EXAM 1: Wound Etiologies Pt 1 Flashcards
Etiology of artificial insufficiency
- trauma
- acute embolism
- DM, RA
Thromboangiitis Buerger’s disease
Arteriosclerosis
1 cause of arterial insufficiency
- thickening / hardening of arteries
Atherosclerosis
- systemic narrowing of arteries
Explain how arterial insufficiency to becomes an ulcer
arterial insufficiency > intermittent claudication > ischemic rest pain > ulcer
Gangrene & types
when oxygen supply does NOT equal demand, you have cell death
WET: surgery needed
DRY: stable “okay”
Indications for performing an ABI
- decreased or absent pulse
- signs or symptoms of AI
- history of PVD
ABI Result Interpretation (CHART)
- normal
- mild/mod AI
- vessel calcification
- severe AI
- Normal: .9-1.1 okay to debride
- Mild/Mod AI: .7-.9 (VI Ulcer apply compression!)
- Vessel calcification: 1.1-1.3
- Severe AI: <.5 (AI Ulcer NO compression)
Trendelenburg test * not hip drop
- to identify vein incompetence and differentiate between which veins
- supine, leg elevation 45 degrees for 1 min
- note venous distension
- tourniquet to distal thigh
- stand upright and note time for superficial venous distension
- repeat process without tourniquet
tourneqet on : <20 sec = deep perforator vein incompetence
off: <10 sec= superficial vein incompetence
Vein Surgery Terms:
- Ligation
- Stripping
- Sclerotherapy
- Ligation: tying off perforating veins to decrease venous hypertension in superficial veins
- Stripping: surgical resection of superficial varicosities
- Sclerotherapy: injecting agent to close dysfunctional veins
Venous Ulcer Healing Time PROGNOSIS
- 8 weeks
- small ulcers 5-7
- large ulcers 10-16 weeks
(wounds w/o signs of healing in 4 wks should be referred)
target muscle groups and exercises for VI?
ankle PF and DF
Gastroc & soleus stretching
- gait training = + influence on respiratory pumps
Compression Methods
- paste bandage
- short stretch compression wrap
- long stretch compression wrap
- paste bandage : gauze impregnated with zinc oxide, calamine, glycerine and gelatin that hardens to a semi rigid support
- short stretch compression wrap : for up and moving pts
- long stretch compression wrap: for paralyzed patients
Laplace’s Law
Bandage Compression = (tensionlayers appliedconstant) / (limb girth*bandage width)
Explain the function of each layer of compression
inner layer: absorbs excess drainage & provides padding without tension
middle layer: absorbs drainage with tension
outer 1-2: increases pressure with tension
Tubular Compression
Compression Garments
light compression off the shelf
knee highs
LE Compression Standards (classes)
20-30mmHg Class 1 : mild venous insufficiency
30-40mmHg Class 2: mod venous insufficiency
>40mmHg Class 3-4: severe venous insufficiency
Pressure Injury Definition
localized area of tissue necrosis that develops when soft tissue is compressed between a firm surface and underlying body prominence
Classification for pressure injuries
NPUAP Injury Classification
National Pressure Ulcer Advisory Pannel Scale
NPUAP SCALE
Stage 1
Stage 2
Stage 3
Stage 4
Unstageable
Braden Risk Scale Interpretation
<18 at risk
15-18 mild risk
13-14 mod risk
<13 risk
Pressure Ulcer Scale for Healing (PUSH)
score 8-24 (higher scores=more severe ulcer)
Healing score - PUSH initial score - reassessment score
(+ = improvements)
at risk patients should be positioned at what angle on their side
30 degrees, not directly on side
Pressure Injury Healing time PROGNOSIS
very slow!
stage 1: 1-3 wks
stage 2: avg 23 days
stage 3-4: 8-13 weeks
Pressure injuries that do not decrease in size within ____ ________ should be reassessed for alternative interventions
2 weeks
after hour of sitting, how long does it take to relieve pressure and reperfuse tissue ?
2 minutes
- should move every 10-15 min seated
- should move every 2 hours in bed
Neuropathic Ulcer PROGNOSIS
- healing time 12-14 weeks
- Wagner 1/2 have good prognosis
When would you use a total contact cast? When should you not?
-neuropathic ulcers
- for wagner ulcers grade 1 and 2
- not when the pt has osteomyelitis, gangrene, fluctuating edema, active infection, ABI < .45
Lymphatic system is divided into superficial and deep lymphatics… what are their jobs
Superficial lymphatics: drains skin and superficial tissue (THIS IS WHAT WE ARE TREATING)
Deep lymphatics: drains muscles, tendons, and joints
Where is the immune system response activated?
in lymph fluid
Flow of Lymph
Lymph capillaries > precollectors> lymph collectors> lymph nodes> thoracic duct/R lymphatic duct> venous system
Lymphedema definition
- fluid stagnation and edema due to dynamic or mechanical insufficiency
Dynamic Insufficiency of Lymphedema
- lymphatic load EXCEEDS transport capacity
(too many cars on the road so back up and wear and tear on road)
Mechanical Insufficiency of Lymphedema
- transport capacity decreases when axillary nodes removed
(the road is under construction so cars cant get by)
Fibrosis
caused by build up of collagen formation in later stages of lymphedema
What stages of lymphedema are reversible?
stage 0 and stage 1
Internal Society of Lymphology Lymphedema Staging
Stage 0: no edema, but impaired lymph transport
Stage 1: fluid build up may subside with elevation, pitting edema present
Stage 2: elevation no longer helps , fibrosis present; early and late (late has no pitting)
Stage 3: skin thickening, hyperpigmentation, papillomas
Unilateral Edema measurements:
- mild
- moderate
- severe
- Mild: <3 cm difference
- Moderate: 3-5 cm difference
- Severe >5 cm difference
Types of Burns
Thermal: severity based on contact time and temperature
Chemical: takes 24-72 hrs to evolve; alkaline burns are more severe than acidic
Electrical: charred entrance, explosive exit
Pathophysiology of Burns (name the zones)
Zone of coagulation: central portion, ischemia, necrosis
Zone of stasis: cellular injury and compromised perfusion
Zone of hyperemia: outer edges, minimal cellular injury
Degrees of burns & Example s
Superficial 1st Degree: bright red; blanches with pressure; SUNBURN
Superficial Partial Thickness 2nd Degree: blistered; blanches with immediate capillary refill; resolves 10-14 days, CONTACT CHEM BURN
Deep Partial Thickness Deep 2nd Degree: molted areas of red with white eschar, 3+ weeks to heal; SEVERE SUNBURN, CONTACT W DILUTE CHEMICALS
Full Thickness 3rd Degree: leathery eschar; very painful; PROLONGED CONTACT W FLAME, IMMERSION SCALD INJURY
Subdermal 4th Degree: charred, mummified appearance, possible ampu; ELECTRICAL BURN, STRONG CHEMICAL BURN
How to estimate rule of 9s
head, chest, thorax, leg, leg 9% each
arms 4.5% each side
groin 1%
Susceptible areas for contractures following a burn
anterior neck, axilla / shoulders, cubital fossa, ankle, posterior knee
Debridement
early debridement often performed on patients with medium and large full thickness burns
Escharotomy
Incision through eschar and subcutaneous tissue to release tissue constricting circulation
Fasciotomy
Incision through fascia to release pressure/improve circulation
