Presentation on theme: "Which area of sterile protective clothing is not considered sterile even before coming in contact with a nonsterile object? a. front of gown above waist."— Presentation transcript:
1 Which area of sterile protective clothing is not considered sterile even before coming in contact with a nonsterile object?a. front of gown above waist levelb. front of gown below waist levelc. sleevesd. gloves
2 Arterial, Venous (and Lymphatic) Systems Their Significance in Chronic Lower Extremity Wounds
4 Pain occurring when an extremity is elevated indicates: Arterial diseaseVenous diseaseLymphatic disease
5 When describing the benefits of your exercise program to your patient (to educate and also to improve compliance), you tell her that regeneration of the affected part of her circulatory system is possible.Which part of the circulatory system would have been impaired for this to be true?
10 “. . .it is best to think of a wound not as a disease, but rather as a manifestation of disease.” Joe McCulloch
11 In order to manage wounds effectively, it is essential to appreciate the underlying cause.
12 A Brief Review of Structure and Function of Vascular Structures Part IA Brief Review of Structure and Function of Vascular Structures
13 Overview of 3 Circulatory Systems ArterialVenousLymphatic
14 Common Vessel Wall Layers or Coats (Tunics) Tunica intima - endothelial cells and basement membrane; uniformly smooth in all structures; (inner)Tunica media - smooth muscle and elastic tissue(middle)Tunica adventitia – collagen fibers plus blood vessels & nerves (outer)
15 Variations in Vessel Walls The common theme of the three layers varies widely, depending on type, size, and location of the artery, vein, or lymph vessel.
16 Arterial System Conveys oxygenated blood to tissues Responds to sympathetic and humoral stimuli that maintain blood pressureShunts blood from nonworking to working organsContains 30% of blood volume
17 Artery Characteristics Aorta to arterioleMedia: thick layers of muscular and elastic tissueDiameter responds to left ventricular pressureLie on flexor side of major joints
18 Arterial Pressure normal systolic pressure< 140 mm Hg arterial capillary pressure 25 mm Hghigh pressure/low volume system
21 Venous System Removes interstitial fluid from tissues Returns deoxygenated blood to right atriumContains 70% of blood volume
22 Vein Characteristics Large, medium, and small Superficial, deep, and perforating veinsValves in medium and large veins formed by folds in intimaTwo large, major veins usually accompany each major artery on flexor side of joints
23 Venous Pressure - wide variation (10-90 mm Hg) - low pressure/high volume- blood conveyed back to heart by:muscle pumprespiratory “pump” (vacuum?)valves
24 ? Questions ? What 3 “factors” return venous blood to the heart? Bonus: What is one more factor not included in this program?What forms venous valves?
27 Lymphatic Systemremoves interstitial fluid and large cells that cannot pass into capillary or venulehas immunologic and phagocytic functionscontrols tone of precapillary arterioles
28 Characteristics of Lymphatics Very thin wallsMany semilunar, paired valves in larger vesselsNo major direct link to artery or vein except the thoracic and right lymphatic ducts
29 Pressures in Lymphatics Very low pressureLymph moved centrally by valves*, negative pressure in chest, muscle pump (like veins)*Lymphangion: lymph vessel segments with valves at either end—a “lymph pump”
32 Capillary Bedcapillaries allow diffusion of O2 and nutrients to tissues, ANDCO2 and other waste products diffuse out of tissues, WHILE- Open-ended lymphatics move comparatively small amounts of fluid from the capillary bed, but handle large cells
33 Review: Equilibrium at the Capillary Bed Adequate Arterial SupplyFunctional Venous Return StructuresPatent Lymphatic StructuresNormal Interstitial “Space”
34 Vascular Diseases Producing Wounds in the Lower Extremity Part IIVascular Diseases Producing Wounds in the Lower Extremity
35 Classifications of Wounds in Lower Extremity ArterialVenousMixed
36 Basis for Wounds of Arterial Origin Arteriosclerosis – “hardening of arteries”-calcification of arteries of all sizes- loss of elasticity of arterial wallsAtherosclerosis – fibrous “plaque”- thickening of inner coat (intima)- fatty degeneration of middle layer (media)
37 Events Producing Wounds of Arterial Origin Diminished arterial flowThrombus or microembolus formationBlockage - most often at bifurcationsTissue hypoxia and cell death
38 Appearance of Limb in Arterial Disease – Trophic Changes Pale, cool skinAbnormal toenail growthHair absentMuscle atrophyEdema
44 Other Examples: Arterial Diabetes – hyperglycemia—”sticky blood” adds to development of atherosclerosisVasculitis – inflammation blocks blood flowSickle Cell Disease – clumps of misshapen red cells occlude small arteries
45 Thromboangiitis obliterans Also called Buerger’s DiseaseAffects adults under age 40*Veins also involvedUnlike arteriosclerosis obliterans, may affect handsPrimary cause: cigarette smoking!
54 Question ???True or FalseYour patient was once told that the reason she developed ulcers at the ankles was that the swelling in her legs prevented adequate oxygen from reaching the tissues.How would you respond?
55 Present Theory of Etiology of Venous Stasis Wounds High pressure causes extravasation of macromolecules (e.g. fibrinogen) and red blood cells into dermal interstitium.Degradation of these molecules and cells attracts leukocytes, macrophages, mast cells (inflammation).Inflammation leads to tissue injury (breakdown) and wound development.
64 Appearance of Limb in Venous Insufficiency (Late) Induration of subcutaneous tissueBrawny (brownish) discoloration: “Hemosiderin” iron-containing pigmentEdemaUlceration usually around medial malleolus
69 Tests for Deep Venous Thrombosis (DVT) - cuff test #- test for Homan’s sign #
70 Combined Pathologies Arterial and venous disease may coexist Venous disease can contribute to lymphatic dysfunction, and vice-versa
71 How is Lymphedema different from Edema? Edema: tissue fluid accumulated in the interstitial spaces secondary to many causesLymphedema: protein rich fluid that accumulates in the tissue secondary to lymphatic blockage
72 Lymphedema itself not usually associated with wounds A complete discussion of lymphedema will be addressed in the oncology section of this course.
73 Combined Pathologies Thorough examination Teamwork Patient education General rule: treat most threatening aspect first (usually arterial insufficiency)