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536 Body Systems > Vascular > Flashcards

Vascular Flashcards

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1
Q

layers of blood vessels include:

A

tunica externa: adventitia - outer layer to support and shape
tunica media: elastic/muscular
tunica intima: inner layer of endothelial tissue, smooth to reduce friction
lumen: hollow passageway

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2
Q

how much of the blood supply is in the arterial system?

A

10-15%

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3
Q

elastic vs muscular arteries

A

elastic closer to heart
muscular: femoral, brachial, radial

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4
Q

function of arterioles

A

supply blood to organs
use smooth muscle responding to ANS input
create peripheral resistance

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5
Q

function of capillaries

A

O2 and nutrient exchange
sphincter between arterial and venous

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6
Q

function of venuoles

A

receive blood from capillaries
part of nutrient exchange
can rupture to form varicose veins

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7
Q

function of veins

A

less pressure than arteries
thin wall
elastic
large capacity
one way valves, aided by muscle contraction

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8
Q

how much blood is in venous system?

A

75%

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9
Q

PVD umbrella term includes

A

aorta diseases: aneurysm, dissection, obstruction
PAD
venous diseases
vasospasms

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10
Q

aortic aneurysm cause

A

infection
trauma
cath puncture
associated with: connective tissue disorders, vasculitis, atherosclerosis, trauma/aortic dissection

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11
Q

% dilation of aneurysm

A

at least 50%

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12
Q

true aneurysm

A

involving all 3 layers of vessel

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13
Q

pseudoaneurysm

A

contained rupture of vessel lumen
blood leaks out of intima and media layers into externa
prone to rupture

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14
Q

aortic aneurysm clinical presentation

A

asymtomatic
pulsatile mass
back pain
nausea
abdominal pain to flanks radiating to legs
malaise

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15
Q

risk factors for rupture of aortic aneurysm

A

Increasing size
Rapid expansion
Tobacco use – smoking cessation is the SINGLE MOST non-surgical intervention
Increasing or uncontrolled HTN
Cardiac or renal transplant due to steroids for immunosuppression
COPD (whether or not they have quit smoking) - ? Due to increased intrathoracic pressure
Female&raquo_space; strong predictor; even though lower incidence overall - ?
Decreased tensile strength and increased wall stress in women
Recent surgery of all kinds> ? Overall stress of surgery

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16
Q

diagnose aortic aneurysm

A

imaging, incidental
abdominal palpation
Screening

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17
Q

aortic dissection

A

tear in intima/media spreading along artery, can lead to rupture
life threatening

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18
Q

aortic dissection risk factors

A

atherosclerosis
blunt trauma to chest
HTN

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19
Q

clinical presentation of aortic dissection

A

hypoperfusion signs
nausea/vomiting
rapid/weak pulse

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20
Q

pathophys of PAD

A

atherosclerosis of peripheral arteries reducing diameter and O2 to LE
during exercise muscles get ischemic when body can’t compensate by dilation of vessels

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21
Q

risk factors for PAD

A

CAD/atherosclerosis
advanced age
hypercholesterolemia
smoking
HTN
diabetes
overweight
family history

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22
Q

pt history indicating PAD

A

claudication
impaired walking function
ischemic rest pain
abn lower pulses
non healing LE wounds
gangrene
palor/rubor abn

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23
Q

clinical presentation of PAD

A

often aorta, femoral, popliteal
intermittent claudication, atypical pain, or asymptomatic
symptoms distal to stenotic area
can have ulceration/infection with chronic
diminished pulses
atrophy
palor when elevated
rubor of dependency
trophic changes
reduced sensation

