Cardio 3 7

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Author:
jld15
ID:
305723
Filename:
Cardio 3 7
Updated:
2015-07-26 12:46:54
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Cardio
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Cardio 3 7
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  1. Arterial Physical agents
    Gentle warming and normothermic wound therapy
  2. ABI: no compression/ debriebment (become necrotic)
    0.7
  3. Arterial Precautions/Limb Protection
    • Protective environment/temperature
    • -----keep warm but not with electric blankets and hot packs bc could burn bc cant dissipate easily,
    • Cotton or lamb’s wool between toes
    • -----keeps toes from rubbing, prevent moisture btwn toes to prevent bacterial and fungal infections
    • Moisturizers daily
    • -----prevent cracking open
    • Debridement/ Compression with caution
    • Refer to MD in a timely manner
    • Avoid vigorous aerobic exercise
  4. Arterial wounds other
    • Inspect feet daily for signs of trauma, careful with new shoes
    • Wash and dry feet carefully
    • Trim nails straight across because when they are rounded will get ingrown more easily
    • With DM can go to the podiatrist to cut needs
    • Smooth socks with clean seam or without seams so don’t get pressure with
    • Take shoes that are easy to take on and off
    • Don’t wear constrictive clothing, wear loose clothing to prevent indentation to not constrict blood flow
    • Avoid un-necessary leg elevation
    • Protect feet and legs from chemicals
    • Corn and callus removers
    • Protect lower legs from heat and cold (hot packs, etc)
    • Wear heavy socks that are comfortable
    • Use a thermometer or use elbow to feel temp of water before getting into the bath tub
    • Don’t put pressure on open wounds
    • Exercise, eat balanced diet, smoking sensation, take medications, call doctor if you have a new wound
  5. Venous insufficiency Risk Factors
    • Trauma
    • Vein dysfunction or DVT
    • Calf muscle pump failure
    • Pregnancies
    • Genetic factors (family history)
    • Obesity
    • Clotting disorders
    • Advanced age
    • Diabetes
  6. Venous Insufficiency
    • Failure of valves to close completely  venous hypertension   risk of ulceration
    • Pathogenesis
    • ----Thrombosis
    • ----Obstruction
    • ----Dilatation or varicosity
    • ----Hemorrhage
  7. Theories: Etiology of Venous Insufficiency
    • Fibrin Cuff Theory:
    • ----venous hypertensionfibrinogen escapes
    • ----polymerization of fibrinogenfibrin deposition cuff is barrier to oxygen diffusion
    • Leukocyte Cell Trapping Theory:
    • ----margination of white blood cells
    • ----further impede circulation
    • ----activate inflammatory process
  8. **Clinical Classification of Venous Disease
    • 0 = no visible signs of disease
    • 1 = telangiectasias, ankle flare sign
    • 2 = varicose veins
    • 3 = edema without skin changes
    • 4 = skin changes: pigmentation, venous eczema, lipodermatosclerosis ( skin is hard and bumpy- elephant skin)
    • 5 = skin changes with healed ulceration
    • 6 = skin changes with active ulceration
  9. Venous Signs and Symptoms
    • Edema
    • ----Pitting
    • ----Indurated
    • Varicose veins
    • Pain
    • ----“Ache”; “heaviness”
    • ----**Increased with dependency; relieved with elevation
    • Cutaneous changes
    • ----Cellulitis common
    • ----Hemosiderin pigmentation
    • ----Lipodermatosclerosis
  10. Characteristics of Venous Wounds
    • Generally superficial; flat borders
    • Location: lower leg, located medially
    • Irregular shape
    • Granulation tissue with thin, yellow, fibrous coating
    • Heavy exudate
    • **Develop slowly and recur
    • Periwound edema and structural changes
    • ----Brawny edema, lipodermatosclerosis
  11. Peripheral Venous Circulation Tests
    • Homans’ Sign (assessment for DVT)
    • ----Use Wells Predictor and Doppler
    • Trendelenburg Test
    • Venous Filling Time
    • Doppler Ultrasound
    • ----Venous patency
    • ----Venous reflux
    • ABI (r/o coexisting arterial insufficiency)
  12. Homan’s Sign Assessment for DVT
    • Positive test suggestive of deep vein thrombosis
    • Squeeze gastroc while forcefully dorsiflexing the ankle with knee extended
  13. Trendelenburg Test
    • “Retrograde Filling Test”
    • Assesses valvular competence
    • Test position: supine, leg elevated to 45-60° x 1 minute, tourniquet to distal thigh, standing; watch vein distention
    • Veins should fill in ~ 30 seconds
    • Distention in < 20 seconds = deep or perforator vein incompetence
    • Tourniquet removed, distention in < 10 seconds = superficial incompetence
  14. Venous Filling Time
    • Supine; observe veins on dorsal foot
    • Elevate limb to 60° for 1 minute
    • Place limb dependent and observe time for superficial veins to fill
    • Normal 5-15 seconds
    • Immediate filling = venous insufficiency

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