Leg Ulcers and Pressure sores

Question 1

what are the three types of leg ulcers?

Answer 1

venous
arterial
diabetic

Question 2

state three causes of venous ulcer?

Answer 2

venous hypertension
imcompetent venous valves
thrombosis

Question 3

what type of ulcer is most common?

Answer 3

venous 90%

Question 4

what are some symptoms of venous ulcers?

Answer 4

pain (relieved by raising leg)
oedema
itchy skin

Question 5

where is the gaiter region?

Answer 5

just above medial malleolus

Question 6

state some signs of venous ulcers?

Answer 6

sloped margins 
haemosiderin staining 
varicose veins 
pink granulation tissue 
venous eczema 
pitting oedema

Question 7

what are the 5 steps of venous ulcer management?

Answer 7

basic wound management
- inspection, lavage, excision, dressing

compression

elevation

drugs
- analgesia, diuretics, antibiotics

surgery

Question 8

what are some risk factors for arterial ulcers?

Answer 8

peripheral vascular disease 
smoking 
age
DM
HTN
hyperlipidaemia

Question 9

what are some symptoms of arterial ulcers?

Answer 9

pain in thighs, buttocks and calves at rest

made worse on lying flat and relieved by standing

Question 10

where are arterial ulcers commonly seen?

Answer 10

arterial ulcers are most commonly found around the toes or on top of the feet

Question 11

state some signs seen with arterial ulcers?

Answer 11

punched out margins
pale, dry wound bed with little granulation tissue
surrounding skin is pale and shiny with hair loss and cool on palpation
reduced pulses
cap refill is prolonged

Question 12

what is beurgers sign?

Answer 12

Beurger’s sign: on elevating the foot to 30 degrees the colour will fade from the ischaemic foot - and pain may also develop in the distal limb. When the patient is then asked to hang their foot over the end of the bed, it will become deep red in colour as it fills with blood.

Question 13

what investigation should be done for arterial ulcers?

Answer 13

Ankle-Brachial Pressure Index

normal = 1
risk <0.5

Question 14

what are the 4 management steps of arterial ulcers?

Answer 14

basic wound management
- inspection, lavage, excision, dressing

conservative therapy
- address risk factors, anti-platelets, statins

endovasuclar angioplasty, stenting

surgery
- arterial bypass, amputation

Question 15

what is the cause of diabetic ulcers?

Answer 15

hyperglycaemia

- neuropathy and peripheral microvascular disease

Question 16

state some signs of diabetic neuropathic ulcers?

Answer 16

surrounding skin is thickened

Question 17

where do diabetic ulcers commonly occur?

Answer 17

plantar surface of foot

Question 18

how do you manage a diabetic ulcer?

Answer 18

patient education
- good glycaemia control, good self foot care, exercise

identify risk factors

regular pt review

Question 19

what are the 4 risk factors for pressure sores?

Answer 19

immobility
incontinence
improper nutrition
impaired sensation