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24
Q

ACSM intermittent claudication scale

A
  1. discomfort
  2. mod discomfort
  3. intense pain
  4. unbearable pain
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25
ABI values
>1.1: normal, no symptoms .5-1: claudication, calf pain while walking .2-.5: critical limb ischemia, atrophy, pain at rest, wounds <.2: severe ischemia, gangrene, necrosis
26
grading of pulses
0: absent 1+: diminished 2+: expected 3+: full/normal 4+ bounding
27
critical limb ischemia and phases of progression
PAD progression so circulation can't meet metabolic needs at rest 1. at first body will compensate then wounds will form as blood is shunted to muscle 2. pain with exercise 3. resting pain, non healing wounds, gangrene
28
acute cold leg
vascular emergency acute arterial occlusion due to embolism, often femoral a. high risk of amputation
29
s/s acute cold leg
sudden onset (perishingly) cold, pale, pulseless, pain, parasthesia, paralytic 6 Ps
30
acute cold leg treatment
revascularize embolectomy, thrombolysis, angioplasty, bypass surgery amputation if leg is mottled, non blanching, woody
31
phases of acute cold leg viability - arterial and venous dopplers
arterial doppler only heard on viable limb with no threat venous doppler heard on viable, marginally threatened, and immediately threatened limbs, absent on irreversible damage
32
ACSM recommendations PAD
aerobic: 3-5x week, RPE 12-16, 20-60 min elicit claudication in 3-5 min of walking, rest once at moderate severity resistance: 2x week, emphasis on LE flexibility: 2-3x week
33
supervised exercise for PAD benefits
supervised exercise equivalent positive effect to stenting with mod PAD lasted 1 year beyond
34
angioplasty for PAD
immediate improvement in claudication, heals distal wounds, resume exercise 72 hours post
35
bypass surgery for PAD
harvest vein from another part of the leg resolve symptoms, OOB day 1, limit on lifting for 6 weeks
36
femoral popliteal bypass for PAD
used for critical limb ischemia OOB day 1, return to activity after limb healing
37
superficial, communicating, deep veins, percentage of blood carried?
superficial contain 10-15% of LE blood, drain in communicating veins drain into deep veins which carry 85-90% of blood back to heart
38
risk factors for venous disorders
prior hx of blood clot family hx obesity pregnancy prolonged standing hx of ankle injury/immobility trauma illness surgery lifestyle
39
clinical presentation of venous disorders generally includes:
edema in LE fatigue LE heaviness hemosiderin staining warmth ulcers/wounds above the ankle frequent infections
40
varicose veins
dilated tortuous superficial veins caused by intrinsic weakness in vessel wall increasing pressure/volume overload also trauma
41
risk factors for varicose veins
female 2-3x pregnancy obesity family hx prolonged standing hx of infection
42
s/s of varicose veins
heaviness dull ache bulging veins local hematoma
43
stages of varicose veins
1. reticular/spider veins 2. varicose 3. edema 4. venous ulcer
44
manage varicose veins
compression stockings elevation manage edema avoid prolonged standing sclerotherapy IV injection endovenous thermal ablation w laser surgical ligation/removal
45
VTE - venous thromboembolism
DVT blood clot in deep vein can also include PE in lungs
46
pathogenesis of VTE
virchow's triad of venous stasis, vascular injury, and hypercoagulability this triggers coagulation cascade in response to tissue bleeding happens in areas of altered blood flow
47
risk factors for DVT
post op obesity pregnancy post partum HF, respiratory failure tobacco oral contraceptives cancer/chemo prolonged travel trauma diabetes/HTN/CVA/SCI varicose veins increasing age
48
risk factors of UE DVT
central venous catheters PICC lines pacemaker insertion
49
s/s of LE DVT
UL edema tenderness/pain in leg/calf warmth/erythma fever cognitive changes in elderly
50
testing to diagnose DVT
serum D-Dimer: degradation of fibrin, normal test excludes and abn requires more testing Doppler US: 95% sensitive proximal veins, 75% calf veins MRI/contrast venography
51
Well's clinical prediction rule for DVT
+1 active cancer +1 paralysis/immobilization of LE +1 bedridden 3+ days within 4 weeks +1 localized tenderness along deep veins +1 entire leg swollen +1 UL calf swelling +1 UL edema +1 collateral superficial veins -2 alt diagnosis as likely or more as DVT 2+ = DVT likely
52
UE DVT clinical prediction rule
+1 venous material in subclavian/jugular OR pacemaker +1 localized arm pain +1 UL pitting edema -1 alt diagnosis as likely or more highly likely if 2+
53
Homan's sign
passive DF and squeeze calf not reliable for DVT
54
DVT treatment
compression stockings/compression anti-coagulation meds (heparin/coumadin) continued at least 3 mo consider IVC filter if anticoagulation not possible
55
When to mobilize after meds administered
LMWH/heparin: 3-5 check w doc, 5+ hours fondaparinus: 2-3 check w doc, 3+ hours UFH: 24-48 check w doc, 48+ hours NOAC: 2-3 check w doc, 3+ hours Coumadin: when INR 2-5 Mobilize if IFC filter in place
56
guidelines for mobilizing with DVT
needs to be anticoagulated or on IVC filter
57
IVC filter
prevents DVT from becoming PE by traveling placed in IVC above level of clot
58
CPG takeaways on DVT
early mobilization = prevention, safety in parameters stratify risk for those w reduced mobility, post op assess risk factors in high risk pts provide prevention measures for those high risk for VTE Use Wells score for LE DVT liklihood Establish likelihood of UE DVT when pt presents with symptoms establish likelihood of PE w symptoms by clinical prediction confirm pharm management before mobilization, wait until therapeutic levels achieved allow UE activites w UE DVT when therapeutic level of anticoagulation mechanical compression not recommended for new DVT mobilize w IVC filter mobilize PE when anticoagulation therapeutic level achieved
