Cardio 3 6

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Author:
jld15
ID:
305722
Filename:
Cardio 3 6
Updated:
2015-07-26 12:45:04
Tags:
Cardio
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Description:
Cardio 3 6
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  1. Arterial wound Location
    • almost always LE
    • ---Toes (dorsal and distal)
    • ---Interdigital space
    • ---Near lateral malleolus
    • ---Anterior lower leg
  2. Arterial Wound presentation:
    • Shallow; gradually increase in size and depth
    • Viable tissue is pale or gray
    • Necrotic tissue is black; gangrene may be present
    • Minimal drainage; minimal bleeding due to poor circulation
    • dressing need to hydrate the wound
  3. Arterial Tests and Measures
    • Pulse Exam & Cap Refill
    • Rubor of Dependency
    • Venous Filling Time
    • Claudication Time
    • Doppler Ultrasound
    • Ankle-Brachial Index (Myers, Table 10-2)
    • ---ABI = ankle  brachial pressure
    • Transcutaneous Oxygen Measurement (tcpO2 < 30mmHg unlikely to heal)
  4. Rubor of Dependency
    • Assesses adequacy of flow in LE’s
    • **Evaluates color changes
    • Test position: supine, leg elevated to 60° x 1 minute, leg lowered into dependency
    • Normal = no significant change in color
    • Abnormal = pallor with elevation or reactive hyperemia with dependency
  5. Rubor of Dependency Results
    • Normal = little or no change with elevation; normal pink color within 15-20 seconds of dependency
    • Mild insufficiency = pallor after 45-60 seconds of elevation; some reactive hyperemia with dependency
    • Moderate insufficiency = pallor after 30-45 seconds of elevation; some reactive hyperemia with dependency
    • Severe insufficiency = pallor within 25 seconds of elevation; dependent rubor
  6. Venous Filling Time
    • Indication of arterial system patency
    • Prolonged time = arterial insufficiency; immediate: venous insufficiency
    • Test position: supine, leg elevated to 60° x 1 minute, leg lowered into dependency
    • Assess time for superficial veins to refill
    • ---Normal = 5-15 seconds
    • ---Abnormal = > 20 seconds
  7. Claudication Time
    • Muscular distress caused by ischemia
    • Objectify test
    • ---Walk on treadmill at 1 mile/hour on level grade
    • ---Note time to claudication pain
  8. **Doppler Ultrasound
    • Audible test for arterial pulses
    • Measure segmental pressures
    • Systolic pressures LE  UE = ABI
    • 0.9 – 1.1 = normal
    • 0.7 - 0.9 = mild to mod arterial insuff.
    • 0.5 - 0.7 = mod arterial insuff., may need limb revascularization
    • < 0.5 = severe arterial insuff., rest pain, limb threatening
    • < 0.3 = rest pain & gangrene
  9. PT Interventions for Arterial Insufficiency
    • Patient/Client-related instruction
    • Wound care
    • Positioning
    • Aerobic Exercise
    • ROM
    • Physical Agents
  10. Arterial Patient related instruction
    • Reduction in risk factors
    • Limb protection & foot care guidelines
  11. Arterial Local wound care
    • Protect surrounding skin
    • *Maintain moist wound bed
    • Debride when appropriate
    • Use compression with caution
    • Gait and mobility training
    • No weight bearing on open wounds
    • Assistive devices for off-loading
    • Healing footwear
  12. Arterial Positioning
    Avoid flexion contractures
  13. Arterial Aerobic exercise
    Graded, gradual, carefully monitored program to increase collateral circulation
  14. Arterial ROM/flexibility exercise
    Avoid increased plantar pressures

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