Arterial/Venous/Neuropathic Ulcers Flashcards
Arterial Ulcers Wound
-5-10% of all LE ulcers
-usually LE on toes, lat mal, and ant leg
Appearance:
-round and regular shaped
-pale wound bed
-may have dark necrotic tissue (gangreeny)
-cold
-minimal bleeding
RK:
-aterial insufficiency
-CVD
-truama
-DM
-embolism
-smoking
S/s:
-cold
-pain increasing with activity and elevation
-caludication distal to occlusion
-rest pain
Precautions:
-Compression
-sharp debridement
Arterial Ulcers Periwound
-lack of hair, thin skin, shiny, moist
-increased fungal growth
-yellowed nails
-pale, cold
-lack palpable pulses
Arteriosclerosis
-primary cause of arterial insufficiency
-thickening and hardening of arterial walls
-most common cause is atherosclerosis (plaque)
AU Smoking
-Nicotine causes vasoconstriction
-decreases o2 by 30% for 1h
-increases clot rate, cholesterol
Arterial Ulcers Testing
-Pulses
-Ultrasound
-Capillary refill
-Venous filling time
-Rubor of Dependency
-Segmental Pressure Measurement
-ABI
-TBI
-Transcutaneous Oxygen Monitoring
-Plethysmography
-Duplex Sxanning
-Arteriography
-CT Angiogram
Arterial Ulcer Treatment/Footwear/Amputation
-local wound care: no compression, periwound, education
-footware
-gait and mobility: offload wound
-positioning: dangle legs
-heat: Vasodilation, increase o2
-drugs: pain
-surgical debridement
-Arterial surgeries
-amputation: 1/2 vascular die in 5yrs, 55% of DM will have other leg in 2-3yrs
Ankle Brachial Index
SBP LE/ SBP UE
Higher (1.1-1.3): calcification, not valid tissue perfusion
Normal (0.9-1.1)
Mild-Mod (0.7-0.9): conservative treatments
Moderate (0.5-0.7): may consider revacularization
Severe (<0.5): rest pain, need revascularization
Gangrene (<0.3): gangrene and rest pain, revascularization and amputation needed
Venous: (<0.7) should not be compressed
Toe Brachial Index
-when suspecting calcification
> 30 is good healing potential
Segmental Pressure Measurement
-localize areas of decreased arterial blood flow
-doppler to check BP and use cuff
-differennce drop of >20 is a sign of occlison
Transcutaneous Oxygen Monitoring
-done when suspecting calcification
> 50 Normal
35 Should heal
<30 Needs surgical intervention
Plethymography
-pulse volume recording
-cuffs placed and measure all areas BP
Venous Ulcers
-15-25% LE ulcers are both
-have wound >1yr
-MC leg ulcer
Appearance:
-medial lower leg
-rarely above knee
-superficial with irregular shape
-mod-max drainage
-has granulation tissue
RK:
-vein dysfunction
-muscle failure
-trauma
-old age
-DM
-previous ulcer
-venous hypertension
S/s:
-painful
-heaviness
Precautions:
-whirlpool
-allergies to dressings
Venous Ulcers Periwound
-dry and scaly
-dermatitis
-warm
-edema
-hemosiderin stains
-pulses present
Venous Ulcer Testing
-Venogram: DVT gold standard
-Ultrasound: for DVT
-Homan’s Sign: poor test
-Wells CPG for DVT
-Trendelenburg Test
-ABI
Trendelenburg Test
-elevate legs 45 for 1 min and monior distension time
-<20s incompetence of veins
Venous Filling Time
-5-15s
-faster is bad
Venous Ulcers Treatment
-local care
-compression
-exercise
-meds
-debridement
-vein surgery
Venous Ulcer Compression Therapy
-must adress hypertension
-no elastic bandages
Benefits:
-muscle pump
-decrease edema
-Increase oxygenation
Contraindications:
-<0.7
-acute infection
-Pulmonary edema
-active DVT
Compression Types
Pressure= (tension x number of layers x 4630)/ (circumference x bandage width)
Precautions:
-ABI of 0.8
-measure circimference (>18cm need extra padding, >26cm need extra compression)
-determine BP
Contraindications:
-ABI of <0.7
-DVT
-infection
-edema
-CHF
Paste Bandage: non elastic, sticky with zinc, hardens
Short-Stretch Compression: need tot be reapplied
Milti-Layer: 4 layers, padding, absorbing, compression
-moderate VI
CircAid: removable, expensive
Tubular: off the shelf, may not work
Compression Garments: stockings
Neuropathic Ulcers
-15-25% of DM
-increased risk of amputation
-cause by lack of sensation
Appearance:
-plantar side of foot
-round, unched out
-rimmed in callous
-light drainage
-light pink wound bed
RK:
-uncotrolled DM type 2
-hispanic and indigenous
-sensory issues
-vascular disease
-mechanical stress
-poor vision
-CVD
-motor neuropathy: charcot foot
Etiology:
-increased platelets to capillaries increasing microvascular pressure
-tissue damage
S/s:
-pulses may be present
Neuropathic Ulcers Periwound
-calloused
-thicked toenails from fungus
-edema
Neuropathic Ulcers Testing
-circulation testing: ABI, TBI, ateriography, capilalry refill, o2
-Sensory testing: 10g (5.07) monofilament test at 1st, 3rd, and 5th digits
Wagner Classification System
-classifies Neuroppathic ulcers
0: no open leisions
1: Superrficial
2: Deep to tendon, bone, capsule
3: Deep with abcess, osteomyelitis
4: Localized gangrene
5: Gangrene of entire foot
Neuropathic Ulcer Treatment
-local wound care: remove callous
-Total contact casting: gold standard, offloads ulcer
-Footware
-Exercise
-Surgery
-DM control