59
Padua prediction score
+3 active cancer +3 previous VTE +3 thrombophilia +3 reduced mobility +2 trauma/surgery within the month +1 elderly +1 acute MI/stroke +1 acute infection +1 obesity +1 hormone treatment high risk VTE = 4+
60
Khorana risk score for VTE
VTE depending on cancer and other factors site of cancer +2 stomach, pancreas +1 lung, lymphoma, gyn, bladder, testes +1 pre chemo platelet count +1 prechemo hemoglobin +1 BMI 1-2 med risk high risk 3+
61
post thrombotic syndrome
permanent damage to vein valves causing reflux of blood in venous system causes venous hypertension reducing muscle perfusion, increases tissue permeability
62
s/s of post thrombotic syndrome
chronic aching arm or leg pain, intractable edema, limb heaviness, leg ulcers, skin changes, heaviness in limb affected by DVT
63
pulmonary embolism
clot breaking off from DVT traveling into IVC, throigh R heart into lungs
64
PE s/s
dyspnea, pleuritic chest pain, hemoptysis, cough, syncope, tachypnea
65
diagnose PE
same as DVT, EKG, CTA, v/q scan
66
PE treatment
anticoagulation, thrombolytic therapy
67
Well clinical prediction rule for PE
3+ clinical symptoms 3+ other diagnoses less likely than PE 1.5+ HR>100 1.5+ immobilization 1.5+ prev DVT, PE +1 hemoptysis +1 malignancy >6 high risk 2-6 mod
68
chronic venous insufficiency S/s and associated with what symptoms?
valve incompetence/obstruction causing leaking and edema into surrounding tissues associated with varicose veins, skin inflam, hyperpigmentation, ulcers
69
treat chronic venous insufficiency
treat edema with diuretics, antibiotics compression dressing changes for wounds
70
types of compression wraps for edema
spiral wrap: 50% overlap of bandage for 2 layers figure 8: 50% overlap provides 4 layers compression stockings unna boot w zinc oxide
71
vascular examination: venous insufficiency Hx
chronic edema slow healing infections varicose veins pain in peripheral extremities ask about alc/tobacco, HTN, diabteres, hyperlipidemia, ulcers
72
vascular exam: arterial insufficiency Hx
aching/cramping distal limbs poor wound healing limited mobility due to claudication
73
vascular exam: what to look for in inspection
skin color edema atrophy venous patterns varicose veins skin changes gait abnormalities
74
inspection: arterial vs venous
venous: heme staining, edema, varicose veins, wounds malleolus and proximal, wet wounds, low pain arterial: pale extremities, atrophy, malleolus and distal wounds, dry wounds, painful due to ischemia
75
vascular exam: palpation
arterial: diminished pulses venous: normal pulses compare edema and pulses BL
76
characteristics of venous wounds
wounds above malleolus insidious wounds with skin color texture changes uneven edges shallow minimal eschar serous drainage less painful
77
characteristics of arterial wounds
on foot at pressure points round punches out appearance yellow/brown/black skin pale dry wound deep very painful toenails brittle, yellow diminished pulse cold to touch around wound
78
cellulitis
bacterial skin infection, not vascular
79
s/s of cellulitis
red, expanding area, quickly swelling tenderness pain warmth open wound fever red spots blisters skin dimpling
80
cellulitis treatment
long term antibiotics, wound care, reduce edema
81
raynaud's disease
decreases blood supply to distal extremities affecting small arteries
82
s/s raynaud's
cold fingers/toes color changes in skin with stress or cold N/T in fingers/toes stinging/throbbing pain w warming or stress relieved ulcers
83
causes of raynaud's
atherosclerosis drugs causing vasoconstriction autoimmune conditions smoking repeated injury
84
Buerger's disease
inflammation and thrombosis of small veins and arteries associated w smoking often in males 20-40 distal to proximal
85
s/s of Buerger's disease
temp and color variance, pain in hands/feet, painful ulcers, pain while walking
86
vascular exam: observation and palpation should include
skin color temperature available ROM trophic changes deformities and abnormalities
87
capillary refill
squeeze plantar toe for 5 seconds should refill in: <1 s child 1 s adult 1.7 s elderly concerning: male 2 s, female 2.8s, elderly 4.5s
88
venous filling time test
mark prominent dorsal veins start supine, elevate LE 45 degrees for 1-3 min lower feet to dependent and measure time to filling of dorsal veins rapid filling indicates venous disease slow filling indicates arterial issue
89
rubor of dependency
start supine, elevate LE 45 degrees for 1-3 min lower feet to dependent and assess color redness and histamine response indicates PAD
90
intermittent claudication testing
have pt walk starting timer and measuring distance mark time and distance of first claudication symptoms (ICD) and time/distance where they have to stop (ACD)
91
Active pedal plantarflexion
do double leg heel raises, up to 50 measure ABI before and after doing less than 33 with severe pain indicates PAD
92
percussion test/tap test
assess venous system place Doppler on saphenous vein, other on proximal area percuss/tap vein increase in blood flow heard on Doppler indicates incompetent veins/backflow
93
Trendelenberg test
assess peripheral venous system to differentiate superficial/perforating incompetent veins 1. elevate LE 45 degrees for 1 min 2. tourniquet thigh 3. assist patient in standing rapidly 4. filling <5s=incompetent valves of deep veins 5. remove tourniquet, filling <5s, incompetent valves of superficial veins
94
Stemmer's sign
base of 2nd toe, pinch and pick up skin + unable, indicate lymphedema
95
Allen test
do in 90/90 position for both radial and ulnar arteries

536 Body Systems (13 decks)

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