Venous Disorders - PVD Flashcards
(92 cards)
1
Q
What are the risk factors for venous disorders?
A
- hx of blood clots
- family hx
- obesity
- pregnant
- prolonged standing
- hx of ankle injury or immobility
- trauma, illness, surgery
- lifestyle
2
Q
What is the clincal presentation of venous disorders?
A
- edema generally in LE’s
- fatigue
- heaviness feeling in LE’s
- hemosiderin staining
- warm on palpation
- ulcers/wounds are common (above ankle)
- frequent infections
3
Q
Varicose Veins
What is the cause?
A
dulated tortuous superficial veins
- the most common are the saphenous and tributaries
- possibilty of hemorrhoids
4
Q
Varicose veins
Intrinsic weakness of the vessel walls will lead to?
A
- increased intralumal pressure
- congenital weakness
5
Q
Varicose veins
What are the risk factors?
A
- females more likely
- pregnant
- obese
- family hx
- prolonged standing
- hx of infection
6
Q
Varicose veins
What are the sx?
A
- heaviness
- dull ache
- bulging veins
- local hematomas (small venuoles rupture)
7
Q
Varicose veins
Stage 1
A
Reticular veins or spider veins
8
Q
Varicose veins
Stage 2
A
Vericose veins or venous nodules
9
Q
Varicose veins
stage 3
A
edema of lower leg
10
Q
Varicose veins
Stage 4
A
varicose eczema or trophic ulcer
11
Q
Varicose veins
What are the management strategies?
A
- conservative
- sclerotherapy (local iv shot)
- endovenous thermal ablation (bring heat to obliterate varicous saph veins)
- surgical
12
Q
Varicose veins
What are the conservative management techniques?
A
- compression hose
- feet elevation
- edema managemenet
- avoid prolonged standing
13
Q
VTE
What are the different categories?
A
DVT - blood clot found in deep vein of UE or LE
PE - blood clot that traveled to the lung
14
Q
VTE
What is used to calculate the probability of VTE?
A
clinical preduction rule and based on risk factors and physical findings
- helps to predict the next steps in medical testing to rile in/out DVT/PE
15
Q
VTE Pathogenesis
What is apart of the virchow’s triad?
A
venous stasis
vascular injury
hypercoagulability
16
Q
VTE Pathogenesis
What is secondary hemostasis?
A
a trigger of the coagulation cascade
- a series of steps in response to a bleed which is caused by tissue injury
- stays active for 5-6 weeks
17
Q
VTE Pathogenesis
Where do VTE’s usually occur?
A
where there’s areas of decreased or mechanically altered blood flow
- VTE can develop weeks after D/C
18
Q
DVT
What are the risk factors?
A
- post-op
- obesity
- pregnant and post-partum period
- heart failure or respiratory fail
- tobacco use
- oral contraceptives
- cancer and chemo
- prolonged travel
- trauma
- diabetes, HTN, CVA, SCI
- varicose veins
- increased age
- UE DVT = CVC, PICC lines and pacemakers
19
Q
DVT
What are the signs and sx?
A
- unilateral edema
- tenderness and pain in the leg
- warmth and erythema
- low-grade fever
- cognitive changes in elderly
20
Q
DVT
Where does it usually occur?
A
Most common in veins of the calves but can happen in the popliteal, femoral or iliac
21
Q
DVT
Who are most commonly affected by DVT?
A
women are more likely to develop especially in pregnancy and early post-partum
22
Q
DVT
What are some diagnosis tools?
A
- serum d-Dimer (measuring fibrin)
- doppler US
- MRI
- contrast venography
23
Q
DVT
What is the score interpretation of Wells Clinical Prediction Rule?
A
greater than 3 = high risk
1-2 = mod risk
lower than 1 = low risk
24
Q
DVT
What is the simplified score interpretation for the Well’s Criteria score?
A
DVT likely = 2 or more points
DVT unlikely = less than 2 points
25
# DVT
What is the clinical features needed for DVT?
- venous materail in subclavian or jugular vein
- localized arm pain
- unilateral pitting edema
- alternative diagnosis
26
# DVT
What should not be relied upon?
Homan's sign
- treat or refer based on the probability of DVT
27
# DVT
What are the treatment indications?
