Lecture 3 Flashcards
Arterial ulcers are caused by?
inadequate perfusion of oxygenated blood
Which ulcer is known as ischemic ulcers?
Arterial ulcers
Arterial insufficiency ulcers can result in?
cell death and tissue necrosis
Primary causes of arterial insufficiency?
Arteriosclerosis
also Thromboangiitis (Buerger’s disease)
What is Arteriosclerosis?
- General term for the thickening/hardening of arterial walls
- Most common form of arteriosclerosis and is the leading cause of arterial insufficiency ulcers
Bifurcations location for acute occlusion
- Distal femoral artery
- Distal popliteal artery
Clinical signs of acute occlusion of LEs: 6P’s
- Paresthesia
- Pain
- Poikilothermia (Coolness)
- Paralysis
- Pulselessness
- Pallor
Arterial Ulcer Factors
- trauma on an already ischemic limb
- Imbalance between oxygen supply and tissue demand
- Repeated bouts of ischemia and reperfusion
what is the first signs of arterial insufficiency?
- intermittent claudication
What is Intermittent Claudication?
Activity specific discomfort due to local ischemia which stops within 1-5 minutes of ceasing the provocative activity
Intermittent Claudication pain
- cramping, burning, or fatigue
- location is typically distal to the site of arterial occlusion
Ischemic rest pain
- 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
Progression of atherosclerotic pain
Arterial insufficiency > Intermittent Claudication > Ischemic Rest pain > Gangrene / Ulcer
What is Gangrene
- dead tissue that is dry, dark, cold, and contracted
Test & Measures for Arterial Insufficiency?
- Pulse palpation
- Doppler ultrasound
- Capillary refill
- ABI index
- Rubor of Dependency
- Venous filling time
Location of Arterial Ulcers
Distal toes, web spaces, dorsal foot, lateral malleolus
Appearance of Arterial Ulcers
Smooth edges, well-defined, “punched out”, minimal granulation tissue; pale, dusky, or cyanotic skin
Pain of Arterial Ulcers
Severe
Wound Care Precautions for Arterial Insufficiency
- Avoid Compression
- Avoid sharp debridement
- Gangrenous tissue must be removed surgically
What is required for the development of venous insufficiency ulcerations?
sustained venous hypertension
Venous hypertension
Increased blood pooling causes increased pressure
Primary venous dysfunction cause
primary : reflux
Obstructions to venous outflow
Obesity
Venous Hypertension Cycle
Venous Hypertension > Retrograde venous flow > Venous distention
Effects of Venous Hypertension Cycle
- Swelling develops
- Poor Oxygen and nutrient exchange
- Fibrotic changes
what is vital to normal venous blood flow, and without it, there could be an increased risk of venous hypertension?
- calf muscle pump
Venous insufficiency ulcers are also called?
- venous stasis ulcers
Test & Measures for Venous insufficiency?
- Homan’s sign
- Doppler Ultrasound
- ABI index
- Trendelenburg Test
- Venous filling time
Venous Ulcers Wound Characteristics
- 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
Precautions for Patients with Venous Insufficiency
- Concomitant arterial disease
- Allergic reactions and sensitization
- Inappropriate whirlpool use
Pressure injuries can be caused by?
- unrelieved pressure or a combination of pressure and shear forces
High Risk Patient groups for pressure injuries
- SCI, Hospitalized patients, Patients in long term care facilities
- Patients with improperly fitting casts or splints and sit for prolonged periods
Pressure Injury Pathophysiology
- External pressure must exceed capillary pressure
How often should you turn and reposition to prevent pressure injuries?
Every 2 hours
Blanchable vs. Non-Blanchable erythema
- 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
Body Structures & Pressure Susceptibility
- Areas over bony prominences
- Muscles
High Risk Bony Prominences for Pressure injury
- Sacrum
- Greater Troch
- Ischial tuberosity
- posterior calcaneus
- lateral malleolus
What is the most common site for pressure injuries
- Scarum
Pressure Ulcer Risk Assessment Tools
- Braden Scale
- Norton Scale
NPUAP Pressure Injury Staging System
- 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
Importance on Pressure injury staging
- Pressure ulcers cannot be classified regressively as the heal
Pressure injuries wound characteristcs
- 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
Patient education for patients with pressure injuries
- Change positions or shift your weight at least every 2 hours while lying down and every 15 minutes while sitting
Neuropathic Foot Ulcers Pathophysiology
- associated with a combination of peripheral neuropathy, atherosclerotic changes and pressure
- usually related to diabetes mellitus
Neuropathetic Foot Ulcers is also known as
diabetic ulcers
What is the leading cause of neuropathic foot ulcers?
- Sensory neuropathy
what does DM neuropathy affect?
Distal nerves first (feet)
Risk Factors for Neuropathic foot ulcers
- Vascular disease, increase risk for PVD
- Mechanical stress: pressure or trauma
- Abnormal foot function
- Inadequate footwear
- Poor vision can lead to foot trauma
Test & Measures for Neuropathic Ulcers
- pulse palpation
- doppler ultrasound
- ABI index
- Capillary refill
- Sensory integrity
Most common location for neuropathic ulcer
- Plantar forefoot (1st/2nd met heads) & plantar heel
Neuropathic ulcers wound characteristics
Appearance: Well defined round “Punched out”, little to no wound bed necrosis with good granulation
Everything normal or increased
