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Integumentary > Lecture 3 > Flashcards

Lecture 3 Flashcards

1
Q

Arterial ulcers are caused by?

A

inadequate perfusion of oxygenated blood

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2
Q

Which ulcer is known as ischemic ulcers?

A

Arterial ulcers

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3
Q

Arterial insufficiency ulcers can result in?

A

cell death and tissue necrosis

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4
Q

Primary causes of arterial insufficiency?

A

Arteriosclerosis
also Thromboangiitis (Buerger’s disease)

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5
Q

What is Arteriosclerosis?

A
  • General term for the thickening/hardening of arterial walls
  • Most common form of arteriosclerosis and is the leading cause of arterial insufficiency ulcers
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6
Q

Bifurcations location for acute occlusion

A
  • Distal femoral artery
  • Distal popliteal artery
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7
Q

Clinical signs of acute occlusion of LEs: 6P’s

A
  • Paresthesia
  • Pain
  • Poikilothermia (Coolness)
  • Paralysis
  • Pulselessness
  • Pallor
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8
Q

Arterial Ulcer Factors

A
  • trauma on an already ischemic limb
  • Imbalance between oxygen supply and tissue demand
  • Repeated bouts of ischemia and reperfusion
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9
Q

what is the first signs of arterial insufficiency?

A
  • intermittent claudication
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10
Q

What is Intermittent Claudication?

A

Activity specific discomfort due to local ischemia which stops within 1-5 minutes of ceasing the provocative activity

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11
Q

Intermittent Claudication pain

A
  • cramping, burning, or fatigue
  • location is typically distal to the site of arterial occlusion
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12
Q

Ischemic rest pain

A
  • more significant arterial disease
  • burning pain that is exacerbated at night or with elevation, and is relieved by dependency
  • Gravity plays a role in helping with blood flow
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13
Q

Progression of atherosclerotic pain

A

Arterial insufficiency > Intermittent Claudication > Ischemic Rest pain > Gangrene / Ulcer

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14
Q

What is Gangrene

A
  • dead tissue that is dry, dark, cold, and contracted
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15
Q

Test & Measures for Arterial Insufficiency?

A
  • Pulse palpation
  • Doppler ultrasound
  • Capillary refill
  • ABI index
  • Rubor of Dependency
  • Venous filling time
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16
Q

Location of Arterial Ulcers

A

Distal toes, web spaces, dorsal foot, lateral malleolus

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17
Q

Appearance of Arterial Ulcers

A

Smooth edges, well-defined, “punched out”, minimal granulation tissue; pale, dusky, or cyanotic skin

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18
Q

Pain of Arterial Ulcers

A

Severe

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19
Q

Wound Care Precautions for Arterial Insufficiency

A
  • Avoid Compression
  • Avoid sharp debridement
  • Gangrenous tissue must be removed surgically
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20
Q

What is required for the development of venous insufficiency ulcerations?

A

sustained venous hypertension

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21
Q

Venous hypertension

A

Increased blood pooling causes increased pressure

22
Q

Primary venous dysfunction cause

A

primary : reflux
Obstructions to venous outflow
Obesity

23
Q

Venous Hypertension Cycle

A

Venous Hypertension > Retrograde venous flow > Venous distention

24
Q

Effects of Venous Hypertension Cycle

A
  • Swelling develops
  • Poor Oxygen and nutrient exchange
  • Fibrotic changes
25
Q

what is vital to normal venous blood flow, and without it, there could be an increased risk of venous hypertension?

A
  • calf muscle pump
26
Q

Venous insufficiency ulcers are also called?

A
  • venous stasis ulcers
27
Q

Test & Measures for Venous insufficiency?