- compression stockings
- anti-coagulation
- 1st DVT dx (usually on rx for 3 mos)
- if can't anti-coagulate patient then IVC filter is considered
28
# DVT
When should you check with the medical team?
if the patient is not on anticoagulants and has a known DVT and does not have an IVC filter
29
# DVT
if on warfarin, what is normal INR levels?
less than 1.1 in healthy normal NOT on warfarin
30
# DVT
if on warfarin, what is the INR levels of therapeutic range?
2-4 therapeutic range when ON warfarin
31
# DVT
When on warfarin, what is the INR levels for risk of hemorrhage?
greater than 4.5
32
# DVT
When on warfarin, what is the INR levels for increased risk of clot?
less than 2
33
# DVT
What is recommended to avoid eating?
* large amounts of green leafy vegetables with vitamin K
* green tea
* cranberry juice
* alcohol
34
# DVT
What is the guideline for unfractionated heparin?
< 24 hours: no mobility
24-48 hours: consult medical team
.>48 hours: mobilize
35
# DVT
What is the guideline for heparin?
< 3 hours: no mobility
3-5 hours: check with physician
.> 5 hours: mobilize
36
# DVT
What is the purpose of an IVC filter?
placed in the inferior vena cava above the level of diagnosed clot
- to help prevent DVT from going to the lungs
37
# VTE
What score is indicative for a high risk of VTE on the Padua Prediction Score?
greater than or equal to 4
38
What is the khorana risk score?
low risk = 0 points
intermediate risk = 1-2 points
high risk = > 3 points
39
what is the score needed to stop anticoagulation?
If the HASBLED score is greater than or equal to 4
40
# HAS-BLED
Condition for H
Hypertension
- uncontrolled
- greater than 160 mmHg
41
# HAS-BLED
Condition for A
abnormal **renal** function: dialysis, transplant, Cr > 2.26 mg/dL or > 200 umol/L
abnormal **liver** function: cirrhosis or bilirubin > 2 x normal or AST/ALT/AP > 3 x normal
42
# HAS-BLED
Condition for S
prior hx of stroke
43
# HAS-BLED
Condition for B
Bleeding
- prior major bleeding or predisposition to bleeding
44
# HAS-BLED
Condition for L
Labile INR (unstable/high INR)
- time in therapeutic range < 60%
45
# HAS-BLED
Condition for E
Elderly
- age 65 and older
46
# HAS-BLED
Condition for D
Drug or alchol usage hx (greater 8 drinks/wk)
medication usage predisposing to bleeding
47
# Post thrombotic syndrome
What is the prevalence of development?
- develops in 20-50% with an LE DVT even with anticoagulation
- 8-28% UE DVT
48
# Post thrombotic syndrome
What is the cause?
permanent damage to the valves of the veins and reflex of the blood in the venous system
49
# Post thrombotic syndrome
What does it lead to?
leads to venous hypertension = reduces muscle perfusion which increases tissue permeability
50
# Post thrombotic syndrome
What are the signs and sx?
- chronic aching arm or leg pain
- intractable edema
- limb heabiness
- leg ulcers
- skin changes
- heaviness of the limb affected by DVT
51
# Post thrombotic syndrome
What is disease associated with?
high morbidity and lower QoL
52
# Pulmonary embolism
What is a PE?
clot, most often from DVT
- it breaks off then dislodges and travels through the vena cava
- right heart to the lungs and lodges in a part of the pulmonary vasculature
53
# Pulmonary embolism
What is the prevalence?
common, especially after surgery and trauma prolonged immobility
- can be fatal (40% fatality rate if left untreated)
54
# Pulmonary embolism
What is the presentation?
- dyspnea
- pleutritic chest pain
- hemoptysis
- cough
- syncope
- tachypnea
55
# Pulmonary embolism
How is it diagnosed?
same as for DVT but also EKG, CTA, v/q scans
56
# Pulmonary embolism
How is it treated?
anticoagulation and thrombolytic therapy
57
# Pulmonary embolism
What is the risk score interpretation for Wells Clinical Prediction Rule?
high risk: > 6
mod risk: 2-6
low risk: < 2
58
What does chronic valve incompetence or venous obstruction leads to?
to extravasion (leaking) of edema into surrounding tissues
59
What is chronic venous insufficiency?
associated with variscose veins, edema, skin inflammations and hyperpigementations and ulcerations
60
# Chronic venous insufficiency
What are the treatments?
