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:
1Which 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
2Arterial, Venous (and Lymphatic) Systems Their Significance in Chronic Lower Extremity Wounds
4Pain occurring when an extremity is elevated indicates: Arterial diseaseVenous diseaseLymphatic disease
5When 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?
21Venous System Removes interstitial fluid from tissues Returns deoxygenated blood to right atriumContains 70% of blood volume
22Vein 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
23Venous 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?
27Lymphatic Systemremoves interstitial fluid and large cells that cannot pass into capillary or venulehas immunologic and phagocytic functionscontrols tone of precapillary arterioles
28Characteristics 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
29Pressures 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”
32Capillary 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
33Review: Equilibrium at the Capillary Bed Adequate Arterial SupplyFunctional Venous Return StructuresPatent Lymphatic StructuresNormal Interstitial “Space”
34Vascular Diseases Producing Wounds in the Lower Extremity Part IIVascular Diseases Producing Wounds in the Lower Extremity
35Classifications of Wounds in Lower Extremity ArterialVenousMixed
36Basis 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)
37Events Producing Wounds of Arterial Origin Diminished arterial flowThrombus or microembolus formationBlockage - most often at bifurcationsTissue hypoxia and cell death
38Appearance of Limb in Arterial Disease – Trophic Changes Pale, cool skinAbnormal toenail growthHair absentMuscle atrophyEdema
44Other 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
45Thromboangiitis obliterans Also called Buerger’s DiseaseAffects adults under age 40*Veins also involvedUnlike arteriosclerosis obliterans, may affect handsPrimary cause: cigarette smoking!
54Question ???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?
55Present 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.
64Appearance of Limb in Venous Insufficiency (Late) Induration of subcutaneous tissueBrawny (brownish) discoloration: “Hemosiderin” iron-containing pigmentEdemaUlceration usually around medial malleolus
69Tests for Deep Venous Thrombosis (DVT) - cuff test #- test for Homan’s sign #
70Combined Pathologies Arterial and venous disease may coexist Venous disease can contribute to lymphatic dysfunction, and vice-versa
71How 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
72Lymphedema itself not usually associated with wounds A complete discussion of lymphedema will be addressed in the oncology section of this course.
73Combined Pathologies Thorough examination Teamwork Patient education General rule: treat most threatening aspect first (usually arterial insufficiency)