Etiology of wounds Flashcards
What do you need for adequate healing
adequate oxygenation
why is it important to differentially diagnose wounds
so we can properly perform our interventions
what is the most common form of peripheral
vascular disease
Venous insufficiency
cause of Venous insufficiency
- valvular incompetence
- obstruction of the deep venous system
risk factors of venous insufficiency
-Smoking • DVT • Trauma • Ortho surgery • Immobility • Family history • CHF -age -frequent flyers
diagnostic tests for venous insufficiency
Venous doppler ultrasound – ABI Arterial brachial index – arterial insufficiency – Duplex scanning
characteristsics of venous insufficiency
-Edema – Trophic changes- brown discoloration – Weeping dermatitis – Irregular margins Depth is shallow – Exudate moderate to heavy (wet) – Minimal pain – Peripheral pulses palpable – Normal skin temperature (may be warm if chronically inflamed)
what is the typical location of venous insufficiency
medial aspect of the lower leg
superior to medial malleolus
what is Hemosiderin
staining
red blood
cells leak into the
tissue and leaves a
“stain” on the skin
Treatment of venous ulcers
Control edema Improve mobility Dressings Education Debridement
ways to control edema
Compression garments, ace wraps, tubigrip, pumps
cause of ARTERIAL insufficiency
– insufficient arterial perfusion
– arteriosclerosis
risk factors of arterial insufficiency
– Diabetes
– Smoking
– Hyperlipidemia
– HTN
characteristics of arterial insuffieciency
Significant pain • with exercise • change in position • nocturnal – Cool skin temperature – shiny taunt skin – hair loss Regular wound margins- often circular - Lack of peripheral pulses - Pallor on elevation – Rubor when dependent – Pale or necrotic ulcer base – Minimal exudate – Gangrene is common – Typically on tips of toes, lateral malleolus, between toes
what causes hair loss
poor circulation
how would you asses if a patient has poor circulation
check pulses
feel temperature of skin
location of arterial insufficiency
typically on tips of toes, lateral malleolus or between the toes
diagnostic tests for arterial insufficiency
–ABI (Ankle Brachial Index)
– Plethysmography
– Duplex scanning
what is the gold standard of diagnostic tests for arterial insufficiency
ABI Compares brachial systolic pressure to radial – Ankle pressure is divided by arm pressure – Normal is 1.0-1.4
significance of ABI < 0.5
Significant peripheral arterial disease
• Refer to vascular specialist
• Compression therapy contraindicated
significance of ABI < 0.51-0.8
Moderate peripheral arterial disease
• Refer to vascular specialist
• Light compression maybe allowed
significance of ABI 0.81-0.99
Mild peripheral arterial disease
• Compression therapy allowed
significance of ABI 1.0-1.4
Normal
• Compression for maintenance if needed
significance of ABI >1.4
May have calcification of arterial walls
• Assess with toe/brachial index
what is plethysmography
Expansion of ABI
– 3-4 cuffs used on LE
– Better able to identify where arterial
disease is
where is the cuff placed for individuals with dM to measure with plethysmography
the great toe because calcification doesn’t occur there
what is claudication
pain caused by too
little blood flow, often during exercise
how to determine claudication time
Use a treadmill or just walk on level grade at 1-2 MPH – Measure time elapsed until claudication pain occurs
Claudication Scale
1= Definite discomfort or pain but only of
initial or modest levels
2= Moderate pain but the patients attn can be diverted by conversation
3= Intense pain from which the person’s attention can’t be diverted
4= Excruciating and unbearable pain
what is the best intervention for intermittant claudication
EXERCISE
ACSM guidelines for intermittant claudication
Warm-up and cool down- mostly UE
– Mode-Track walking or treadmill
– Intensity-Workload set to elicit claudication within 3-5 min.; continue until moderately severe claudication
Rest and repeat
Duration- 35 min intermittent walking, ↑
5 min each session until 50 min with goal of 35-50 min continuous walking
– Frequency- 3-5x/wk
symptoms of chronic arterial insufficiency
Skin temperature is cooler – Color is typically pale – Intermittent claudication – Rest pain -LE elevation worsens pain -Ulcers result from vessel occlusion
treatment of arterial ulcers
Exercise • Keep clean • Dressings • Stop smoking • Avoid the cold • Debridement • Protect surrounding skin • Dangle feet when in pain
which type of wound is most likely to heal
venous insufficiency
which type of wound is least likely to heal and why
arterial insufficiency because the blood supply is significantly compromised
what can you do to restore integrity to the venous wall
provide an outside counter pressure
what would be the focus of PT for patients with venous insufficiency
control edema
interventions for venous insufficiency
- muscle pumps for calves in supine
- walking (at least 30min/day)
- elevation
- compression via stockings or tubigrip
- aerobic exercise via stair climbing
- diaphragmatic breathing because every breath in drops the pressure and brings fluid up
- education on diet and fluuid intake and smoking cessation
