Arterial Ulcers

Question 1

Etiology of arterial ulcers?

Answer 1

arterial insufficiency, vessel stenosis, or occulusion (blood supply inadequate to meet metabolic demands = tissue death)

Question 2

What is the primary cause of arteriosclerosis?

Answer 2

thickening and hardening of arterial walls

Question 3

What is the most common form of arteriosclerosis?

Answer 3

atherosclerosis - systemic, degenerative process in which fatty material is deposited on arterial walls and then thickens and hardens causing blockage

Question 4

What is angiopathy?

Answer 4

poor perfusion of blood supply, nutrients and oxygen for wound healing

Question 5

What is the difference between macro and microangiopathy?

Answer 5

macro: large vessel disease affecting bilateral LE
micro: small vessel disease (possible sclerosis)

Question 6

Risk factors for ischemic/arterial ulcers

Answer 6

arteriosclerosis, DM, high cholesterol, thrombosis, smoking, males >50 yrs old

Question 7

How does an arterial ulcer present?

Answer 7

1. poor pulses, 2. distal 1/3 of LE, 3. pretibial or dorsum of foot, 4. cool to touch, 5. rubor of dependence, 6. PUNCHED OUT APPEARANCE, 7. some necrotic tissue, eschar present, 8. loss of hair, 9. edema due to position of comfort, 10. PAINFUL, 11. DRY

Question 8

arterial ulcer tests and measures

Answer 8

capillary refill, palpable pulses, doppler, rubor of dependence, venous filling time, ABI, toe pressures, segmental pressures, transcutaneous oxygen measurement, arteriogram

Question 9

What is capillary refill? what is the normal time for refill?

Answer 9

push against distal tip of toe to blanch it, hold for 5 sec, then release; should return to normal color in < 3 seconds

Question 10

What pulses do you use for palpable pulses exam?

Answer 10

dorsalis pedis and posterior tibialis

3+ is a normal pulse

Question 11

In a doppler exam, what does mono,bi, and triphasic stand for?

Answer 11

triphasic = normal
biphasic = moderate
monophasic = severe

Question 12

what is the rubor of dependency?

Answer 12

elevate legs for 1 min bring leg to depend position, assess color of plantar foot – note if it is a dark red discoloration which indicates severely impaired circulation

Question 13

What does a dark red coloration indicate when doing the rubor of dependency test?

Answer 13

severely impaired circulation

Question 14

What is normal time for venous filling time?

Answer 14

elevate foot until blanched, put back in dependency position, note time for veins to re-distend on dorsal feet
normal: < 15 sec
moderate arterial insufficiency: 15-40 sec
severe ischemia: > 40 sec

Question 15

How do you measure ABI?

Answer 15

find systole pulse of both UE and LE; divide LE by UE
Normal: 1
venous pathology: > 1
some arterial involvement: 0.8 -1.0
arterial involvement: < 0.8 (avoid compression)
vascular referral: < 0.5

Question 16

at what ABI should you avoid compression?

Answer 16

0.8

Question 17

when do you use toe pressure?

Answer 17

diabetic patients because they get false norm on ABI due to arteries sclerosed open

Question 18

what are segmental pressures used for?

Answer 18

identify circulation deficiencies and help surgeons determine the level of amputation

Question 19

Transcutaneous oxygen measurement

Answer 19

used to measure hypoxia (how much oxygen is getting to the level of the extremity) - place one lead by the heart and the others on the extremities

Question 20

What is an arteriogram?

Answer 20

x-ray of the blood vessels

Question 21

what does an arteriogram identify?

Answer 21

blockages, sclerosis and aneurysms to arteries

Question 22

What is the #1 cause of ischemia?

Answer 22

lack of oxygen to tissue

Question 23

What does ischemia cause?

Answer 23

mummification and dry gangrene

Question 24

What are medical complications related to arterial ulcers?

Answer 24

amputation and infection

Question 25

POC for arterial ulcers

Answer 25

improve blood flow, exercise, wound care treatment,

Question 26

what should you avoid with arterial ulcers?

Answer 26

COMPRESSION

Question 27

What are treatment options for arterial ulcers?

Answer 27

surgical (revascularization) or medical (drugs) interventions

Question 28

If arterial supply is adequate, what are the treatment options?

Answer 28

debridement, wound protection, treat infection, add additional moisture, minimize trauma of the environment (pH, temperature, and dressing change)

Question 29

What are some educational tips for the caregiver?

Answer 29

avoid vasoconstrictives, WALK and EXERCISE, control HTN, cholesterol and diabetes, NO smoking and participate in foot care

Question 30

What are the 3 things you should know before you debride eschar?

Answer 30

nutrition, circulation, and pressure distribution

Question 31

What is thromboangilitis obliterans (buerger’s disease)

Answer 31

blood vessels of the distal extremities obstructed; painful, cool and pale; NO CURE

Question 32

What is Raynaud’s?

Answer 32

narrowing of the smaller arteries in hands, feet, nose and ears; numbness, cool, and color changes;

Question 33

What do patients with Raynaud’s need to stay away from?

Answer 33

cold temperatures and stress