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Arterial Physical agents
Gentle warming and normothermic wound therapy
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ABI: no compression/ debriebment (become necrotic)
0.7
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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
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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
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Venous insufficiency Risk Factors
- Trauma
- Vein dysfunction or DVT
- Calf muscle pump failure
- Pregnancies
- Genetic factors (family history)
- Obesity
- Clotting disorders
- Advanced age
- Diabetes
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Venous Insufficiency
- Failure of valves to close completely venous hypertension risk of ulceration
- Pathogenesis
- ----Thrombosis
- ----Obstruction
- ----Dilatation or varicosity
- ----Hemorrhage
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Theories: Etiology of Venous Insufficiency
- Fibrin Cuff Theory:
- ----venous hypertensionfibrinogen escapes
- ----polymerization of fibrinogenfibrin deposition cuff is barrier to oxygen diffusion
- Leukocyte Cell Trapping Theory:
- ----margination of white blood cells
- ----further impede circulation
- ----activate inflammatory process
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**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
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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
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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
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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)
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Homan’s Sign Assessment for DVT
- Positive test suggestive of deep vein thrombosis
- Squeeze gastroc while forcefully dorsiflexing the ankle with knee extended
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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
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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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