Cardio 3 5

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jld15
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305721
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Cardio 3 5
Updated:
2015-07-26 12:41:35
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Cardio 3 5
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  1. Most common causes Vascular Wounds
    • Arterial insufficiency
    • Venous insufficiency
    • Diabetic/neuropathic
    • Pressure
  2. Less common causes vascular wounds
    • Connective tissue disorders (RA, SD, SLE)
    • Neoplastic disorders (SCC, BCC, lymphoma)
    • Hematologic disorders (sickle cell anemia)
    • Infections (bacterial, fungal)
    • Trauma (arterial or venous)
    • Acute embolism
    • Diabetes (microvascular disease)
    • Hypertension ( blood to peripheral vessels)
  3. Vascular and Neurologic Tests
    • pulse
    • cap refill
    • girth
    • cutaneous sensibility
  4. Pulse Exam (Myers, Table 4-9)
    • 0 = absent pulse
    • 1+ = diminished pulse
    • 2+ = normal pulse (easily felt)
    • 3+ = bounding, aneurysmal
  5. Capillary Refill
    time in seconds (normal < 3 sec)
  6. Girth
    • circumferential measurements
    • volumetric measurements
    • Cutaneous sensibility
    • monofilament testing: 5.07 seems Weinstein filament
  7. Peripheral Vascular Risk Factors
    • Genetic factors
    • --- lymphedema
    • --- varicose veins
    • Smoking
    • ---decreased blood flow to extremities
    • ---vasospasm
    • ---inhibition of prostacyclin formation
    • HTN
    • ---more prone to atherosclerosis
    • Hypercholesterolemia
    • ---more prone to atherosclerosis
    • Cardiac history
    • --- if have atheroscleroris in coronary arteries probably have it in peripheral too
    • DM
  8. Arteriosclerosis Obliterans
    • Primary cause of arterial insufficiency
    • **Thickening/hardening of arterial walls
    • Most common form is atherosclerosis
    • Degenerative disease that obstructs blood flow by narrowing arterial lumen
    • Collateral circulation is often inadequate
    • Intermittent claudication results
    • Lack of arterial blood flow leads to formation of arterial ulcers
  9. Atherosclerosis
    • Progresses with age
    • Risk factors include:
    • ---Smoking
    • ---Diabetes mellitus
    • ---Hyperlipidemia (elevated LDL)
    • ---Hypertension
    • ---Trauma
    • ---Advanced Age
  10. Thromboangitis Obliterans (Buerger’s Disease)
    • 2nd most common chronic occlusive vascular disease
    • **Occurs in young adults who smoke
    • Inflammation causes occlusion of both arteries and veins (distal vessels 1st)
    • Occlusion can cause tissue ischemia
    • **Signs and symptoms: cold sensitivity, ulcers, gangrene of UE and LE’s
    • stop smoking/ refer to smoking cessation program
  11. **Arterial Signs, Symptoms, and Dx
    • Pain!!!* (with cool or cold)
    • *Cool or cold distal extremities
    • *Weak or absent pulses
    • Intermittent claudication*
    • Ischemia and tissue necrosis *
    • *Trophic changes: color changes, slow nail growth, thickened nails, loss of hair, shiny, dry, and flaky skin
    • Dx: clinical presentation, ABI, Doppler
  12. Intermittent Claudication
    • One of the 1st signs of arterial insufficiency
    • Activity-related pain or discomfort (may be cramping or burning) caused by local ischemia
    • At rest, tissue demands for oxygen are met
    • Pain distal to site of arterial occlusion
    • Obstructed ileofemoral arteries  buttock, thigh, calf pain
    • Obstructed infrapopliteal arteries  foot pain
    • Pain abates within 1-5 minutes of rest
    • Pain is repeatable and predictable (OBJECTIFY!)
    • Treatment: is a walking: ex prescription walking 1 mile per an hour 3-4 times a day for 50ft (increase frequency, not duration/intensity)
  13. Ischemic Rest Pain
    • Pain due to lack of blood supply
    • Represents more advanced arterial disease than intermittent claudication
    • Described as “burning” pain
    • Exacerbated by elevation; relieved by dependency
    • Ulcerations usually occur at or beyond this point in the disease process
  14. Tissue Necrosis
    • Ulcerations related to ischemia
    • Most commonly result from some sort of trauma to an ischemic limb
    • May also result spontaneously from lack of arterial blood supply

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