1.21 Differentiating Ulcers Flashcards
arterial ulcers: predisposing factors
- diabetes
- atherosclerosis
- Raynaud’s
- smoking
- PVD
- sedentary lifestyle
venous ulcers: predisposing factors
- PVD
- chronic venous insufficiency
- diabetes
- lack of exercise
- obesity
- pregnancy
diabetic ulcers: predisposing factors
diabetes
What are diabetic ulcers also referred to as?
neuropathic
arterial ulcers: anatomic locations
- lateral malleolus
- dorsum of foot
- tips or between toes
venous ulcers: anatomic locations
- medial malleolus
- medial aspect of leg
diabetic ulcers: anatomic locations
- typically over WB surfaces
- heel
- first metatarsal head
- dorsal metatarsal heads due to shoes
arterial ulcers: other features of patients
- pale
- thin
- shiny
- lower leg missing hair
- thick toenails
- fat pads die on bottom of foot
- no dorsalis pedis pulse
- cold
venous ulcers: other features of patients
- dilated veins
- swelling
- weirdly warm
- brawny edema
- limb is heavy
- activity tolerance low
- fatigue
diabetic ulcers: other features of patients
- excessive callus formation
- still have a warm foot
- thick toenails
- may have pulses
- subcutaneous fat pads gone as well
wound characteristics: margin/border
arterial ulcer
- circular
- even
wound characteristics: margin/border
venous ulcer
random, heaped, irregular edges
wound characteristics: margin/border
diabetic ulcer
even, perfect ulcer (due to pressure)
wound characteristics: color of wound bed
arterial ulcer
pale with necrotic tissue
wound characteristics: color of wound bed
venous ulcer
- granular
- dark
- brawny skin
- red/ruby color
- hemosiderin staining
hemosiderin staining
- dark, reddish brown color due to iron
- doesn’t go back to normal
wound characteristics: color of wound bed
diabetic ulcer
- pale
- clean base of wound
wound characteristics: periwound skin
arterial ulcer
- necrotic tissue, pale, eschar
- typically no slough
- gangrene
wound characteristics: periwound skin
venous ulcer
- yellow
- mucousy
- moist
- slough
wound characteristics: periwound skin
diabetic ulcer
pale, not much necrotic tissue
wound characteristics: pain?
arterial ulcer
severe pain, even at rest
wound characteristics: pain?
venous ulcer
none
wound characteristics: pain?
diabetic ulcer
- no pain
- slow onset cell death so they can’t feel it
wound characteristics: exudate?
arterial ulcer
- not much (dead tissue)
- no fluid (blood)
wound characteristics: exudate?
venous ulcer
- lots, heavy exudate
- waterfall, drippy
wound characteristics: exudate?
diabetic ulcer
low
wound characteristics: depth
arterial ulcer
- deep
- to where blood supply should be coming from
wound characteristics: depth
venous ulcer
- very shallow
- epidermis gone, down to some of the dermis
wound characteristics: depth
diabetic ulcer
deep
Which ulcer type has the highest chance of gangrene?
arterial ulcer
80% of LE ulcers are this type
venous
Which ulcer type carries with it a high risk for osteomyelitis?
diabetic
Which ulcer type is indicative of people who might have cellulitis?
arterial
What is osteomyelitis?
- bone infection
- can happen when a wound bed bottoms out at or close to the bone
What test is used to see how well blood sugar is maintained long term?
A1C
patient education: arterial ulcers
- no elevation (crossing legs, tight socks, recliner with legs up)
- stop smoking
- activity
- water checks before bathing with a body part that has sensation
patient education: If they have PVD, they are at risk for arterial ulcers. What preventative measures would you educate them on?
- wear shoes
- don’t pick your nails
- don’t compress
- keep feet in dependent positions
patient education: venous ulcers
- elevate the foot
- compress (as long as there’s no comorbidity), daily compression hose if skin is healthy without an active wound
- intermittent compression device
- any type of activity (develop more active lifestyle)
- avoid dependent positions
patient education: diabetic ulcers
- water checks before bathing
- daily foot inspection
- prevention
- proper footwear (specialty shoes)
- controlling sugars
- avoid pressure
What are arterial ulcers caused by overall?
anything that prevents blood flow to the tissue
What might be done for patients with PVD (surgery)?
- bypass (usu saphenous vein)
- may cause more pain after because suddenly they have blood flow
- may have to do slice and dice amputation
chronic venous insufficiency produces
varicose veins
Why might hypertension cause venous ulcers?
blood pushing through, but pooling
Why does a diabetic lose motor and sensory function?
- lose circulation
- cells die
- function lost
Why do diabetics form such large calluses? Should you address these?
- lays down more skin to recreate the padding that gets lost
- don’t want them to fall off or remove
