Week 2 Arterial Insufficiency

Question 1

what is AI and what is an example

Answer 1

decreased arterial blood flow either by arteriosclerosis (thickening and hardening) or atherosclerosis (lumen is encroached by fatty walls)

Question 2

what is intermittent claudication

Answer 2

activity specific discomfort, that goes away within 1-5 minutes of stopping activity. you can repeat this and reproduce this

Question 3

how can you differentiate intermittent claudication with spinal stenosis

Answer 3

AI: s/s relief with cessation of activity, and predictable with the same level of activity
SS: s/s relief with change of position

Question 4

what is the etiology of the AI

Answer 4

ischemic rest pain, and burning when the leg is elevated, and relieved with dependency , ischemic ulcers and even gangrene

Question 5

what are some potential risk factors

Answer 5

hyperlipidemia

hypertriglyceridemia, smoking, DM, HTN, Trauma (shoes, bites bump injury, burn, MVA), age, PAD, obesity

Question 6

what does smoking cessation do to circulation and CAD risk

Answer 6

circulation improves within 4 weeks, and CAD risk decreases by 1/2 in 1 year.

Question 7

how does normal DM affect AI

Answer 7

you may not feel the pain associated with AI because of neuropathy

Question 8

AI: how does the skin look

Answer 8

dry, withered, shiny, taut, thin

Question 9

how is the skin temp with AI

Answer 9

cooler

Question 10

Hair?

Answer 10

no

Question 11

how does the limb surrounding look

Answer 11

pale and dusky, with pallor with elevation and rubor with dependency

Question 12

AI and sensation?

Answer 12

decreased

Question 13

muscles and AI

Answer 13

atrophy, and weakness, and claw toes from weak intrinsics

Question 14

nails and AI:

Answer 14

brittle and yellow, hard and thick

Question 15

do you have edema with AI

Answer 15

not usually

Question 16

what are the 6 tests you can do with your clinical vascular exam

Answer 16

palpation for temp and pulses 
capillary refill
rubor of dependency 
claudication time 
ABI
venous filling rate

Question 17

what is the pain pattern associated with AI

Answer 17

increased with elevation, and exertion (walking)
numb, tingling, cold ache with exertion 
worse at night 
wakes with pain 
needs rests when walking

Question 18

what is increasing pain indicative of

Answer 18

capsular consult, and meds, education, lifestyle modifications, revascularization.

Question 19

what are two factors that might lead to amputation

Answer 19

uncontrolled pain and poor QOL

Question 20

TF: in neuropathy with DM, you will always get pain

Answer 20

false the neuropathy can mask it

Question 21

where are AI wounds usually found

Answer 21

below the ankle, not he foot, heel, met heads, tips of the toes and in bunion areas. sometimes superior to the lateral malleolus or on the anterior leg

Question 22

what is the presentation of an AI wound

Answer 22

shallow then deep
punched out look
usually round

Question 23

drainage of an AI wound

Answer 23

minimal to none, usually dry and hard

Question 24

what is the tissue like in an AI wound

Answer 24

black or brown eschar

pale granulation tissue or a mix

Question 25

dry gangrene (drainage, odor, demarcation)

Answer 25

mummification, and no drainage, and hard, little to no odor and clear demarcation

Question 26

what is the wet gangrene like (drainage, odor, demarcation)

Answer 26

drainage, odor, flactuance/edema, erythema, less clear demarcation

Question 27

what do you do for dry gangrene

Answer 27

protect and off load and monitor for conversion to wet and wait for it to auto amputate

Question 28

what do you do for wet gangrene

Answer 28

urgent referral and vascular surgeon.

Question 29

what do you do if you think they have AI

Answer 29

• MD refer for vascular testing, and cardiac workup
• PT education about the disease and self care
• safe, graded exercise

Question 30

what kinds of things do you teach the patient about self care

Answer 30

• skin care and protection (checking shoes, keeping them warm)
• hot water bottle at the groin for gentle warming (warmth vasodilator and can bring blood in)
• behavior modification (smoking, diet, exercise, meds)
• sleep (positioning)
• wound management (protection, off-loading and care)