A
  • Homan’s sign
  • Doppler Ultrasound
  • ABI index
  • Trendelenburg Test
  • Venous filling time
28
Q

Venous Ulcers Wound Characteristics

A
  • Location: Medial Malleolus, Medial Lower leg
  • Appearance: Irregular shape, fibrous yellow or glossy coating over wound bed
  • Mild to moderate Pain
  • Flaking, dry skin (hyperkeratosis)
  • Leg elevation or compression reduces pain
29
Q

Precautions for Patients with Venous Insufficiency

A
  • Concomitant arterial disease
  • Allergic reactions and sensitization
  • Inappropriate whirlpool use
30
Q

Pressure injuries can be caused by?

A
  • unrelieved pressure or a combination of pressure and shear forces
31
Q

High Risk Patient groups for pressure injuries

A
  • SCI, Hospitalized patients, Patients in long term care facilities
  • Patients with improperly fitting casts or splints and sit for prolonged periods
32
Q

Pressure Injury Pathophysiology

A
  • External pressure must exceed capillary pressure
33
Q

How often should you turn and reposition to prevent pressure injuries?

A

Every 2 hours

34
Q

Blanchable vs. Non-Blanchable erythema

A
  • Blanchable: Capillary blood flow returns rapidly after a short-term pressure is removed
  • Non-blanchable erythema: Skin does not blanch when pressure is applied, indicating prolonged reactive hyperemia related to tissue ischemia
35
Q

Body Structures & Pressure Susceptibility

A
  • Areas over bony prominences
  • Muscles
36
Q

High Risk Bony Prominences for Pressure injury

A
  • Sacrum
  • Greater Troch
  • Ischial tuberosity
  • posterior calcaneus
  • lateral malleolus
37
Q

What is the most common site for pressure injuries

A
  • Scarum
38
Q

Pressure Ulcer Risk Assessment Tools

A
  • Braden Scale
  • Norton Scale
39
Q

NPUAP Pressure Injury Staging System

A
  • Stage 1: Nonblanchable erythema of intact skin
  • Stage 2: Partial thickness skin loss with exposed dermis
  • Stage 3: Might have undermining or tunneling
  • Stage 4: Deep ulcer with extensive necrosis; often has undermining or sinus tracts, Slough or eschar obscures the depth of tissue involvement
  • Unstageable: Base is obscured by eschar or slough
  • Deep Tissue Pressure Injury: Persistent nonblanchable area of deep red blood blister
40
Q

Importance on Pressure injury staging

A
  • Pressure ulcers cannot be classified regressively as the heal
41
Q

Pressure injuries wound characteristcs

A
  • location: over bony prominence or medical device
  • Pain: Tender or painful if sensory nerves are intact
  • Edema usually not present
  • Hyperemia are warm to palpate, area of ischemia are cool to palpate
42
Q

Patient education for patients with pressure injuries

A
  • Change positions or shift your weight at least every 2 hours while lying down and every 15 minutes while sitting
43
Q

Neuropathic Foot Ulcers Pathophysiology

A
  • associated with a combination of peripheral neuropathy, atherosclerotic changes and pressure
  • usually related to diabetes mellitus
44
Q

Neuropathetic Foot Ulcers is also known as

A

diabetic ulcers

45
Q

What is the leading cause of neuropathic foot ulcers?

A
  • Sensory neuropathy
46
Q

what does DM neuropathy affect?

A

Distal nerves first (feet)

47
Q

Risk Factors for Neuropathic foot ulcers

A
  • Vascular disease, increase risk for PVD
  • Mechanical stress: pressure or trauma
  • Abnormal foot function
  • Inadequate footwear
  • Poor vision can lead to foot trauma
48
Q

Test & Measures for Neuropathic Ulcers

A
  • pulse palpation
  • doppler ultrasound
  • ABI index
  • Capillary refill
  • Sensory integrity
49
Q

Most common location for neuropathic ulcer

A
  • Plantar forefoot (1st/2nd met heads) & plantar heel
50
Q

Neuropathic ulcers wound characteristics

A

Appearance: Well defined round “Punched out”, little to no wound bed necrosis with good granulation

Everything normal or increased

51
Q
A

Integumentary (4 decks)

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