Cardiopulm - Peripheral Vascular Dysfunction

Arterial vascular disease includes

- Stenosis

- Aneurysm

- Dissection

Venous vascular disease includes

- Stasis/insufficiency

- Thromboembolism - DVT and PE

An aneurysm is

When part of an artery wall weakens, allowing it to balloon out or widen abnormally

Aneurysm most notably occur in the

- Brain

- Heart

- Thoracic aorta

- Abdominal aorta

A dissection is

A tear in intima layer that allows blood to leak through, separating inner and middle layers

S/s of a dissecting aneurysm includes

- Sudden severe chest or upper back pain

- Sudden severe stomach pain

- Syncope

- SOB

- Sudden vision problems

- Difficulty speaking

- Weakness or hemiparesis

- Unilateral weak pulse in one arm of thigh

PAD is

A narrowing or occlusion of arteries outside of the heart

PAD causes reduced

Blood flow to the extremities and viscera

What is the primary cause of PAD

Atherosclerosis

If atherosclerosis is gradual then _ may develop

Collateral circulation

Risk factors for PAD includes

- Smoking

- HTN

- Hyperlipidemia

- Obesity

- Diabetes

- Older age

- CAD

PAD typically presents with

- Intermittent claudication

- Limb pain or cramping with exercise

- Burning or aching at rest

- Ulcers/sores/wounds that heal slowly

- Coldness in affected extremity

- Pale or cyanotic

- Possible numbness

- Weak or absent pulse

Level 1 on the claudication scale indicates

Initial discomfort (established but minimal)

Level 2 on the claudication scale indicates

Moderate discomfort but attention can be diverted

Level 3 on the claudication scale indicates

Intense pain (attention cannot be diverted)

Level 4 on the claudication scale indicates

Excruciating and unbearable pain

Neurogenic pain is _ whereas vascular pain is _

Postural dependent; Demand dependent (how hard you are working)

Acute limb ischemia is

A sudden decrease in limb perfusion, potentially threatening limb viability

Acute limb ischemia is caused by

Embolism or thrombosis

S/s of acute limb ischemia includes

- Pain

- Pallor

- Paresthesia

- Coldness

- Pulselessness

- Paralysis

Critical limb ischemia developed

Slowly; chronic

Critical limb ischemia s/s includes

- Pain at rest with elevation

- Arterial insufficiency ulcers

- Gangrene

Critical limb ischemia can lead to

- Osteomyelitis

- Stroke

- MI

What are general chief complaints of PAD

- Pain (claudication)

- Poor/non healing wound

- Decreased exercise/activity tolerance

- Impaired peripheral circulation

- Impaired muscle function/strength

- Impaired aerobic capacity

- Impaired respiration/gas exchange

The vascular exam consists of

Inspection and palpation

Arterial skin changes includes

- Shiny, tight, dry, hairless skin

- Thickened toenails

- Cold to the touch

- Pallor, pale, or blueish and worse with elevation

- Ulcers

- Rubor of dependency

Dorsalis pedis pulse is found

On the dorsum of the foot lateral to the EHL

The post tibial pulse is found

Behind the medial malleolus

A 4+ pulse is

Bounding

A 3+ pulse is

Increased

A 2+ pulse is

Normal

A 1+ pulse is

Diminished

A 0 pulse is

Absent and unable to be palpated

How do you test for capillary refill

Compress the nail bed until blanched and wait for flesh to recolor

Normal capillary refill time is

3-5 seconds

A prolonged capillary refill time indicates

Arterial insufficiency

Rubor of dependency assesses for

Arterial insufficiency

In rubor of dependency, there is change in color with

Position

In rubor of dependency you should see _ with elevation and _ in a dependent position

Pallor; Deep red color within 20-30 seconds

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