Exam 2: Chapter 5 & 6 Flashcards
What are all of the basic wound characteristics to look for when assessing a wound (Let us not see miss deght)
location, shape, size, depth, edges, undermining/tunneling, necrotic tissue, exude, edema, surrounding skin tissue, induration, granulation, epithelialization, maceration, and hemorrhagic tissue
Important aspects of the location characteristics of a wound
Be very specific when taking notes.
Body diagrams are helpful and we can even draw the wound on a body diagram
Important aspects of the shape characteristics of a wound
The shape of the wound will change with healing. The shape also determines the size of a wound
Important aspects of size characteristics of a wound
Determine size by using LxW method (most common) or undermining technique. Using the same reference point improves the reliability since it difficult to determine where to measure the wound
Important aspects of the depth characteristics of a wound
Depth is hard to measure and is not very accurate, but measuring multiple parts of a wound is more accurate. It is hard to measure because all tissue heals at different rates
Important aspects of the edges characteristics of a wound
Note if its indistinct and diffuse, attached or not attached, rolled under and thickened, or hyperkeratosis
True or False:
Not attached wound edges give the appearance of depth because it is truly showing there is depth to the wound
False, it gives the appearance of depth but does not have depth
Why are rolled under and thickened wound edges bad news
If they continue to thicken or go through fibrosis then the edges are hard and healing is hard to progress
What is hyperkeratosis and what wound characteristic does it fall under?
It falls under wound edge characteristics and it is a callus tissue that can form around wound edges that make healing difficult to take place
Important aspects of undermining/tunneling characteristics of a wound
It represents the loss of tissue underneath the intact surface which means we aren’t seeing the extent of the damage
Important aspects of necrotic tissue characteristics of a wound
The amount that is present, the color, consistency, and adherence to wound bed
Which is less severe, slough or eschar?
slough
What can be defined as dead devitalized tissue
necrosis
What are the color characteristics of necrotic tissue and what are the two types of necrotic tissue
The color can be yellow, brown or black. The two types of necrotic tissue are slough and eschar.
What type of tissue is slough and eschar considered to be?
necrotic tissue
What are the two methods to measure necrotic tissue
- Clinical judgement using transparency/tracing
2. Liner measurements of length and width
Important aspects of exudate characteristics of a wound
Can be difficult to asses using moist wound healing dressings. Judging the amount is done by observing the wound itself or wound dressing
Important aspects of surrounding skin characteristics of a wound
Can be the first sign of further tissue damage, erythema may be present (halo of erythema) and check for blanchability
Important aspects of edema characteristics of a wound
edema slows healing, check if it is pitting or nonpitting, check the periwound tissue within 4cm of wound edge
What does induration mean
hardness
Important aspects of surrounding induration characteristics of a wound
indication of further pressure-induced tissue trauma, abnormal firmness with margins should be assessed within 4 cm of wound edge
When we check for maceration of a wound what should we look for
whiteness around a wound indicating there is too much moisture
When we check for hemorrhagic tissue, what should we look for
blue/red color that indication trauma from the wound
Important aspects of granulation characteristics of a wound
It is a marker of wound healing and signals proliferation phase of wound healing and eventual closure
What type of wound thickness does granulation only occur in
full thickness wounds
Important aspects of epithelialization characteristics of a wound
Process of epidermal resurfacing and appear as pink or red
What are the different types of tools to monitor wound healing
- Sussman wound healing tool (SWHT)
- Pressure Ulcer Scale for Healing (PUSH)
- Bates-Johnson Wound Assessment Tool (BWAT)
Which wonld healing tool describes changes in tissue status and size over time using the acute wound healing model
SWHT sussman wound healing tool
Is the SWHT qualitative or quantitative
qualitative
Which wound healing tool develops a biologically accurate and easy to use instrument to replace reverse staging
PUSH pressure ulcer scale for healing
Is the PUSH healing tool quantitative or qualitative
quantitative
Which wound healing tool evaluates 13 wound characteristics rating them with a numerical score from best to worst
BWAT Bates-Johnson wound assessment tool
What type of wounds is the BWAT recommended for use as a method of assessment and monitoring?