* Treating the edema
* diuretics
* antibiotics (when infection is present)
* compression
* dressing changes
61
# Chronic venous insufficiency
What do most chronic wounds most likely lead to?
lead to an amputation
- one of the most difficult to treat
62
# Chronic venous insufficiency
What are some of the types of compression?
bandage pressure
spiral wrap of LE (50% overlap provides 2 layers)
figure 8 (50% overlap provides 4 layers)
compression garments
63
# Chronic venous insufficiency
What are the options for compression garments?
- graded compression stockings
- Unna boot (zinc oxide paste and gauze boots)
- multilayer bandaging
64
What do we take into account for venous insufficiency hx?
- can report chronic edema issues
- slow healing
- h/o infections
- h/o varicose veins
65
What do we take into account for arterial insufficiency hx?
- aching or cramping of distal limbs
- poor wound healing
- limited mobility
66
What are the special tests for vascular examination?
- capillary refill time
- ABI
- venous filling time / rubor of dependency test
- intermittent claudication test
- Wells' clinical prediction rules
- DVT clinical practive guidelines
- response to exercise
67
# Difference in vascular wounds
Skin characteristics - arterial
- shiny
- dry
- cool/cold
- loss of hair
- rubor with dependent positioning
- pallor in elevation
68
# Difference in vascular wounds
Skin characteristics - venous
* warm
* pigmentation
* mottling
* thickened
* rough skin
* changes in appearance of skin after wound healing
69
# Difference in vascular wounds
Pain - arterial
positive for pain due to ischemia
70
# Difference in vascular wounds
pain - venous
wounds generally minimally painful
71
# Difference in vascular wounds
Exudate - arterial
Not observable, dry
72
# Difference in vascular wounds
Exudate - venous
commonly seen, oozing
73
# Difference in vascular wounds
Pulses - arterial
can be absent or dimished
74
# Difference in vascular wounds
Pulses - venous
normal
75
# Difference in vascular wounds
Common sites - arterial
toes, feet, distal to malleoli
76
# Difference in vascular wounds
Common sites - venous
above malleoli, distal 1/3 lower leg
77
# Difference in vascular wounds
Wound characteristics - arterial
- small
- defined borders
- punched out
- deep
- tunneling
- dry
- necrotic tissue
78
# Difference in vascular wounds
Wound characteristics - venous
- uneven borders
- shallow
- drainage
- can be large
79
# Cellulitis
What is cellulitis?
bacterial (staphylococcus aureus or streptococcus) skin infection of dermis or subcutaneous tissue
- breaks in skin, splinters, bug bites, incisions, IV sites
- not a vascular disorder but can be confused for a developing venous wound
80
# Cellulitis
What are the sx?
- red area of the skin that tends to expand
- swelling
- tenderness
- pain
- warmth
- occasional open wounds
- fever
- red spots
- blisters
- skin dimpling
81
# Cellulitis
What are the treatment?
* long term antibiotics
* wound care
* reduction of edema
82
# Cellulitis
What can it progress to?
osteomyelitis - infection of the bone
83
# Raynaud's Disease
What is Raynaud's disease?
Intermittently affects small arteries and arterioles = decreased blood supply to distal extremity
84
# Raynaud's Disease
What are the sx?
- 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)
85
# Raynaud's Disease
What are the causes?
1. Atherosclerosis
2. drugs that cause narrowing of the arteries
3. certain autoimmune conditions
4. smoking
5. repeated injury or usage
86
# Raynaud's Disease
What are the treatments?
1. no smoking
2. avoid caffeine
3. avoid medications that cause tightening of the blood vessels
4. keep the body warm, stop going to the cold, wearing mittens or warmers
5. wear comfortable, roomy shoes and wool socks
87
# Buerger's Disease
What is burger disease?
| I mean Buerger's Disease
inflammation and thrombosis of small and medium sized veins and arteries
- onset is distal to proximal in extremities
88
# Buerger's Disease
What is the cause?
unknown but possibly smoking
89
# Buerger's Disease
What is the prevalence?
common in males aged 20-40s
90
# Buerger's Disease
What are the sx?
- temp 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 LEs
91
# Buerger's Disease
What are the treatments?
* no cure for disorder
* stop smoking
* pain management
* improve circulation thru surgery that restores blood flow
92
