to protect fragile skin during foot and nail care extra caution to avoid breach of skin if client is on anticoagulants identify any areas of pressure from footwear and work with client to prevent skin breakdown if compression stockings (not referring to compression dressings or bandages) are removed to do foot care, keep both legs elevated during foot care and reapply hose before allowing legs to dangle

Question 91

Nursing Foot Care for Clients with Lower Limb Edema: Evaluation: (3)

Answer 91

evaluate effectiveness of interventions including teaching and referrals identify changes in client’s behaviour or lack of change (e.g. have they bought new compression hose or have they forgotten to put it on) document changes to care plan along with any new goals or interventions

Question 92

Foot Care Nurses and Wound Care Wound care is part of the basic training for all nurses but demands...? Wound care is NOT provided, however...?

Answer 92

more frequent visits and access to supplies that are beyond the scope of the foot care nurse in independent practice All Licensed and Registered Nurses DO give first aid assistance if required e.g. loosening a constrictive dressing in the event of pain, numbness or cyanosis of an extremity, then refer client to Home Care, MD, Urgent Care or ER as appropriate.

Question 93

Foot Care Nurses and Wound Care Wounds on the lower limb are often serious in elderly or chronically ill clients and best managed by?

Answer 93

a multidisciplinary health care team

Question 94

Foot Care Nurses and Wound Care What might cause a client to fail to seek appropriate tx???

Answer 94

Clients may fail to seek appropriate treatment if they believe that you can look after them.

Question 95

Foot Care Nurses and Wound Care Foot Care nurses DO need to be aware of...? Why?

Answer 95

current wound care practices and best practice guidelines in their region to be a supportive member of the health care team

Question 96

Foot Care Nurses and Wound Care Speak to wound dressings during routine foot care.

Answer 96

Typically wound dressings would not be disturbed during routine foot care.

Question 97

Foot Care Nurses and Wound Care If unable to access toes?

Answer 97

delay foot care

Question 98

Foot Care Nurses and Wound Care If delay in providing foot care will be prolonged?

Answer 98

discuss foot care with client and wound caregiver

Question 99

Foot Care Nurses and Wound Care What do to if S/S of wound infx???

Answer 99

Strongly advise all clients to seek medical aid Document Follow up outcomes at the next visit

Question 100

Characteristics of Leg Ulcer Wounds Venous / Arterial / Diabetic LOCATION

Answer 100

Venous -- Gaiter area*, often over malleolus Arterial -- Can occur anywhere on lower leg Diabetic -- Usually on foot, but can be anywhere on lower leg and hands *Gaiter area = area extending from just above the ankle to below the knee

Question 101

Characteristics of Leg Ulcer Wounds Venous / Arterial / Diabetic SIZE

Answer 101

Venous -- Usually large Arterial -- Usually small Diabetic -- Small, but can be larger once callus is removed

Question 102

Characteristics of Leg Ulcer Wounds Venous / Arterial / Diabetic DEPTH

Answer 102

Venous -- Shallow Arterial -- Deep, punched out appearance Diabetic -- Can go to bone

Question 103

Characteristics of Leg Ulcer Wounds Venous / Arterial / Diabetic BORDER

Answer 103

Venous -- Irregular, ragged Arterial -- Sharp edges Diabetic -- Smooth edges

Question 104

Characteristics of Leg Ulcer Wounds Venous / Arterial / Diabetic WOUND BED

Answer 104

Venous -- Bright red Arterial -- Pale Diabetic -- Pale, dry

Question 105

Characteristics of Leg Ulcer Wounds Venous / Arterial / Diabetic EDEMA

Answer 105

Venous -- Generalized Arterial -- Minimal Diabetic -- Localized

Question 106

Characteristics of Leg Ulcer Wounds Venous / Arterial / Diabetic PERIWOUND

Answer 106

Venous -- Lipodermatosclerosis*, hemosiderin staining, dermatitis Arterial -- Pale, cool, shiny, hairless Diabetic -- Callus Lipodermatosclerosis = a chronic inflammatory condition characterised by subcutaneous fibrosis and hardening of the skin on the lower legs. Hemosiderin staining = occurs when red blood cells are broken down, causing hemoglobin to be stored as hemosiderin. Your white blood cells, or immune system cells, can clear up some of the excess iron released into your skin. But there are some medical conditions that can overwhelm this process, resulting in a stain. Dermatitis = skin inflammation

