Arterial/Venous/Neuropathic Ulcers

Question 1

Arterial Ulcers Wound

Answer 1

-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

Question 2

Arterial Ulcers Periwound

Answer 2

-lack of hair, thin skin, shiny, moist
-increased fungal growth
-yellowed nails
-pale, cold
-lack palpable pulses

Question 3

Arteriosclerosis

Answer 3

-primary cause of arterial insufficiency
-thickening and hardening of arterial walls
-most common cause is atherosclerosis (plaque)

Question 4

AU Smoking

Answer 4

-Nicotine causes vasoconstriction
-decreases o2 by 30% for 1h
-increases clot rate, cholesterol

Question 5

Arterial Ulcers Testing

Answer 5

-Pulses
-Ultrasound
-Capillary refill
-Venous filling time
-Rubor of Dependency
-Segmental Pressure Measurement
-ABI
-TBI
-Transcutaneous Oxygen Monitoring
-Plethysmography
-Duplex Sxanning
-Arteriography
-CT Angiogram

Question 6

Arterial Ulcer Treatment/Footwear/Amputation

Answer 6

-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

Question 7

Ankle Brachial Index

Answer 7

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

Question 8

Toe Brachial Index

Answer 8

-when suspecting calcification

> 30 is good healing potential

Question 9

Segmental Pressure Measurement

Answer 9

-localize areas of decreased arterial blood flow
-doppler to check BP and use cuff
-differennce drop of >20 is a sign of occlison

Question 10

Transcutaneous Oxygen Monitoring

Answer 10

-done when suspecting calcification

> 50 Normal
35 Should heal
<30 Needs surgical intervention

Question 11

Plethymography

Answer 11

-pulse volume recording
-cuffs placed and measure all areas BP

Question 12

Venous Ulcers

Answer 12

-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

Question 13

Venous Ulcers Periwound

Answer 13

-dry and scaly
-dermatitis
-warm
-edema
-hemosiderin stains
-pulses present

Question 14

Venous Ulcer Testing

Answer 14

-Venogram: DVT gold standard
-Ultrasound: for DVT
-Homan’s Sign: poor test
-Wells CPG for DVT
-Trendelenburg Test
-ABI

Question 15

Trendelenburg Test

Answer 15

-elevate legs 45 for 1 min and monior distension time
-<20s incompetence of veins

Question 16

Venous Filling Time

Answer 16

-5-15s
-faster is bad

Question 17

Venous Ulcers Treatment

Answer 17

-local care
-compression
-exercise
-meds
-debridement
-vein surgery

Question 18

Venous Ulcer Compression Therapy

Answer 18

-must adress hypertension
-no elastic bandages

Benefits:
-muscle pump
-decrease edema
-Increase oxygenation

Contraindications:
-<0.7
-acute infection
-Pulmonary edema
-active DVT

Question 19

Compression Types

Answer 19

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

Question 20

Neuropathic Ulcers

Answer 20

-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

Question 21

Neuropathic Ulcers Periwound

Answer 21

-calloused
-thicked toenails from fungus
-edema

Question 22

Neuropathic Ulcers Testing

Answer 22

-circulation testing: ABI, TBI, ateriography, capilalry refill, o2
-Sensory testing: 10g (5.07) monofilament test at 1st, 3rd, and 5th digits

Question 23

Wagner Classification System

Answer 23

-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

Question 24

Neuropathic Ulcer Treatment

Answer 24

-local wound care: remove callous
-Total contact casting: gold standard, offloads ulcer
-Footware
-Exercise
-Surgery
-DM control