Pressure ulcers and other chronic wounds
True or False:
In regards to the BWAT scoring a lower number results in a more severe wound status
False, the higher the number the more severe a wound is
What three things should a physical examination include
- Inspection
- Palpation
- Special Diagnostic physical exam maneuvers`
One of the key aspects of physical examination is the inspection. What are some examples of what to look for during inspection
Look at the size of the limb and check for swelling and type of edema if present. Also check for color, texture, capillary refill on nailbeds, and hair on feet/toes for circulation.
One of the key aspects of physical examination is palpation. What are some examples of places to palpate
Skin, popliteal fossa, pulses, varicose veins, scars, and rashers
During palpation, what is the most important thing to palpate
area of pulses
What location and arteries for checking pulse were mention in Dr. Matheny’s Vascular Evaluation PowerPoint
Femoral artery, popliteal artery, dorsalis pedis, and posterior tibial artery
Which arteries/pulses that were discussed in the Vascular Evaluation PowerPoint are the most distal?
Dorsalis Pedis and Posterior Tibial Arteries. Although the dorsalis pedis artery is technically a little more distal than posterior tibial artery
During the history and physical examination, ____________ can distinguish the cause of the wound. As a PT, I need to be able to differentiate between ____ and ____ involvement. Make sure to consider claudication.
Symptomatology, venous and arterial
In the comparison of arterial and venous insufficiencies, describe what an arterial wound looks like
Distal ulceration especially on toes, heels, and in between web spaces. May develop gangrene and severe joint loss
In the comparison of arterial and venous insufficiencies, describe what an venous wound looks like
Shallow ulcers in the gaiter distribution of the foot and ankle, usually on the medial surface above the malleolus
What does the term “gaiter” mean
The are of the leg from the knee to the ankle
When it comes to vascular testing, there is an invasive method and a noninvasive method. Which method uses ultrasound?
noninvasive
What is the most common noninvasive vascular testing technique?`
ultrasound
When it comes to vascular testing, there is an invasive method and a noninvasive method. Which method uses contrast injection and data acquisition using radiographs
Invasive
What are the most common invasive vascular testing techniques
contrast injection and data acquisition using radiographs
What is the most common technique to measure ABI and what does it measure?
The technique is a noninvasive instrument called the continuous wave doppler and it determines the velocity and direction of blood flow
True or False:
The continuous wave doppler gives a phasic flow patter representing four phases
False, it does have a phasic flow but there are only three phases
What are the three phases of the continuous wave doppler
- forward flow during systole
- Reverse Flow in diastole
- Returns to forward
What does an ABI compare?
Ankle pressure to the arm pressure
Discuss how the ABI is taken
First assess the highest arm pressure and then place the BP cuff just above the ankle and obtain the systolic number with the Doppler. Observe the posterior tibial artery and dorsalis pedis artery. Ankle pressure is then divided by arm pressure
If someone has an ABI of less than 0.5, what are the implications?
Refer to a vascular specialist because they have a severe arterial disease. Compression should not be used to treat
If someone has an ABI from 0.5-0.8, what are the implications
Refer to a vascular specialist because of a moderate arterial disease. Intermittent claudicant present so don’t use compression to treat
Is someone has an ABI from 0.8/9-1.00, what are the implications?
Mild peripheral arterial occlusive disease, can be treated with compression with caution
ABI higher than 1.0-1.4, what are the implications
Refer to refer to a vascular specialist because calcified vessels are present
What are segmental and digital plethysmography
Expansions of the ABI that utilize BP along the entire leg
Where are pressures obtained from with segmental and distal plethysmography
high thigh, low thigh, below the knee, above the ankle
What is an arterial and venous duplex
a combination of ultrasound and color flow doppler that indicates blockage if reversal of flow is present.
What is the venous duplex scanning using to detect?
It detects any echogenic material such as thrombus
What does transcutaneous oxygen measure and what are do the pressure amounts indicate?
It measures diffusion of oxygen from the capillary level to the skin level. Less than 20mmHg the wound/ulcer won’t heal. Measurements above 30mmHg indicate wound healing without difficulty and safe debridement can take place
What is a Magnetic Resonance Angiography?
A cheaper, noninvasive technique that uses a non-nephrotoxic contrast to identify target vessels.
