Vascular Pathology: Exam 1 Flashcards
(31 cards)
1
Q
Types of vascular pathos
4
A
- arterial
- inflammatory
- venous
- vasomotor
2
Q
Types of Vascular pathos
Arterial
A
-
Acute
- arterial embolism
-
PAD/Chronic
- arteriosclerosis/PAD
3
Q
Types of vascular pathos
Inflammatory
A
- Thromboangitis obliterans
- Buerger’s dis.
- vasculitis
- Chilblains
- Covid toes
4
Q
Types of vascular pathos
Venous Disorders
A
- Chronic venous insuff.
- DVT
5
Q
types of vascular pathos
Vasomotor disorders
A
- Raynaud’s
- CRPS
6
Q
Inflammatory disorders
Buergers/Thromboangiitis obliterans
arterial ****
A
- vasculitis affecting intima of periph blood vessels
-
Pathophys
- inflamm in intima + sm thrombus/platelet accum.
-
Causes
- heavy smoking
- unknown, but heavy inflamm markers
- homocysteine, SED, ESR
- age >40
-
Dx
- biopsy
- Rubor of dependency
7
Q
Buerger’s Dis.
Sequelae
A
necrosis
can lead to amputation
8
Q
Buerger’s Dis
Symptoms/Tx
A
- Symptoms
- cool extremities
- pain
- ulcers of digits
- intermitt claud
- Tx
- grade ex. to avoid claud
- work below claud threshold
- encourage to quit smoking
- initial cause
- grade ex. to avoid claud
9
Q
Inflammatory disorders:
Vasculitis
A
- inflamm blood vessels
- acute OR chronic
- Sx’s
- sudden or dev over time of pain/throb
- PT involve:
- pain relief
- prevent LOF
- wound care
10
Q
Venous Disorders:
Chronic venous stasis/insuff.
A
- == inad. venous return over long pd of time
-
pathophys:
-
damaged valves w/in veins==decd venous return
- chronic venous stasis (stuck)
-
damaged valves w/in veins==decd venous return
-
Causes
- DVT
- idiopathic
- trauma to pelvic floor
- varicose veins (females)
- neoplastic obstruct of pelvic veins—cancer
- CHF
-
Dx
-
venous trendelenberg
- if leg elevated is blood return better?
- rule out lymphedema
- ABI
- rules OUT PAD
- rules IN CVS
-
venous trendelenberg
11
Q
Venous Disorders:
CVS sequelae
A
- chronic venous ulcers
- inad. cellular O2
- prone to infection
12
Q
Venous disorders:
CVS Sx’s and Tx
A
- Sx’s—> very comfortable w/ leg elevated
- edema
- pulses ALWAYS norm
- pain in dep. pos
- hemosiderin staining—- HgB stains
- varicose veins
- wet wounds–uneven borders
- Tx
-
compression devices
- MAKE SURE THEY HAVE NORMAL AA PERFUSION ****
-
compression devices
13
Q
Pitting Edema Scale
A
- 1+: barely perceptible depression
- 2mm
- 2+: easily ID’d depression
- 4mm
- skin rebounds <15s
- 3+: easily ID’d depression
- 6mm
- skin rebounds 15-30s
- 4+: easily ID’d depression
-
8mm
- skin rebounds >30s
-
8mm
14
Q
Venous disorders:
DVT
ACUTE!!!
A
-
S/S—> UNILATERAL
- PAIN
- ipsilat. edema— only DVT leg
- palpable cords
- redness
- leg warmth
15
Q
Venous disorders: DVT
risk factors
A
- immobility
- trauma/endothelial injury
- lifestyle
- hypercoagulation
- other
- family hx/genetics
- diabetes
- prior DVT
- Beurger’s
- idiopath
- >60yo
16
Q
PT and PREVENTION OF DVT
A
- EARLY mobility—-aerobic act.
- Compression therapy
- TEDs
17
Q
Wells Score
Dx of DVT
A
2 pts or more== DVT likely
Fewer than 2 pts== DVT unlikely
18
Q
DVT
Dx Tests
A
- Wells Criteria Prediction Rules
-
If >2 on Wells
-
D-dimer
-
(+) if elevated
- >400-500
-
(-) if NORMAL
- <400
-
(+) if elevated
-
Venous Duplex Dopplers
- US veins
-
D-dimer
-
If >2 on Wells
19
Q
PT implications:
UnDx’d high sus DVT
A
- Our fear…
- dislodge clot if move them
- limtd research
- facility protocol
- Wells, D-dimer, Homan’s
- obtain clearance from MD
20
Q
Med Mgmt DVT
Anticoagulants or “Blood thinners”
A
- Heparin
- Warfarin
-
Function:
- inhibit synthesis of clotting factors
-
Contraindications:
- actively bleeding and high fall risk
21
Q
IVC filter and DVT
A
used for higher risk bleeding or lg wound
22
Q
PT implications DVT:
Once Dx and med tx initiated
A
- check lab vals to ensure pt therapeutic
- TREAT BALANCE TO LOWER RISK OF FALLS***
- Educate on protective measures to prevent falls
- Ambulation helps DEC sx’s of DVT and risk of PE
-
wound care
- careful!!!
- clearance before debridement
23
Q
Labs: MD det’d Therapeutic Lvl
PT (prothrombin time) for warfarin (coumadin)
A
- norm== 11-15s
- anticoag. therapeutic lvl== 1.5-2.5x normal
- 15-37s
-
if >38s
- INCd risk hemorrhaging
-
if >88s
-
HIGH risk hemorrhaging
- only do ADL/safety check
-
HIGH risk hemorrhaging
24
Q
Labs: MD det’d Therapeutic lvl
aPTT
activated partial thromboplastin time for Heparin
A
- norm== 20-35
- anticoag. therap. lvl== 2.25x normal
- 60-110s
-
if >110s
- INCd risk hemorrhaging
- NO agreed aPTT apon lvl for high risk hemorrhaging
25
Labs: MD det'd Therapeutic lvl
## Footnote
**INR**
**International Ratio**
* for Warfarin (coumadin)
* Normal== 1
* anticoag. therapeutic lvl: 2-3.5
* **if \>3.6**
* **INCd risk hemorrhaging**
* **if \>5**
* **HIGH risk hemorrhaging**
26
Labs: MD det'd Therapeutic lvls
**Plt**
**platelets**
Normal: 150,000-400,000/mm3
27
EARLY ambulation in mgmt of PE, DVT, both
early amb associated w/
* LOWER incidence of new PE
* LESS progress of dx'd DVT
* DECd mortality
28
Phys act in pts w/ DVT
* early walking exercise:
* is safe w/ acute DVT
* reduces acute sx's AND chronic sx's
* help to prevent/improve postthrombotic syndrome
29
LE DVT
once meds therapeutic lvls or accept. time pd been reached post admin......
Mobilization should begin!!!
* although risks assoc'd w/ mobilization....
* **risk of INACTIVITY is greater!!!!**
30
Vasomotor disorders:
## Footnote
**Raynaud's Syndrome====**
VASOSPASMS
* **Pathophys:**
* ****vasospasm of vessel's in pts digits **aggravated by cold temps------DEC vascular supply**
* **Causes:**
* ****unknown
* women
* **sequelae**
* **remains static**
* **Dx Tests**
* ****descript of sx's
* **Sx's**
* ****white/cyanotic digits in cold
* Hyperemia when initially return to warm temps/recirculation
* **Tx**
* ****wear gloves
* aquatic tx
* warm pools
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