Impairment of arterial blood flow leading to tissue ischemia and potentially

Impairment of arterial blood flow leading to tissue

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Impairment of arterial blood flow leading to tissue ischemia and potentially necrosis Risk factors: Atherosclerosis Age Smoking Diabetes mellitus Hypertension Dyslipidemia Family history Obesity Sedentary lifestyle.
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Arterial Ulcers Assessment: thorough history and physical examination. Ulcer presentation: Location: On the feet - often on the heels, tips of toes, between the toes or anywhere the bones may protrude and rub against bed sheets, socks or shoes. Appearance: Base : Has a yellow, brown, grey or black color and usually does not bleed. Borders : The borders and surrounding skin usually appear punched out. If irritation or infection are present, there may or may not be swelling and redness around the ulcer base. There may also be redness on the entire foot when the leg is dangled; this redness often turns to a pale white/yellow color when the leg is elevated. Arterial ulcers are typically very painful, especially at night. The patient may instinctively dangle his/her foot over the side of the bed to get pain relief.
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Arterial Ulcers Management of arterial ischemic ulcers classically includes conservative debridement, pain control, use of occlusive dressings, and improvement of circulation
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Acute Arterial Occlusion Caused by: Trauma Thrombus: develops in a damaged vessel by atherosclerosis Embolism: wall of artery is healthy and obstruction is from thrombus that was dislodged from heart (A.fib, MI, heart valves…) 90% occurs in LE Acute obstruction causes decrease in mean and pulse pressures in the distal arteries and decreased oxygenation Collateral circulation may develop
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Acute Arterial Occlusion Clinical manifestation: 6P’s (discussed earlier) Muscle necrosis may occur 2-3 hours after occlusion. Treatment: Surgery to correct arterial embolism (embolectomy) Surgery to correct thrombus: arterial reconstruction to revascularize LE. Anticoagulant therapy: heparin, warfarin Fibrinolytic agents to dissolve thrombus or embolus Awaiting surgery : bed rest, warm room, keep LE at room temp., prevent pressure or trauma in LE, position: level or slightly dependent LE
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Amputation Amputation is used to treat: Injuries Cancers Severe limb gangrene Lib-threatening arterial disease
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Amputation Care of a patient scheduled for LE amputation Pre-op care Rehabilitation team assesses patient and plans pre-op and post-op with patient BEFORE amputation Patient assessment Type of amputation to be performed Open or guillotine– for infection. Stump is not closed to allow drainage then another surgery is performed for stump closure Closed or flap– stump is closed with skin flap.
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  • Spring '16
  • LorraineHaertel
  • Nursing

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