What is a computed tomography angiography
A new technique that obtains multiple serial images enhance with contrast and reconstructed into 3D images. It is fast for the patient but a lot longer for the 3D image to appear
What are the 6 types of venous imaging discussed in the Vascular Evaluation PowerPoint
Venous Pressure Measurements, photo plethysmography, light reflective rhenography, string gauge plethysmography, air photo plethysmography, and duplex ultrasound
Which venous imaging records the true pressure that is seen in the veins while the patient ambulates
venous pressure measurements
Which venous imaging measure the venous refill time
photo plethysmography
Which venous imaging is more accurate than photo plethysmography because overall effect of external light and surface reflection have been reduced
Light reflective rhenography
which venous imaging measures venous refill time and overall venous emptying
string gauge plethysmography
Which venous imaging uses air cuffs volumetric changes in the leg to be quantified to measure venous reflux time
air photo plethysmography
which venous imaging is a continuous doppler ultrasound along with color flow
duplex ultrasound
Which tool used to monitor wound healing describes 10 tissue attributes and 9 descriptive attributes of size
sussman wound healing tool
What type of would healing tool is used to measure pressure injuries only
PUSH
Which wound healing tool incorporates surface area, exudate amount, and surface appearance?
PUSH
Which would healing tool evaluates 13 wound characteristics
BWAT
What is claudication
Pain typically in the calf due to low oxygen after some amount of physical activity. The pain goes away when the physical activity stops
What is resting pain
Pain that affects an individual typically across the forefoot when they are lying down doing nothing
How do you resolve resting pain
Swings the legs over the bed and let the blood run down to the lower extremities.
What is dependent rubor
Typically occurs in resting pain. A patients leg is raised to 30 degrees and the foot turns pale, but when you move the foot off the bed all of the blood rushes to the foot and it turns red
Distinguish whether the description falls under arterial insufficiency or venous insufficiency and also what category the description is (i.e. pain, color, edema)
Intermittent claudication may progress to rest pain. Chronic, dull aching pain, progressive throughout the day
Arterial pain
Distinguish whether the description falls under arterial insufficiency or venous insufficiency and also what category the description is (i.e. pain, color, edema)
Pale to dependent rubor, a dull to bright, reddish color, more common with advanced disease
arterial color
Distinguish whether the description falls under arterial insufficiency or venous insufficiency and also what category the description is (i.e. pain, color, edema)
Normal to cyanotic, more common with advanced disease
venous color
Distinguish whether the description falls under arterial insufficiency or venous insufficiency and also what category the description is (i.e. pain, color, edema)
Piokilothermic, taking on the environmental temperature. Much cooler than normal body temp
arterial skin temp
Distinguish whether the description falls under arterial insufficiency or venous insufficiency and also what category the description is (i.e. pain, color, edema)
Usually no effect on temperature
venous skin temp
Distinguish whether the description falls under arterial insufficiency or venous insufficiency and also what category the description is (i.e. pain, color, edema)
Diminished to absent without Doppler stethoscopre
arterial pulses
Distinguish whether the description falls under arterial insufficiency or venous insufficiency and also what category the description is (i.e. pain, color, edema)
Usually normal, may be difficult to palpate, secondary to significant edema
venous pulses
Distinguish whether the description falls under arterial insufficiency or venous insufficiency and also what category the description is (i.e. pain, color, edema)
Usually not present unless combined disease or can be relate to cardiac disease and congestive heart failure
arterial edema
Distinguish whether the description falls under arterial insufficiency or venous insufficiency and also what category the description is (i.e. pain, color, edema)
Present from mild to severe pitting edema. Can have weeping edema fluid from open wounds
venous edema
Distinguish whether the description falls under arterial insufficiency or venous insufficiency and also what category the description is (i.e. pain, color, edema)
Thin and shiny. Hair loss. Tropic changes of the nails. Muscle wasting
arterial tissue changes
Distinguish whether the description falls under arterial insufficiency or venous insufficiency and also what category the description is (i.e. pain, color, edema)
Stasis dermatitis with flaky, dry, scaling skin. Hemosiderin deposits-brownish discoloration. Fibrosis with narrowing of the lower legs, “bottle legs”
Venous tissue changes
What is the most commonly used noninvasive test instrument for vascular testing
continuous wave doppler
A continuous wave doppler is used to determine the _____ and _____ of blood flow
velocity and direction
Invasive studies and contrast angiography involves the puncture of which arerty
femoral artery
During invasive contrast angiography, cathers are manipulated which can potentially cause _____ to break off and _____ or even sustain permanent damage to the vessel walls
plaques, embolize
What is the Gold Standard for vascular evaluation
invasive contrast angiography
