Integ (Skin Ulcers)

Question 1

Describe etiology of a Venous Ulcer

Answer 1

Associated with chronic venous insufficiency, valvular incompetence, history of a DVT, venous hypertension, calf muscle pump failure

Question 2

Describe the clinical features of a venous ulcer.

Answer 2

Common over MEDIAL malleolus
Pulses are normal
Pain is none to aching pain in dependent position
Color: Normal or cyanotic in dependent position. Dark pigmentation may appear in chronic stages
Temp: Normal
Edema: Present, often marked
Skin changes: Pigmentation, stasis dermatitis, thickening of skin
Ulceration: May develop, especially medial ankle; wet, with large amount of exudate
Gangrene: Absent

Question 3

What is the etiology of an arterial ulcer?

Answer 3

Associated with chronic arterial insufficiency; arteriosclerosis obliterans; atheroembolism; history of minor non healing trauma

Question 4

What are some of the clinical features of an arterial ulcer?

Answer 4

Common on small toes, feet, bony areas of trauma (more prominent on LATERAL malleolus.

Pulses poor or absent, preceded by intermittent claudication and arterial insufficiency

Pain: Often severe, intermittent, progressing to pain at rest, gets worse when limb is elevated

Color: Pale on elevation; dusky rubor on dependency

Temperature: Cool

Skin changes: Trophic changes, loss of hair on foot and toes, nails thickened

Ulceration: Can be deep

Gangrene: Black, gangrenous skin adjacent to ulcer can develop

Question 5

Describe the differences of a venous and arterial ulcer

Appearance, location, pulses, pain, drainage, gangrene

Answer 5

Appearance: Arterial-irregular smooth edges, usually deep. Venous-Irregular, dark pigmentation, usually shallow

Location: Arterial-Toes, feet, lat malleolus. Venous-distal lower leg, med malleolus

Pedal Pulses: Arterial-decreased or absent. Venous-usually present

Pain: Arterial-Painful especially with elevation. Venous-Little pain, comfortable with elevation

Drainage: Arterial-none, Venous-moderate to large amounts

Gangrene: Arterial-may be present. Venous-none

Question 6

What are some clinical features of a diabetic ulcer?

Answer 6

Pain: Typically not painful, sensory loss usually present
Pulses: may be present or diminished
Absent ankle jerks with neuropathy
Sepsis common; gangrene may develop

Question 7

Describe the staging for a pressure ulcer (decubitus) (6 stages)

Answer 7

Stage 1: Nonblanchable erythema of intact skin
Stage 2: Partial-thickness skin loss: involves epidermis, dermis, or both. Ulcer is superficial (abrasion, blister, or shallow crater)
Stage 3: Full-thickness skin loss: Involves damage to or necrosis of subcutaneous tissue. Can reach fascia, but not past. (deep crater)
Stage 4: Full-thickness: extensive destruction, tissue necrosis, or damage to muscle/bone/supporting structure.
Unstageable: Tissue depth is obscured due to slough or eschar
Deep Tissue Injury: Discoloration area of tissue (bruise) that is not reversible and will progress to full-thickness injury

Question 8

Describe the Wagner Scale for grading ulcers

Answer 8

0: Intact skin
1: Superficial ulcer of skin or subcutaneous tissue
2: Ulcer extends into tendon, bone, or capsule
3: Deep ulcer with osteomyelitis, or abscess
4: Gangrene of toes or forefoot
5: Midfoot or hind foot gangrene