Peripheral Venous Disorders Most venous occurs in legs  some degree of failure to venous blood flowing  proper direction  Settle in leg veins = Venous Congestion Factors- gravity winning= being on feet too long  Valve imcompetance- disorder of venous insufficeincy CHRONIC VENOUS INSUFFIENCY (CVI) INCOMPETENT VENOUS VALVES PATHO: CAUSED BY LEG VEIN VALVES WEARING OUT  BECOMING FLOPPY  DON’T CLOSE DURING DISTOLE (RALAXATION)  BACKFLOW= LEGS & FEET (VENOUS CONGESTION)  NON MOVING BLOOD= VENOUS STASIS  ↑HYDROSTATIC PRESSURE  EDEMA (MILD/MODERATE DISCOMFORT OVERTIME = -DRY, TIGHT SKIN, BROWNISH DISCOLORATION)  EASILY BROKEN TISSUE  BONY PROMINECES - HEELS, ANKLES, COCCYX = VENOUS STASIS, ULCERS EX. HYPOOSMOLAR PROBLEMS, HTN, RT SIDE HF, KIDNEY DISEASE FACTORS: AGING, INHERITED PREDISPOSITION OBESITY, PREGNACY, JOB RELATED, POOR MUSCLE TONE, IMMOBILITY /INACTIVITY EX:(MINI MAP)= FLOPPY VALUES  HYDROSTATIC PRESSURE DISTAL TO BAD VALUES VENOUS CANNOT RETURN TO HEART  ENGORGED PERIPHERAL VEINS  PUSHES FLUID OUT TO TISSUE  EDEMA DVT (DEEP VENOUS THROMBOSIS) CLOT THAT DEVELOPS ON WALL VEINS (DEEP)  THIGH/CALVES  DVT ENTERS  AREA INFLAMMED/SWOLLEN = THROMBOPHLEBITIS S&S = LOCAL REDNESS  PAIN, WARMTH, EDEMA, UNILATERAL,ERYTHEMA  EXTREME HARDLY/ NO S&S HIGH RISK: VIRCHOWS TRIAD  INJURY TO ENDOTHEILUM  STASIS TO BACKFLOW OF CVI, INACTIVITY OF MUSCLES  HYPERCOAGULABILTY STATES  DEHYDRATION BLOOD MORE CONCENTRATED  COAGULOPATHY= CLOT EASILY - SITTING PEOPLE, CAST, BED RIDDEN, PREGNACY, OBESITY, MEDS(DIURETICS), BCP-HOROMONE THERAPY, PRE-EXISTING, SURGERY, CLOTTING PROBLEMS DVT  PE DVT LEG  IVC  RA  RV  PA  STICK IN PULMONARY ARTERIOLES S&S: CHEST PAIN, SOB, HEMOPTYSIS(BLOOD IN SPUTUM, SHOCK) EX: EMBOLUS ENTER PULM ARTERY  SMALL ARTERIOLES GET STUCK BLOCK DEOXGENATED BLOOD FROM ALVEOLI FROM OXGENATION  SOB IRRITATES ARTERIAL INTIMA  INFLAMMATIO  BLOOD LEAK IN LUNG TISSUE  HEMOPTYICS  LARGE PART LUNG INFLAMMED  MASSIVE RELEASE OF INFLAMM MEDIATORS  SYSTEMIC VASODILATION =>SHOCK TX: ENCOURAGE MOBILITY, ENCOURGE DEHYDRATION, ELEVATE LEGS/ INCREASE VENOUS RETUR  PROMOTES NORMAL FLOW, CAREFUL OF SKIN BREAST SWELLING/EDMA ↑RISK OF SKIN INTEGRITY, BLOOD THINNER (HEPARIN, COUMADIN)  ASPIRIN TO PREVENT CLOTTING PERIPHERAL ARTERIAL DISEASE ARTERIES: THICK WALLED  ACCEPT OXYGENATED BLOOD FROM HEART  ALL OVER BODY NORM: MUSCLE TONE AKA VASOMOTOR TONE  MUSCULAR ELEMENT CONSTRICT/ DILATE  FLEXIBLE COMPLIANT, NOT TOO CONSTRICTED (JUST RIGHT)= GOOD PERFUSION   LUMEN- SMOOTH/ PATENT(OPEN) FREE BLOCK=(DELIVERY OF OXYGEN/NUTRIENTS VIA ARTERIAL)  DETERMING BY CARDIAC OUTPUT S&S (GOOD)  DESIRED BP 110/60 +115/70(NORMAL ↓120/80)  PULSE= EVERY HEART,

CONTRATION  CAROTID=NECK, RADIAL=WRIST , PEDAL=DORSALIS PEDIS= ON TOP OF FOOT, POSTERIOR TIBIALS INSIDE MEDIAL, NEXT TO MALLEOLUS (ANKLE) EX: BARELY PALPABLE/ THERAPY= TOO NARROW ARTERIES Bounding pulses= Too full  high BP/Fluid overload NORMAL CAP REFILL(NAIL BLANCHING) <2SEC