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24 Cards in this Set
- Front
- Back
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Lymphatic obstruction
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Lymphatics pick up large proteins, if they become obstructed you will see local edema
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Primary causes of Lymphedema
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-Congenital
-Lymphedema praecox -Lymphedema tarda |
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Secondary causes of Lymphedema
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-Recurrent lymphangitis
-Filariasis -TB -Neoplasm -Sx or trauma -Radiation Tx |
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IJV pulsations
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Biphasis
Descend with inspiration |
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Best bedside test for volume status...
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JVP N <4.5cm
also assesses R atrial fnx |
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Color changes associated with Arterial disease
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Chronic:
-pallor when leg elevated (>10sec cap refill then dependent rubor) Acute: -leg/foot pale all the time |
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Color changes associated with Venous disease
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Chronic
-Hyperpigmented, brown Acute -Erythemic |
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Color changes in Lymphatic disease
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No discoloration or ulceration unless lymphangitis/cellulitis (infection)
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Skin changes in Arterial disease
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-Painful toe, heel, & fingertips ulcers that are painful, 'punched out', full thickness w/ pale or necrotic base +/- gangrene
Acute +++ PN Chronic - PN (nerve damage) |
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Skin changes in Venous disease
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-Initially less painful ulcers on the malleoli with superficial, irregular margins w/ a granulomatous base, cobblestone/hyperpigmentationof surrounding skin
Acute + PN Chronic ++ PN |
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Skin changes in Diabetic Neuropathy
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-Painless, 'punched out' ulcers
-Plantar or lateral surface |
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Superficial vs Deep Venous Insufficiency
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Superficial=Varicose veins +/- edema
Deep=Edema |
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When will you see pitting edema?
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-valvular insufficiency
-low protein/fluid ratio in CHF & hypoalbuminemia (in liver dz) |
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When will you see non-pitting edema?
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-higher protein/fluid ratio in advanced lymphedema & inflammation
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Grading Pitting Edema
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1+ mild, pitting to 2mm
2+ mild to moderate, pitting to 4mm 3+ moderate to severe, pitting to 6mm 4+ severe, pitting to 8mm |
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What are the most common aneurysm sites?
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Aortic & Popliteal
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Where do I palpate the Dorsalis Pedis Pulse?
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Dorsom of foot lateral to extensor tendon....if needed, explore more laterally
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Allen test for Arterial patency
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Used to evaluate claudication, preop CABG or dialysis fistula
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Ankle Brachial Index (ABI)
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Used to evaluate suspected PAD or acute arterial insufficiency
-Test: ratio of ankle systolic BP to brachial systolic BP -place BP cuff just above ankle -use doppler probe instead of stethoscope -assess in both legs -take highest BP of arm over highest BP in each ankle *Ratio of <0.9 in non-DM is specific for PAD |
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Assessing for Varicose veins....
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Varicose veins can be mapped by transmitting pressure waves along them. Compress a vein and feel for pressure wave transmitted to fingers of other hand. Palpable wave indicates two parts of vein are connected. Waves are transmitted up more easily.
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Assess for pitting edema
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Press firmly with thumb for 5 seconds over:
-Dorsum of each foot -Behind each medial malleolus -Over shins. |
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Assessment for arterial occlusion & insufficiency: Postural change....
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-Raise both legs to 60 degrees until maximal pallor of feet develops (about a minute)
-Ask patient to sit up with legs dangling down -Compare feet, noting time required for: 1) return of pinkness to skin (<10 sec) 2) filling of the veins of the feet and ankles (15 sec) |
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Dependent rubor means....
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Arterial insufficiency
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Assessment for venous occlusion & insufficiency: Trendelenburg test....
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Retrograde filling test
1) Pt is supine 2) Elevate one leg to 90 degrees to empty it of venous blood 3) Occlude great saphenous vein in upper thigh via manual compression 4) Patient stands, keeping vein occluded 5) Watch for filling; normally it fills from below (35 sec) 6) After 20 sec, release compression and look for additional filling 7) If + additional filling: valves are incompetent *High rate of false + |
