Cardio 3 8

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Author:
jld15
ID:
305727
Filename:
Cardio 3 8
Updated:
2015-07-26 12:55:08
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Cardio
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Cardio 3 8
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  1. Doppler Ultrasound
    • Measures relative velocity of blood flow in a vessel; gold standard
    • Augmentation test
    • ----Probe placed over proximal vein
    • ----Intermittent pressure applied over distal leg
    • ----Increased intensity of signal = normal
    • Reflux test
    • ----Probe placed over distal vein
    • ----Intermittent pressure applied over proximal leg
    • ----No increase in signal = normal
  2. PT interventions for Venous Insufficiency
    • Patient-related instruction
    • Whirlpool
    • Integumentary repairs
    • ROM
    • Aerobic Exercise
    • Gait and Mobility Training
  3. Venous ROM, Aerobic, Gait and Mobility Training
    • Maximize ankle DF range
    • Active ankle pumps or heel raises
    • Weight loss and glucose control
    • Enhance overall health and well-being
  4. Venous Patient related instruction
    • compression/edema control
    • Risk factors for ulcer recurrence (up to 81%)
    • Protection of lower extremities
    • Active ankle pumps to increase calf muscle pump
  5. Venous Precautions
    • Arterial disease (Use of compression with caution)
    • Sensitization and allergic reaction
  6. Venous Whirlpool
    • Dependency exacerbates edema and venous hypertension
    • Over-hydration of highly-exudating wounds
    • If necessary, limit time and temperature!
  7. Venous Integumentary Repair Techniques
    • Protect surrounding skin
    • Choose dressings that absorb drainage: Ca alginate
    • Manage edema and venous return with compression
    • Debride as necessary
    • Monitor for signs of infection
    • Educate patient/caregivers
  8. Venous Physical Agents: Compression
    • Enhances calf muscle pump
    • Improves venous return
    • Decreases peripheral edema
    • Reduces venous distention
    • Increases tissue oxygenation
    • Softens tissue
    • Protects limb from trauma
    • Allows for increased activity level
  9. Compression Guidelines Contraindications:
    • ABI < 0.7
    • Acute infection
    • Pulmonary edema
    • Severe CHF
    • Active DVT
    • Compression must exceed venous intralumen pressure (at least 30-40 mmHg at ankle)
  10. Methods of Compression
    • Paste bandages
    • Short stretcb wraps
    • Multi layer compression bandage
    • tubular bandage
    • compression garments
    • -----Decrease risk of ulcer recurrence
    • -----Custom or off-the-shelf garments
    • vasopneumatic compression
  11. Paste bandages
    • e.g. Unna’s Boot
    • non-elastic bandage
    • assists calf muscle pump with ambulation
    • **unable to accommodate changes in size
  12. Short-stretch wraps
    • elastic and non-elastic qualities
    • LaPlace’s Law
    • incorrect technique may lead to ischemia
  13. Multi-layer compression bandage systems
    • First layer absorbs wound drainage and pads
    • Second layer absorbs wound drainage
    • Third layer provides compression
    • Fourth layer provides compression
    • Graduated compression
    • Maintain compression longest
    • The bandage system is $150 works well but is expensive
    • Once the leg is a normal size and wound is healed control edema with compression stockin
  14. Vasopneumatic compression
    • Consists of sleeve and pump
    • Pump fills with air, compressing leg
    • Multi-chamber have been shown to enhance venous ulcer healing
    • Use 1-2 sessions per day, 1-2 hrs
    • High cost, Low compliance

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