Question 107

Characteristics of Leg Ulcer Wounds Venous / Arterial / Diabetic ANKLE-BRACHIAL PRESSURE INDEX

Answer 107

Venous -- 0.8 - 1.0+ Arterial -- Below 0.6 Diabetic -- Unreliable Blood pressure is measured in units of millimeters of mercury (mmHg)

Question 108

Characteristics of Leg Ulcer Wounds Venous / Arterial / Diabetic PULSES

Answer 108

Venous -- Readily palpable once edema is reduced Arterial -- Reduced or absent Diabetic -- Can be bounding, but this is misleading

Question 109

Characteristics of Leg Ulcer Wounds Venous / Arterial / Diabetic PAIN

Answer 109

Venous -- Can be severe Arterial -- Claudication and/or pain on elevation of limb, most often noted at night in bed Diabetic -- Often absent d/t sensory neuropathy

Question 110

Characteristics of Leg Ulcer Wounds Venous / Arterial / Diabetic COMPRESSION

Answer 110

Venous -- Often used Arterial -- Never Diabetic -- Possibly, but modified

Question 111

Role of the Foot Care Nurse as a Member of the Health Care Team (5)

Answer 111

``` Supportive Referrals Advocating Follow-up Communication ```

Question 112

Role of the Foot Care Nurse as a Member of the Health Care Team Supportive: (2)

Answer 112

demonstrate support for whatever treatment and caregivers are currently in place encourage clients to ask questions and be active participants in their own care

Question 113

Role of the Foot Care Nurse as a Member of the Health Care Team Referrals: (2)

Answer 113

refer clients to their family physician for diagnosis and treatment of persistent edema, especially edema that has no simple explanation or does not resolve readily with leg elevation refer clients back to the home care or wound care nurse for questions about therapy

Question 114

Role of the Foot Care Nurse as a Member of the Health Care Team Advocating: (3)

Answer 114

advocate for clients to have access to a family physician can suggest calling Health Links or Manitoba Medical Association for a list of physicians taking new clients advocate for home care assessment through family physician

Question 115

Role of the Foot Care Nurse as a Member of the Health Care Team Follow-up:

Answer 115

document referrals and ask the client about outcomes at subsequent visits

Question 116

Role of the Foot Care Nurse as a Member of the Health Care Team Communication: (2)

Answer 116

if concerns are urgent or more detail is required consider a phone call, letter or fax to clarify communication keep a record of communications

Question 117

chronic venous insufficiency

Answer 117

Chronic venous insufficiency (CVI) is a condition that occurs when the venous wall and/or valves in the leg veins are not working effectively, making it difficult for blood to return to the heart from the legs. CVI causes blood to “pool” or collect in these veins, and this pooling is called stasis.

Question 118

lymphedema

Answer 118

Lymphedema, or lymphatic obstruction, is a long-term condition where excess fluid collects in tissues causing swelling (edema). Lymphedema results from a blockage in your lymphatic system, which is part of your immune system. The blockage prevents lymph fluid from draining well, and the fluid buildup leads to swelling.

Question 119

Hemosiderin staining

Answer 119

occurs when red blood cells are broken down, causing hemoglobin to be stored as hemosiderin. Your white blood cells, or immune system cells, can clear up some of the excess iron released into your skin. But there are some medical conditions that can overwhelm this process, resulting in a stain.

Question 120

edema

Answer 120

"Edema" is the medical term for swelling. Body parts swell from injury or inflammation. Edema happens when your small blood vessels leak fluid into nearby tissues.

Question 121

venous stasis

Answer 121

Venous stasis, is a condition of slow blood flow in the veins, usually of the legs. Venous stasis is a risk factor for forming blood clots in veins (venous thrombosis), as with the deep veins of the legs (deep vein thrombosis or DVT).

Question 122

venous reflux

Answer 122

Normally, one-way valves in the veins keep blood flowing toward the heart against the force of gravity. When the valves become weak and do not close properly, they allow blood to flow backward and this is a condition called reflux.

Question 123

Compression therapy

Answer 123

The concept of compression therapy is the external application of a controlled pressure to an extremity to help increase the efficiency of the venous and lymphatic systems. This is done with an elastic garment that has a specific amount of compression that is strongest around the ankle and gradually decreases up the extremity/garment. Depending on the pathology, compression therapy can be applied in different forms such as socks, stockings, pantyhose, or sleeves.